This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
Older adults: I have looked for the primary source twice and failed twice. Either it does not exist or it is somewhere I do not know to look, and I would like to know which.
The most useful contribution here is usually a citation to whichever published document comes closest, with a plain statement of how far it is from the question.
Speaking for myself and not for anyone else who has posted here.
Confirming post #92 from a second method, which matters more than confirming it from a second person.
Posting my older adults numbers with the method attached so they can be discounted properly. Uncontrolled, unblinded, and collected by someone who wanted a particular answer.
Understood. Thank you for being specific about the limits of it.
The practical version of older adults is three sentences long. The rigorous version is three pages and reaches the same conclusion with the conditions attached.
Body weight at the extremes of the studied range affects exposure and the trials rarely reported enough to say by how much.
Adolescents: a distinct evidence base exists. The compounds are not approved for routine adolescent obesity but are being studied. Adolescent physiology and psychology differ from adults' in ways that matter for this medication class.
I would rather be precise about what I do not know than vague about what I do.
Where I part company with post #95, and it is a narrow parting.
On older adults the community has more anecdote than the confidence in this thread implies, and I include my own contribution in that.
Narrowing post #96, because the general version has more than one answer.
Older adults: sarcopenia risk is higher, polypharmacy is common, and the clinical trials did not enroll many people over 75. Extrapolating to very old people is extrapolating beyond the data.
Not a conclusion. A place to stand while looking for one.
One caution on older adults: everything above assumes the underlying documentation is what it claims to be. That assumption is doing real work and is rarely stated.
Being outside the studied population does not mean a treatment is unsafe. It means the usual evidence is not available and the reasoning has to be explicit.
Post #100 describes the usual case. This is about the unusual one.
Hypoglycemia risk: in people already on insulin or sulfonylureas, adding a GLP-1 agonist requires insulin dose reduction and close monitoring for hypoglycemia. This is manageable with attention.
That is the honest state of it as of this week.
The version of older adults that I was taught turned out to be a teaching simplification. Useful, and not true in the way I had assumed it was.
Answering the question post #104 raises rather than the one it answers.
The number people quote for older adults is a central estimate presented without its interval, and the interval is wide enough that the estimate is nearly uninformative on its own.
Older adults were included in the trials in smaller numbers than their share of the eventual population, so precision in that subgroup is poor.
It took me longer than it should have to see that.
Post #108 and I disagree about the size of the effect, not about the direction.
Older adults is a good example of a question where the honest answer is boring and the interesting answers are unsupported. I would go with boring.
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