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.
Type 1 diabetes: off-label use and the evidence gap — what changed since — setting out what I have, and where I think it stops being reliable.
What changes if the standard account of Type 1 diabetes is wrong? I ask because I have been treating it as settled and I noticed this week that I could not say why.
Working through the consequences rather than the evidence, since others here are better placed on the evidence.
The opening post answers the question as asked. The question underneath it is different.
I read the earlier replies on Type 1 diabetes twice before writing this, because I had assumed the opposite and wanted to be sure I was disagreeing with what was said rather than what I expected.
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.
Extrapolating a point estimate to somebody well outside the enrolled range should be described as an extrapolation every time it is done.
I would put the burden of proof on the interesting explanation, not the dull one.
Post #4 put the caveat in the right place and I want to underline it.
Worth stating the null on Type 1 diabetes before we explain it: the observation may be nothing. That possibility deserves a sentence and usually does not get one.
Building on post #7 rather than restating it.
A note on how Type 1 diabetes gets discussed rather than on Type 1 diabetes itself: the confident posts get the replies and the careful ones get ignored, and the careful ones have been right more often.
I had written a reply contradicting post #7 and deleted it. Here is what survived.
Body weight at the extremes of the studied range affects exposure and the trials rarely reported enough to say by how much.
Coming back to post #10, because the follow-up matters more than the original answer.
Pregnancy and planning: these compounds are not approved for use in pregnancy. Planning windows (how long to wait before attempting pregnancy) are not formally established. Conservative approaches wait several months to allow clearance.
It took me longer than it should have to see that.
Good question, well framed, and I would like to see it answered properly.
Post #12 answers the question as asked. The question underneath it is different.
Athletes and people in substantial training loads are effectively unstudied, and the questions asked here about performance have no trial evidence behind them at all.
One of those cases where knowing the mechanism does not help the decision.
I have three months of notes on Type 1 diabetes and the honest summary is that the trend is real and the week-to-week numbers are noise. I nearly drew the opposite conclusion from the first fortnight.
Something worth flagging about Type 1 diabetes: the strongest-sounding claims in this thread are the ones with no source attached, which is the usual pattern and not a coincidence.
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.
The strength of my opinion here exceeds the strength of my evidence.
What I would check first on Type 1 diabetes is whether the thing being measured moved or whether the way of measuring it moved. Those look identical in a graph.
Answering the question post #19 raises rather than the one it answers.
Type 1 diabetes is worth one more sentence than it usually gets, and the sentence is the one about how the number was arrived at.
Medullary thyroid carcinoma history: an absolute contraindication because of the preclinical findings in rodent toxicology. The history (personal or family, especially multiple endocrine neoplasia type 2) is an important screening question.
No disagreement from me. Posting only so the question does not look ignored.
Post #22 is the version of this I will quote in future. One addition.
Where I would push back on the Type 1 diabetes consensus is the confidence, not the direction. The direction looks right. The confidence is borrowed.
Distinguishing three things in the Type 1 diabetes discussion that keep getting used interchangeably: the observation, the proposed mechanism, and the recommendation that gets attached to both.
Dedicated trials in under-studied populations are the only real remedy and several are ongoing, which is worth saying rather than speculating.
I would be interested in a counterexample if anyone has one.
I had written a reply contradicting post #24 and deleted it. Here is what survived.
Type 1 diabetes sits at the boundary between what this community can usefully discuss and what it cannot, and I think it falls on the discussable side, narrowly.
Adding a null result on Type 1 diabetes. I looked, carefully, and found nothing, and null results deserve posting precisely because they never are.
Nothing in this subcategory is medical advice and the questions asked here are precisely the ones that need an individual assessment.
I have seen it go both ways, which is why I hedge.