Optimising GLP-1 Use: Indications, Titration, and Monitoring

我想快速感谢一下我们的赞助商——马奇地区医生组织。

I'd like to give a quick shout out to our sponsor Doctors 4 Mudgee Region.

新南威尔士州美丽的马奇地区目前正在寻找全科医生和全科医生培训生，加入澳大利亚最热情、最有活力的社区之一。

The beautiful Mudgee Region in NSW is currently looking for fellow GPs and GP trainees to join one of the most welcoming and vibrant communities in Australia.

从悉尼开车只需三个小时，马奇不仅提供令人难以置信的生活方式——想想那些很棒的咖啡馆、学校、体育俱乐部和世界级的酒庄——还提供绝佳的职业机会，拥有出色的医疗设施和强大的支持性同事环境，让你在那里发展事业。

Just a three hour drive from Sydney, Mudgee offers not only an incredible lifestyle, think great cafes, schools, sports clubs and world class wineries, but also fantastic professional opportunities with outstanding medical facilities and a strong supportive collegial environment where you can grow your career.

通过马奇地区医生计划，全科医生可以获得45,000澳元的搬迁奖励，以及个人生活方式礼宾服务，让搬家变得无缝顺畅。

Through the Doctors 4 Mudgee Region initiative, fellow GPs can access a 45,000 relocation incentive and a personal lifestyle concierge service to help make the move seamless.

对于全科医生培训生，该计划还提供生活方式礼宾支持，并持续未来三年，这意味着那些留下来并继续工作的人，之后也有资格获得同样的现金奖励。

For GP trainees, the program also offers lifestyle concierge support and runs for the next three years, meaning that those who stay on and furlough can later qualify for the same cash incentive.

所以，如果你正在考虑职业生涯的下一个激动人心的阶段，那就想想新南威尔士州的马奇吧。

So if you're thinking about the next exciting phase of your career, think Mudgee New South Wales.

但别只听我的一面之词。

But don't just take my word for it.

下面是一些当地全科医生的看法。

Here's what some of the local GPs have to say.

马奇不是路过的地方，而是你专程来的地方。

Mudgee isn't a place that you go through, it's a place that you come to.

我特别喜欢马奇的一点是，我们有一群非常靠谱的全科医生。

One of the things that I really love about Mudgee is that we have a really solid group of GPs.

马奇提升了我的生活质量，因为我是社区的一份子。

Mudgee has improved the quality of my life because I'm a part of a community.

我可以是母亲，可以是医生，可以是朋友，也可以是队友。

I can be a mother, I can be a doctor, I can be a friend, I can be a teammate.

这对我来说真的很重要。

And that's something that's really important to me.

而且我离工作地点只有五分钟的路程。

And I'm five minutes from work.

马奇提升了我的生活质量，因为它让我能专注于真正重要的事情。

Mudgee's improved the quality of my life because it's allowed me to focus on the things that really matter and that are really important.

更多信息，请访问 www.doctors4mudgee.com。

For more information, please visit www.doctors4mudgee.com.

你正在收听的是《好全科医生》，一档为忙碌的全科医生准备的播客。

You're listening to The Good GP, the podcast for busy GPs.

大家好，欢迎收听《好全科医生》。

Hello, and welcome to The Good GP.

我是肖恩·史蒂文斯。

I'm Sean Stevens.

在开始之前，我想先向这片播客录制地的传统土地所有者致敬。

And before we start, I'd like to acknowledge the traditional owners of the lands on which this podcast is recorded.

我现在在努恩加族的瓦朱克地区，而泰瑞·琳在布里斯班的图尔巴尔和尼奥加拉地区。

I'm on Whadjuk country in the Noongar nation and Terri Lynn is on Turrbal and Nyogarra country in Brisbane.

我们向过去和现在的长老们致敬，也向今天收听我们节目的所有原住民和托雷斯海峡岛民听众表示敬意。

We pay our respects to their elders past and present and acknowledge any Aboriginal and Torres Strait Islander listeners joining us today.

我今天的嘉宾是泰瑞-琳恩·索斯医生，她是一位全科医生，拥有RAC GP认可的肥胖管理高级技能和认证资格，同时也是Lifestyle Metabolic的医疗总监，除了医学训练外，她还拥有营养学和饮食学的资质。

My guest today is Doctor Terri-Lynne South, a GP with an RAC GP recognised extended skills in obesity management and scope certification, medical director of Lifestyle Metabolic with qualifications in nutrition and dietetics alongside her medical training.

这是我们GLP-1对话的第二部分，接着第224集的内容，那一集我们讨论了患者选择、治疗目标、多学科护理以及与团队合作。

This is part two of our GLP-one conversation following episode two twenty four where we covered patient selection, goals of therapy, multidisciplinary care and working with teams.

欢迎回来，Terri Lynn。

Welcome back, Terri Lynn.

谢谢你的邀请。

Thank you for having me.

太好了。

Great.

自从我们录制了第一部分，你有没有注意到更多的全科医生来向你咨询GLP-1类药物？他们最常问的是什么？

So since we recorded part one, are you noticing more GPs coming to you for advice on GLP-1s and what are they asking most about?

是的。

Yeah.

确实有更多的全科医生开始了解和有兴趣使用GLP-1类药物，但他们想知道如何最有效地使用它们。

Definitely there's more GPs becoming aware interested in using GLP-1s, but wanting to know how to use them with best effect.

所以我觉得人们知道这些药是可用的，但关键在于我该如何为眼前这位患者实际使用这种药物。

And so I think people are aware that they're available, but it's about how do I actually use this medication for this person in front of me?

关于选择哪种GLP-1药物以及如何最大化健康益处，确实存在一些问题。

There are issues in regards to what GLP-one medication to choose and then how to maximise the health benefits.

我们看到重点正在从单纯的体重管理、减重和肥胖问题，转向更全面的整体健康关怀，更关注健康收益。

We're seeing a shift away from about weight management and weight loss and obesity more to a holistic whole person care with regards to focusing on health gains.

这一点也反映在TGA批准的GLP-1适应症不断增加上，除了体重管理，还有专门针对阻塞性睡眠呼吸暂停的适应症。

And we see this reflected in the number of increasing TGA approved indications for GLP-1s in addition to weight management, so specifically obstructive sleep apnoea.

最新的适应症是关于MASLD，也就是代谢相关脂肪性肝病，还有心血管疾病的二级预防。

The most recent indication is in regards to MASLD, so metabolic associated steatosis liver disease, in addition to secondary prevention of cardiovascular disease.

二型糖尿病从一开始就有，现在我们看到慢性肾病也加入了进来。

Type two diabetes has been there from the very beginning, but we're also seeing in regards to chronic kidney disease as well.

对，你看，越来越多的这些代谢相关合并症。

Yeah, look, more and more of these metabolic associated comorbidities.

那么Terri-Lynne，给我们讲讲剂量滴定的过程吧。

So Terri-Lynne, walk us through dose titration.

比如有人刚开始用司美格鲁肽或者替尔泊肽，头六个月大概是什么情况？

What does the first six months look like for someone starting, say semaglutide or tirzepidide?

基本上就是从小剂量开始，慢慢加量。

Basically the message is starting low and going slow.

所以即使病人可能有点着急，想尽快看到药物起效的证据，但指南明确规定了剂量增加不能超过每四周一次。

So even though patients may be in a little bit of a rush to want to start to see some evidence that the medication is working, there are absolute guidelines in regards to not increasing the dose more than four weekly.

但这并不意味着每四周就必须增加剂量。

But that also means you don't have to increase the dose every four weeks as well.

这就是为什么何时增加剂量的建议非常个体化，取决于病人的反应，既要看正面效果，也要控制副作用。

And this is where individual recommendations around when to increase a dose is very individual specific, and that would be depending on how the patient is responding both in a positive way, but also limiting any side effects.

一般来说，我们说的是每周一次的剂量，无论是司美格鲁肽还是替尔泊肽，每四周增加到下一个推荐剂量。

So in general, it's a weekly dose that we're talking about with semaglutide and tirzepatide, and every four weeks it's increasing to the next recommended dose.

每种药物都有目标剂量，而且各不相同。

There are target doses and they are different for the different medications.

特别是替尔泊肽，我们所说的第一个临床目标剂量是五毫克。

So particularly with tirzepatide, the first what we would say clinical target dose is five milligrams.

对某些病人来说，可能不需要超过五毫克，这取决于他们的具体健康目标和个体对药物的反应。

And that may be appropriate for some patients that they don't necessarily need to go higher than five milligrams, depending on their particular health goals and their individual response to medication.

但替尔泊肽的剂量最高可以到十五毫克。

But to zegetaize does go all the way up to fifteen milligrams.

任何以半毫克为单位的剂量，我们都称之为滴定剂量。

And anything that's ending in a half milligram dose is what we would call a titration dose.

所以剂量有2.5、5、7.5、10、12.5和15毫克。

So that comes as two point five, five, seven point five, ten, twelve point five and fifteen.

那些带点五的剂量就是用来做滴定的。

Those point five doses are meant to be titration doses.

这一点也体现在这些药物的价格上，通常带点五的滴定剂量和靶向剂量价格一样，靶向剂量就是5、10或15毫克。

And this is shown in the costs around these medications, where often the point five titration dose is the same price as what the target dose would be, which is five, ten or fifteen.

相比之下，司美格鲁肽可能需要更长时间才能达到我们认为的第一个合适的临床剂量，对于2型糖尿病血糖控制来说，这个剂量是1毫克，而对于肥胖管理、二级心血管疾病或MASLD适应症，可能需要达到1.7或2.4毫克。

Compare this to the semaglutide, which can take a little longer to get to what we would consider the first appropriate clinical dose, which would be one milligram for type two diabetes blood glucose control and up to one point seven or two point four from obesity management or secondary cardiovascular disease or the MASLD indication.

所以达到这些靶向剂量可能需要20到24周的时间。

And so that can take up to twenty to twenty four weeks to achieve those target doses.

这两种药的主要区别就在于，你实际想要达到的第一个临床靶向剂量是什么。

And that would be the main difference between the two medications is what are you actually trying to achieve for that first indicated clinical target dose.

好的，很有意思。

Okay, very interesting.

那你通常会建议做哪些监测？你一般多久给病人做一次监测？

And what monitoring would you routinely recommend and how often target would you be monitoring your patients?

对。

Yeah.

我想首先就是初筛。

So I guess the first one is the initial screen.

我会从代谢健康和营养风险两方面来筛查，因为我知道很多BMI较高的人更容易出现营养缺乏，特别是维生素D、铁和B12。

I screen both from a metabolic health point of view as well as from a nutritional risk point of view, knowing that a lot of people with a higher BMI are at increased risk of nutritional deficiencies, particularly vitamin D, iron and B12.

我也会从代谢健康的角度看所有这些指标，特别是血脂谱，同时也会关注胰岛素抵抗、糖尿病和糖尿病前期的情况。

I'm also looking from all of those parameters from a metabolic health point of view, particularly with regards to the lipid profile, but also looking for insulin resistance and diabetes, prediabetes.

如果他们没有阻塞性睡眠呼吸暂停或精神健康方面的诊断，我也会从这些方面做个基线评估，因为我们知道代谢问题和心理健康是双向关联的。

If they don't already have diagnosis with regards to obstructive sleep apnoea or mental health diagnosis, I am actually getting a baseline from that point of view because we know that, again, your metabolic concerns are associated in a bidirectional relationship with regards to mental health.

这还包括进食障碍的风险。

And this also includes eating disorder risk.

而且睡眠呼吸暂停也可能加重代谢问题。

And also sleep apnoea can drive metabolic concerns.

我觉得这在临床实践中经常被忽视。

And I think it can often be overlooked in clinical practise.

另外，我还会关注人体测量指标。

In addition, I'm looking at anthropometric measurements.

具体来说就是身高、腰围、血压、BMI和身体成分。

So what we're talking about there is height and waist circumference, blood pressure, BMI, body composition.

然后我会根据情况定期复查这些指标。

And then I will repeat those measures appropriately.

人体测量指标大概每月一次，但那些代谢方面的检查更可能是每季度一次。

Anthropometric measures probably monthly, but those metabolic measurements more likely to be three monthly.

另外，我还会筛查所谓的饮食史，既包括患者开始用药前，也包括用药后的反应情况。

In addition, I am screening in regards to what we would call a diet history, both before the patient start the medication, but also in their response.

我还在评估其他一些方面。

And I'm also assessing things.

你信不信，我还会用布里斯托大便分类法呢？

Would you believe I use the Bristol stool chart?

好的。

All right.

行。

Okay.

为了了解基线情况，你知道，如果我们讨论这些药物的胃肠道副作用，我想知道患者平时的排便习惯是怎样的，因为我们经常提到便秘是GLP-1药物的副作用之一。

To get a baseline, you know, if we're talking about some of gastrointestinal side effects of these medications, I want to know what the patient's baseline bowel habits are, because we often talk about constipation as being one of the side effects of GLP-one medications.

但是，你知道，患者对临床意义上的便秘理解并不一样。

But, you know, patients don't have the same understanding of what we would call clinical constipation.

所以我需要知道他们在开始用药前的排便情况。

So I need to know what are their bowels like before they start the medication.

所以可能会出现排便频率减慢的情况。

And so there might be a slowing of their bowel motion.

比如原来一天一到三次，可能会减少到一天一次或者三天一次。

So rather than being a one to three times a day, you know, that might reduce that to once a day or once every three days.

但这不一定符合临床上便秘的定义。

But that's not necessarily the clinical different definition of constipation.

所以我也学会了在开始用药前先问清楚他们正常的情况。

So I've learnt that to ask of what their normal is before they start the medication as well.

对。

Yeah.

好建议。

Good tip.

谢谢。

Thank you.

那么，如果患者停用GLP-1，生理上会发生什么？你通常看到体重反弹的时间线是怎样的？

So what happens physiologically if a patient stops a GLP-one and what timeline do you usually see for weight regain?

是的，我们需要明白这些药物是用来治疗慢性复杂疾病的，无论是肥胖症、2型糖尿病、已有的心脏病、MASLD，还是其他慢性病，自然病程不会自行缓解。

Yeah, we need to understand that the medications are there to treat a chronic complex medical condition, whether that is obesity or type two diabetes, existing heart disease, MASLD, chronic condition is not the natural history is not for it to spontaneously remit.

一般来说，所有这些慢性病都会随时间进展。

In general, all of these chronic conditions progress over time.

所以如果我们停用有助于这些临床状况的药物，我们会看到那些健康指标的改善出现逆转，包括体重管理方面看到的减重效果也会反弹。

So if we stop a medication that helps these clinical conditions, we will see a reversal of the improvements in those health parameters and including a reversal of any weight management that we saw in weight loss.

这个过程发生得相对较慢，因为你要记住，这是一种每周注射的药物，而且它的半衰期比较长。

How quickly this happens is relatively slowly because remember, this is a weekly medication and the time life of this medication is quite long.

所以如果病人因为要做手术或者出国不方便带药而停药，我并不会看到食欲、体重或者代谢改善的快速反弹。

So if a patient were to stop prior to a procedure or an operation or because they were going overseas and it wasn't convenient for them to take the medication overseas, I don't see a rapid return of appetite, weight gain or reversal of those metabolic improvements.

但几周后确实会出现这种情况，病人回来时会发现食欲增加，特别是对高热量食物的渴望，通常体重会回升，根据STEP试验之一，第一年减掉的体重中，有三分之二会在接下来的一年里重新长回来。

But it does happen after a few weeks and then patients will come back and they'll notice an increased appetite, particularly in regards to what we would call cravings for those higher energy foods, usually weight regain, and up to two thirds of what is lost in the first twelve months is regained in the next twelve months according to one of the STEP trials.

代谢健康的改善也会逆转，但时间线会稍微长一些，体重回升是最先出现的。

The changes or reversal of improvements in metabolic health do also reverse, but it tends to be a little bit of a slower timeline, the weight regain is seen first.

好的。

Okay.

在我们讨论中，你提到了瘦体重是一个担忧点。

And in our discussions, you flagged lean body mass as a concern.

肌肉流失的问题有多严重，你有什么建议来保护肌肉？

How significant is the muscle loss issue, and what do you recommend to preserve it?

是的，我认为全科医生需要明白，这是一个非常微妙的问题，涉及到定义。

Yeah, I think that GPs need to understand that this is a very nuanced question and it comes in regards to definitions.

所以提醒一下，瘦体重不仅包括肌肉量，还包括器官的重量、骨量和血液量。

So just a reminder that lean body mass is made up of both muscle mass, but also the mass of our organs, also our bone mass and our blood volume.

所以我们需要搞清楚，他们说的是整个瘦体重，还是特指肌肉量？

And so we need to understand, is someone actually talking about that whole lean body mass or are we talking specifically muscle mass?

而且要知道，肌肉量本身并不等于肌肉功能。

And also to know that muscle mass alone does not equal muscle function.

所以在减重过程中，患者流失瘦体重和脂肪量是意料之中的。

And so with weight loss, it is expected that patients will lose lean body mass as well as fat mass.

但在那些瘦体重里，有一部分可能是肝脏脂肪减少了。

But of that lean mass, some of it may be, for example, reduction in the fat in their liver.

所以他们的肝脏重量会下降。

So their liver mass will go down.

但也可能是他们在流失肌肉内部的肌间脂肪。

But it also might be that they are losing what we would call intramuscular fat from within the muscle.

所以肌肉量看起来会减少，肌肉体积也会变小。

So the muscle mass would actually look to be decreased, muscle volume decrease.

但这并不一定意味着肌肉功能会变差。

But that doesn't necessarily mean that the muscle function will worsen.

所以，要理解一个人减掉的瘦体重是否令人担忧，最好的方法之一就是不仅要看肌肉量，还要看肌肉功能。

So one of the best ways to look at understanding it is a concern of how much lean mass someone is losing is to actually look at not just muscle mass, but muscle function.

我们可以通过一些简单的方法来评估，比如在全科医生诊所里测一下站立时间，或者使用一种叫做握力计的设备，也就是握力测力计，就能了解一个人的功能是否得到保持，或者在一些研究中，尽管瘦体重减少了，功能反而有所提升。

And we can do this with some simple things such as the time restricted to stand in our GP offices, or if you have a something called a hand grip dynamometer, which is known as a grip strength dynamometer, You can get an idea of whether someone's function is being preserved or in some of the studies, the function actually increased despite the actual lean body mass reducing.

我认为关于这些药物和体重减轻的另一个误区是，这似乎是GLP-1类药物独有的。

I think another myth around these medications and loss of body mass is that this is something unique to GLP-1s.

实际上，任何方式的减重，无论是通过生活方式、饮食和运动，还是药物或手术，都会如此。

It's not any sort of weight loss, whether it's through, you know, lifestyle, diet and exercise, medications or surgery.

所有这些干预措施带来的体重减轻，其中一部分都会包括瘦体重的减少。

All of that weight loss with those interventions, some of it will include lead body mass.

一般来说，这个比例预期是1比4。

And in general, it is expected to be a ratio of one is to four.

所以，无论通过哪种方式减重，25%的瘦体重减少都是可以接受的。

So 25% would be an acceptable percentage of lean body mass no matter which way someone achieves that.

我觉得问题的第二部分是，如何从两个方面来保持瘦体重。

I think the second part of the question was how do you preserve the lean body mass in two ways.

一个是要摄入足够的蛋白质，这个量比我们说的推荐膳食摄入量要高很多。

One is in regards to adequate protein intake, and it's a lot higher than what we would call the RDI, so the recommended dietary intake.

那个推荐量是基于避免营养不良来定的。

This is based on avoiding malnutrition.

所以它只是最低标准，每公斤体重0.8克。

So it's the very minimum amount of 0.8 grams per kilogram body weight.

如果一个人想通过药物来帮助减肥，那蛋白质摄入量就要高得多，大概每公斤体重1.2到1.5克。

If someone is looking at a medication to help with regards to weight loss, then it would be much higher, more around the 1.2 to 1.5 grams per kilogram.

还有一个细节是，这些计算用的是理想体重，而不是实际体重。

And the other nuance around that is we're talking about ideal body weight, not actual body weight with having those calculations.

说实话，有时候患者要达到这个标准挺难的。

And to be honest, sometimes that can be quite difficult for patients to achieve.

也就是说，一天可能要摄入高达90克的蛋白质，这确实不容易做到。

So that might be up to 90 grams of protein in a day, and that can be difficult.

通常需要分散在一天中摄入，这又跟蛋白质消化和利用的动力学有关，从肌肉功能的角度来看。

Often needs to be spread throughout the day, again, just with regards to kinetics around protein digestion and utilisation from a muscle function point of view.

而且，光吃蛋白质本身并不能保住肌肉量或瘦体重。

And in addition, just eating protein alone won't spare muscle mass, lean body mass.

你确实需要真正刺激肌肉去利用那些蛋白质。

You do need an actual trigger of the muscles to want to utilise that protein.

也就是说要进行体育锻炼，最好是肌肉抗阻训练，不管患者用什么方式达到这个目的。

So that means physical exercise and preferably that is muscle resistance exercise no matter how the patient can achieve that.

太好了。

Great.

好的。

Okay.

所以高蛋白饮食加上肌肉抗阻训练。

So high protein diet and muscle resistance exercise.

非常关键。

Very key.

好的。

Alright.

展望未来，有什么让你感到兴奋的事情？

Looking ahead, what's on the horizon that excites you?

哦，太多了。

Oh, there's so much.

我觉得最让我兴奋的，是认识到这些药物应该被视为疾病修饰剂。

I think the first thing that excites me is actually understanding that these medications should be considered disease modifying agents.

所以当社交媒体和大众媒体称它们为减肥药时，我会有点生气。

So I get a bit cranky when the social media and the popular media call them weight loss medications.

我认为我们需要超越减肥这个目标，真正理解这些药物现在正在显著改善生活质量，特别是围绕我们讨论过的那些关键代谢健康问题，比如二型糖尿病、肌肉减少症、慢性肾病等。

I think we need to move beyond weight loss as a goal and actually understand that these medications now are significantly improving quality of life and particularly around those key metabolic health conditions that we talked about, type two diabetes, muscle D, chronic kidney disease, etc.

因此，对于高风险人群，我们实际上可以降低他们发生二次心血管事件的风险，同时配合我们所说的标准治疗。

And so we can actually reduce the risk of a person having a secondary cardiovascular event when they are high risk, in addition to all of the what we call standard of care.

我们还看到这些药物可以减缓慢性肾病的进展。

And we're also seeing that these medications can reduce the progression of chronic kidney disease.

而且这些效果似乎和减重完全无关。

And these seem to be completely independent of any weight loss.

所以这也是为什么我们开始把GLP-1类药物重新定位为疾病修饰药物。

And that's why we're starting to shift this focus of GLP-1s to be disease modifying agents.

对某些患者来说，减重可能只是副作用，但不一定是开药的主要原因。

And for some patients, weight loss might be a side effect, but not necessarily the main reason for prescribing.

所以我觉得这方面会有很大的转变。

So I'm seeing a big shift around there.

另一个让人兴奋的前景是，现在有很多新药正在研发中。

The other exciting thing on the horizon is the number of medications that are coming through the pipeline.

我们之前聊过司美格鲁肽，它是一种单一的GLP-1受体激动剂。

So we've talked about semaglutide, which is a GLP-one singular agonist.

替尔泊肽实际上是双重激动剂，它既作用于GLP-1受体，也作用于GIP受体。

Tirzepatide is actually a dual agonist, so it's got action through the GLP-one receptor, but also through the GIP receptor.

接下来还会有其他药物，比如瑞他鲁肽，它是一种三重激动剂。

And we'll be seeing other medications, ritachotide, which is a g g g agonist.

而且它还会在GLP-1的基础上，同时作为胰高血糖素激动剂。

It will also be in addition to GLP-one, GLP-one, will also be a glucagon agonist.

现在有很多胰高血糖素激动剂正在研发中，它们往往不止一种作用机制，所以有很多双重激动剂。

And there's a number of glucagon agonists coming through, often having more than one mechanism, so a number of dual agonists.

所以我们也会看到不同的分子。

So we also see different molecules as well.

我们正在关注淀粉样蛋白通路。

So we're looking at the amylin pathway.

未来我们还会看到每月一次的注射剂。

We're looking at once a month injections in the future.

但在接下来的十二个月内，我们就会看到这些药物的口服版本。

But within the next twelve months, we're going to see oral versions of these medications.

对。

Yeah.

那将是一个颠覆性的改变。

That'll be a game changer.

最后，如果全科医生们觉得这些信息有点让人应接不暇，你最希望他们记住的一两件事是什么？

Finally, if GPs are feeling a bit overwhelmed by all of this, what are one or two things you'd most want them to take away?

我觉得他们需要明白，患者的期望是关键，而且他们需要帮助患者理解，无论使用GLP-1药物是针对什么适应症，这都是一个慢性病，需要持续管理，而且管理不仅仅是初期的体重下降。

I think they need to understand that patient expectations are key and I think that they need to help the patient understand that whatever the indication they're using the GLP-one medication for, it is for a chronic condition, you know, one that will need ongoing management and the management is beyond initial weight loss.

如果患者停药了，无论是体重还是那些代谢功能的改善，都会反弹回来。

And if the patient stopped the medication, there will be a return of whether it is weight or improvements in those metabolic functions.

所以这些药不应该被视为一种速效解决方案。

So they shouldn't be seen as a quick fix.

它们是预期需要长期使用的药物。

They are a medication that is expected to be long term.

好的，非常好的建议。

Great, okay, very good advice.

非常感谢Terri-Lynne，我们真的很感激你的时间。听众朋友们，别忘了评分、评论、订阅，并查看节目笔记中的资源。

Thanks very much Terri-Lynne, we really appreciate your time and to our listeners don't forget to rate, review, subscribe and see the resources in the show notes.

再次感谢大家，下次再聊。

Thanks again, everyone, and speak next time.

感谢收听Good GP播客，我们是Talking HealthTech播客网络的骄傲成员。

Thanks for listening to the Good GP podcast, a proud member of the Talking HealthTech Podcast Network.

请确保在您常用的播客平台上订阅，以免错过任何一期节目。

Make sure you're subscribed on your favorite podcast player so you don't miss an episode.

如果您有任何问题或想联系Good GP，请发送邮件至TheGoodGP@Gmail.com。

If you have any questions or would like to contact The Good GP, send an email to TheGoodGP@Gmail.com.

本播客的内容仅代表Good GP、主持人和嘉宾的观点。

The content of this podcast represents the opinions of The Good GP, hosts, and guests of the show.

这些内容面向在澳大利亚工作的全科医生，并不构成医疗建议。

The content is aimed at general practitioners working in the Australian context and is not intended to represent medical advice.

任何听众如果出现症状或对自己的健康有疑虑，应咨询注册医疗专业人士。

Any listeners experiencing symptoms or who have concerns about their health should seek advice from a registered health professional.

我们尽力确保录制时分享的信息准确且最新，但也欢迎任何反馈或更正。

We make every effort to ensure that the information shared is accurate and up to date at the time of recording, but welcome any feedback or corrections.

本播客的内容具有普遍性，不涉及具体的患者管理。

The content of this podcast is general in nature and does not refer to specific patient management.

我们建议所有医疗专业人员在做出任何临床决策之前，查阅当地最新的指南。

We recommend all health professionals review local and up to date guidelines prior to any clinical decisions.