The Shape of a GLP-1 Program
Semaglutide and tirzepatide are once-weekly injections with labels that describe a starting dose and stepwise increases over months. The pivotal trials ran 68 to 72 weeks, with a dose-escalation period of several months at the start. In SURMOUNT-1, most gastrointestinal side effects occurred during that escalation, and adverse events led 4.3% to 7.1% of tirzepatide participants to stop.
Operationally that means three things for a clinic:
- The protocol changes on a schedule the patient has to follow at home.
- The side effects cluster exactly when the dose changes.
- Whether a patient is still on the program is something the clinic learns late unless it is tracking logs.
This guide is about the tracking and operations layer. Dose selection, escalation decisions and contraindication screening belong with the prescriber and the label.
1. Titration Adherence, Measured Against the Schedule
"Adherent" on a GLP-1 program means two things: the patient injected weekly, and the patient is on the step the prescriber intended. Both need a protocol template with phases, so the schedule exists somewhere other than a text message.
What to measure:
- Scheduled versus logged doses over a rolling window. Eight weeks catches a skipped week and a drifting day.
- A short-window rate (two weeks) against the assigned protocol, plus the last dose date, so a coordinator can scan a roster.
- A threshold that triggers action. Pick a line, then decide what staff do when a patient crosses it: a nudge message, a call, a task for the prescriber.
In the PeptIQ provider console, the roster shows the 14-day adherence rate against the assigned protocol and the last dose, the default low line is 40%, and staff can send a nudge email from the roster or rely on the weekly staff digest.
2. Side-Effect Logs the Prescriber Actually Reads
The trial data tell you what to expect: nausea, diarrhea, vomiting and constipation, mostly mild to moderate, concentrated at dose increases. The label adds the class warnings (thyroid C-cell tumor boxed warning, pancreatitis, gallbladder disease, hypoglycemia with insulin or sulfonylureas, delayed gastric emptying).
A useful side-effect log is simple and patient-entered: what, when, how bad, and which dose step. The clinic's job is to make sure it reaches the prescriber before the next escalation decision rather than after. Patients log symptoms alongside doses in the PeptIQ app, so the entry lands on the same timeline as the injection it followed.
Two patterns worth a standing rule:
- A side-effect entry in the first two weeks after a step up should be visible to the prescriber before the next step.
- Vomiting, severe abdominal pain or signs of dehydration are "call the clinic now" items in patient instructions, not log entries to review at the next visit.
3. Vials, Pens and Refill Timing
A missed refill is the most common reason a GLP-1 patient silently stops. Pens and vials run out on a predictable schedule once the step is known, which makes this the easiest problem on the list to get ahead of.
- Have patients log the vial or pen they are using, so the clinic sees supply, not just doses.
- Flag likely needs a week ahead. The PeptIQ console's vial flags highlight likely supply needs; it does not place orders or confirm pharmacy inventory, so the refill call is still a staff task.
- For vial-and-syringe products, instructions must address unit math. FDA has reported adverse events, some requiring hospitalization, that may be related to dosing errors with compounded injectable semaglutide products, including patients measuring incorrect doses. The reconstitution math mistakes guide is written for patients; use it or write your own.
4. Check-in Cadence
A cadence that matches the schedule:
- At each step up: a check-in within the first two weeks, when side effects peak.
- Monthly during escalation: weight, waist, side-effect review, refill status.
- Maintenance: longer intervals, with a plan for what happens if the patient wants to stop. Weight regain after discontinuation is well documented; see GLP-1 discontinuation and weight maintenance.
Check-ins work better when the patient's own data arrives first. Weekly weight under the same conditions, waist measurements and a protein-intake note make a ten-minute visit productive. Patient-facing education your clinic can hand out: GLP-1 nutrition strategy for protein and muscle and food noise.
5. Labs in Context
Baseline and follow-up bloodwork is a prescriber decision. The operational need is that results sit next to the protocol timeline so a lab drawn at week 12 is read against the step the patient was on at week 12. Patients can keep lab draws beside their protocol in the PeptIQ app. PeptIQ does not sell labs; Hundred Health is an educational partner for physician-reviewed bloodwork.
