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Biopsy-proven NASH : Patients with histologically confirmed NASH, particularly those with significant inflammation or early fibrosis (F1-F2), may be considered for off-label GLP-1 therapy, especially if they have failed lifestyle modification or have contraindications to other therapies like vitamin E or pioglitazone

GLP-1 microdosing, starting below the standard dose or titrating more slowly, is an emerging conversation, but clinical evidence is still limited

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Many factors come into play, such as: GLP-1 shortages Restrictive insurance Lack of Medicaid coverage (only 13 states allow GLP-1s for obesity) High out-of-pocket costs Administrative barriers What I found particularly interesting is that some of the states seeing a decrease are also still among the highest rates of users in the nation