The OS for GLP‑1 and metabolic health — for programs that read the body before every step
iksa is the harness for n‑of‑1 medicine. Your whole program can decide each patient’s next step on their own lean mass, with side effects and HbA1c watched through every hold.
A regional DEXA shows what the scale and a whole-body total miss, and the labs say whether the patient needs to climb at all
Since the trials’ average says little about one patient’s arms, legs or visceral fat, you’re running a trial of one each time you decide whether that patient climbs again. No label or guideline asks for a scan before a step and no trial has held one to protect lean mass, so this is your rule, on the four-society advisory’s case that the pace of loss helps decide how much of it is lean.
- Lean mass by regionPooled across 20 trials (Diabetes, Obesity and Metabolism), about a quarter to a third of the weight lost was lean on these medicines and on lifestyle programs alike, and 17.5% when those programs added resistance training, an indirect comparison. MRI reads much of that lean as proportionate, so what holds a step is how little the patient has to spare. Before every step, though the four-society advisory considers a DEXA every year or two and concedes that may miss early muscle loss.
- Visceral fatIn women over 40, cardiometabolic risk climbs past about 800 g on the cut-offs in the International Journal of Obesity (2021). Visceral fat falls on this class, so for a patient held at the lowest dose that works, it says whether there’s any reason to climb. With every DEXA, on the same scanner and software.
- HbA1c, insulin and lipidsHbA1c and fasting insulin make the case for staying at a dose that’s working. Over three years on the GLP‑1 and GIP dual agonist, 1.3% of adults with obesity and prediabetes progressed to type 2 diabetes, against 13.3% on placebo (New England Journal of Medicine). ApoB and triglycerides answer for the heart, and a weekly GLP‑1 injection’s label carries a reduction in major cardiovascular events for adults with established cardiovascular disease and obesity or overweight. Every three months in the first year, kidney function after any bad run of vomiting, and with diabetes, the patient’s eyes and any insulin or sulfonylurea watched as HbA1c falls.
- ToleranceGI symptoms mostly arrive with the climb and fade, and what a label offers for a dose a patient can’t tolerate is a four-week delay of the next step. Severe belly pain that won’t pass gets pancreatitis and the gallbladder looked at before any step. On the weekly GLP‑1 injection, two missed doses in a row restart the climb from a lower step, and at its newly approved higher top step, skin dysesthesia reaches 22% against 6% a step below (FDA label). At every step, in the patient’s words.
- Face and hairOf surveyed patients who lost over a fifth of their weight, 72% reported sagging skin and 52% hair loss (Dermatology and Therapy). With no validated treatment algorithm yet, aesthetic follow-up runs on the dose’s timeline. Asked about at each step.
The patient’s visceral fat argued for the next step and their arms and legs argued against it, so the doctor kept the dose
What held the patient was the 1.2 kg of arm and leg lean keeping them over the European sarcopenia group’s 5.5 line, set for older adults. The sarcopenic obesity criteria Europe’s nutrition and obesity societies wrote for adults this size at any age test grip and chair stands first and then read their lean against their weight.
When a patient tolerates the dose and the scan says wait, which one wins in your protocol?
Request a walkthroughRequest a walkthrough for GLP‑1 and metabolic healthA pivotal trial scanned a sliver of its patients, first and last, and your protocol scans before each step
That trial’s body composition substudy scanned 160 of its 2,539 patients (Diabetes, Obesity and Metabolism, 2025), with people paid to arrange each scan. A patient paying for this brings nobody like that, so the record lands on the doctor who wrote the dose. FDA called the shortages of both weekly incretins over in December 2024 and February 2025, outsourcing facilities can no longer make them from bulk, and a pharmacy can copy one regularly only on the prescriber’s documented reason it differs for that patient, so which product, which pharmacy and that reason belong in the record.
Titration schedule
A hold has an end date only if someone keeps it, so twelve weeks at this dose, the scan before the next step and why the last one waited have to survive on one spreadsheet.
Data capture
The patient’s weights come in by text, their step is in your note and the DEXA is a PDF, so how much of what they lost was muscle can’t be answered until you’ve pulled all three.
Safety reporting
Two days of vomiting after a step can be a bad week or a kidney at risk, and their text reads the same either way.
Scanner precision
On one published scanner the arms and legs carry a precision error near 2%, which works out to a least significant change near 6%, so a 600 g fall can be muscle, water, last night’s dinner or the machine.
Twelve weeks at one dose is the plan, and the patient knows why their arms and legs come before the next step
Through those weeks, the harness monitors the labs your notes follow and any side effect the patient reports, and the climb itself stays the doctor’s to order.
Before the next step, the doctor can ask why the last one waited and read the note that held it
The answer quotes the line in the note that made the hold and the ALMI written there, and a step held with no reason written down shows up as exactly that.
Clinical Intelligence: clinical AI and lab trackingThe nurse watches HbA1c and kidney function through the hold, and hears when the patient asks about their next step
Your nurse sees the labs the doctor follows and clears what’s flagged. When the patient writes in Week 8 to ask how long the hold runs, Patient AI explains it and, on their yes, a question about the next step reaches your nurse.
Agentic CRM: scheduling and follow-upThe patient can ask what their lean mass number means for the next step, and why the doctor wrote twelve weeks
Patient AI takes them through what that number means and the resistance work that goes with it, from their record and the doctor’s note.
Patient AI: the treatment companion
Trials climbed at a set pace, so whether a slower climb protects lean mass is a question your program could start to answer
If a patient stops and comes back a year later, you restart from the hold in its note and what their body did on the way up. With identifiers removed and each patient’s consent, the holds you wrote and the scans either side of them are what a research group would ask for first. How a question about dose steps becomes a first study →
Asked by the physician who owns the next step
My patient has had DEXAs on two scanners. Will iksa line them up for me?
No, your note does.Each DEXA report goes on file under its date and kind, next to that month’s labs, and iksa takes the ALMI, the visceral fat and what you made of them from your note, so the norm and the scanner are yours to write down.
Can each patient climb at a pace I set, and wait when I say?
At the pace you write.The steps, how long each one runs and what you read before it are yours, whether that’s the injection’s four weeks, a tablet’s 30 days or twelve weeks at one dose. A step you hold stays in your note with your reason, and the next one you write goes on their plan.
Where do the questions I ask before a first dose live?
In your note.Medullary thyroid cancer in the patient or their family, MEN2, a serious reaction to this class, past pancreatitis, gallbladder disease, severe gastroparesis, a restrictive eating disorder, retinopathy with diabetes, insulin or a sulfonylurea, surgery or sedation coming up, pregnancy plans and an oral contraceptive are yours to ask and write down, and Clinical Intelligence can quote the patient’s answers back with the note. On the dual agonist, an oral contraceptive means a non-oral method or an added barrier for four weeks after the start and each step.
A patient vomits for two days after a step. Who finds out?
Safety questions first.What they write to Patient AI starts with safety questions and, when it needs a person, reaches your nurse or you on a card with what they’ve told it and why it was raised. What they hear about food and fluids comes from what you wrote, and whether the next step waits is your decision.
My patient wants to stop. What does the record do for them?
It keeps your plan for that.Stopping gives the weight back: about 0.4 kg a month across 37 studies, and 0.8 kg a month after the two newer weekly incretins, projected back to starting weight in about a year and a half (BMJ, 2026). Stepping the dual agonist down held more of the loss than placebo (The Lancet). Your patient’s last DEXA stays on file beside your plan.
Is this the weight loss platform I’ve already been pitched, under a new name?
No, a different job.Whatever you already run for your GLP‑1 patients keeps handling visits and the calendar, and your EHR keeps documenting each one. Your charts reach iksa by connection or by upload, which leaves it holding the titration: each step, why it waited, each DEXA report and the decisions you wrote.
We’ve outgrown the spreadsheet, and people keep pitching GLP‑1 clinic software as an OS for GLP‑1 and metabolic health. Is this it?
Something that can wait.We call it the harness for n‑of‑1 medicine, because the same dose can take mostly fat from one patient and too much lean from the next, so what runs around a titration has to be able to wait for the one in front of you.
What is n‑of‑1 medicine?All practicesiksa beside your EHRProtocol management softwareWhat iksa adds
What you scan before each step and what makes you wait are what we’d open first
Bring a protocol you run. We’ll walk one patient through it.