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However, exenatide had a statistically significant greater effect in these clinical outcomes compared to sitagliptin

Results Time course of blood BHB levels following oral MCT oil administration To evaluate the time-dependent effects of MCT oil on blood BHB concentrations, rats were administered a single dose of MCT or LCT oil (0.8 mL) via oral gavage, and blood BHB levels were measured at 0 (pre-administration), 15, 30, and 60 min, and at 3 and 6 h post-administration

doi: 10.1016/j.trsl.2015.08.010 37 ZinmanBGerichJBuseJBLewinASchwartzSRaskinPet al

It is not a normal side effect of tirzepatide and should not be dismissed as an expected adjustment