According to the Centers for Disease Control and Prevention (CDC), obesity affects more than 40% of American adults. The link between type 2 diabetes and obesity has been apparent and well documented for quite some time. And while the causality of this relationship is not known for certain, there is sufficient evidence suggesting that weight loss can provide positive benefits for people with diabetes and obesity. Within the last 20 years, a class of diabetes drugs known as glucagon-like peptide-1 (GLP-1) agonists were introduced, providing significant reductions in A1C as well as noticeable weight loss in people with type 2 diabetes. Since their arrival, GLP-1 agonists have become a standard treatment option for prescribing practitioners as well as source of hope for people with diabetes and obesity.
In May 2022, the FDA approved a combination GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 receptor agonist, tirzepatide (Mounjaro ™) for the treatment of type 2 diabetes mellitus in combination with diet and exercise. Since its approval, there have been heightened levels of discussion regarding tirzepatide: not so much about its role in diabetes management, but its positive effect in weight loss. The SURPASS trial, funded by the makers of the drug (Eli Lilly), studied tirzepatide and its A1C lowering effect and showed as much as a 2.4% reduction in A1C. The reduction in A1C by tirzepatide is significant, and it warrants recognition among the related GLP-1 agonist class as an effective treatment option for patients with type 2 diabetes. However, what the SURPASS trial showed regarding weight loss is astonishing. In the 40-week length of the study, participants taking tirzepatide lost as much as 25 pounds on average (in conjunction with lifestyle modification). For the participants that continued beyond the 40 weeks, those individuals experienced as much as 52 pounds of weight loss. It should be noted that the weight loss experienced by participants in this study was a secondary endpoint. Reduction in A1C was the primary endpoint, and at the time of the publication of this article, tirzepatide is not indicated for weight loss.
The reduction in A1C by tirzepatide is significant, and it warrants recognition among the related GLP-1 agonist class as an effective treatment option for patients with type 2 diabetes.
Tirzepatide is available in multiple strengths (2.5mg, 5mg, 7mg, 10mg, 12.5mg, and 15mg) as a once weekly subcutaneous injection that involves titration to the appropriate dose. Tirzepatide, similar to other GLP-1 agonists, produces its effect by enhancing insulin secretion, reducing glucagon levels, delaying gastric emptying and decreasing food intake. The gastrointestinal side effect profile of tirzepatide is like other GLP-1 agonists, with nausea, vomiting, and diarrhea being the most common. As a class, GLP-1 agonists are contraindicated in patients with personal or family history of certain types of thyroid cancer.
While additional studies will likely be published in the future regarding its use in weight loss, tirzepatide provides itself as an appropriate GLP-1 agonist treatment option for prescribers. It also provides an opportunity for diabetes care and education specialists to relay key counseling points and education regarding this new drug and highlight its implication for people with type 2 diabetes and obesity.
References
- Overweight and Obesity (Adult Obesity Facts). Center for Disease Control and Prevention. 17 May 2022. https://www.cdc.gov/obesity/data/adult.html
- Clinical Pharmacology. Elsevier. Tirzepatide (Mounjaro). Drug monograph. 2022. https://www.clinicalkey.com/pharmacology/monograph/5403?n=MOUNJARO
- America Diabetes Association. Standards of Medical Care in Diabetes-2022. January 2022. https://doi.org/10.2337/cd22-as01
- New England Journal of Medicine. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes. https://www.nejm.org/doi/pdf/10.1056/NEJMoa2107519. 15 July 2021.
- Mounjaro. Prescribing Information. Eli Lilly. 2022 https://www.mounjaro.com/hcp
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