Tirzepatide cuts HbA1c, body weight for adults with type 1 diabetes in real-world study
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Key takeaways:
- Tirzepatide lowered HbA1c by 0.45 percentage points at 3 months for adults with type 1 diabetes.
- Time in range increased and time above range declined at 3 months.
- There were no reports of DKA during follow-up.
Adults with type 1 diabetes who received tirzepatide in a real-world setting had reductions in HbA1c and body weight at 3 months that were sustained for up to 8 months, according to study data.
“Tirzepatide use was associated with significant reductions in weight and HbA1c in adults with type 1 diabetes without an increase in risk for hypoglycemia or diabetic ketoacidosis,” Viral N. Shah, MD, professor of medicine in the division of endocrinology and metabolism and director of diabetes clinical research at the Indiana University Center for Diabetes and Metabolic Diseases, told Healio. “Since this was a pilot study, we cannot draw a definite conclusion, but it provides reassuring data and calls for a randomized trial of tirzepatide in type 1 diabetes.”
Shah and colleagues conducted a retrospective observational study with data from 26 adults with type 1 diabetes attending the Barbara Davis Center for Diabetes at University of Colorado Anschutz Medical Campus who were prescribed tirzepatide from June 15, 2022, to Jan. 30, 2023 (mean age, 42 years; 54% women). Each participant received a 2.5 mg dose at drug initiation, with dosage increasing based on the physician’s or patient’s goals. HbA1c, weight and BMI were collected from electronic medical records at the date of prescription and all follow-up visits for 8 months. Continuous glucose monitoring data were also obtained during the study period. Severe hypoglycemia, DKA and other potential adverse events requiring medical assistance or hospitalization were collected.
The study was published in the Journal of Diabetes Science and Technology.
“GLP-1 receptor agonists has revolutionized the management of type 2 diabetes,” Shah said of why the study was conducted. “Due to great weight loss and cardiorenal benefits, it is being used off-label in people with type 1 diabetes as well. To our knowledge, there was no study evaluating efficacy and safety of tirzepatide in type 1 diabetes.”
Tirzepatide improves HbA1c
Of the study group, 24 adults were still receiving tirzepatide at 8 months. Participants had a 0.45 percentage point reduction in HbA1c from baseline to 3 months (P = .027). The decrease in HbA1c was maintained at 8 months. Body weight declined by 3.4% from baseline to 3 months and by 10.5% from baseline to 6 months. No further weight reductions were seen after 6 months. In a mixed-effect model, a 1 percentage point decrease in body weight was associated with a 0.05 percentage point drop in HbA1c (P = .004).
The study group had a 12.6 percentage point increase in time in glycemic range with a glucose of 70 mg/dL to 180 mg/dL from baseline to 3 months and a 12.6 percentage point decline in time above range with glucose of more than 180 mg/dL during that same period (P = .0002 for both). Time below range with a glucose of less than 70 mg/dL did not change during the study. Time in tight target range with a glucose of 70 mg/dL to 140 mg/dL improved by 10.7 percentage points from baseline to 3 months (P = .0016) and by 11.5 percentage points from baseline to 6 months (P = .0008).
“Interestingly, most improvement in time in range was due to improvement in time in tight range,” Shah said. “This suggests that tirzepatide has a great potential in normalizing post meal-associated hyperglycemia and may help people with type 1 diabetes achieve optimal time in tight range.”
No reports of DKA
Total daily insulin dose dropped by 21.6 IU per day from baseline to 3 months. The reduced daily insulin dose was maintained at 6 and 8 months.
Two adults discontinued tirzepatide during follow-up, one due to severe hypoglycemia and one due to severe constipation. There were no reports of DKA.
“I believe that GLP-1 receptor agonists molecules have great potential in management of type 1 diabetes,” Shah said. “I would love to see GLP-1 manufacturers conducting regulatory phase 3 studies to seek FDA approval in type 1 diabetes.”
For more information:
Viral N. Shah, MD, can be reached at shahvi@iu.edu.
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