Tirzepatide lowers body weight, improves glycemic control for adults with type 1 diabetes
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Key takeaways:
- Tirzepatide induced a mean weight loss of 18.5% for adults with type 1 diabetes and overweight or obesity.
- Adults prescribed tirzepatide had greater increase in time in range than those not using the agent.
Adults with type 1 diabetes and overweight or obesity prescribed tirzepatide off-label had a reduction in body weight and improvements in HbA1c and continuous glucose monitoring metrics, according to data from a real-world study.
“About 67% of people with type 1 diabetes have overweight or obesity. Thus, they have some insulin resistance, and they get all of the problems that you get with type 2 diabetes,” Satish K. Garg, MD, professor of medicine and pediatrics at the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, told Healio. “[Tirzepatide is prescribed to] help them lose weight.”
Garg and colleagues analyzed data from 62 adults aged 18 to 80 years with type 1 diabetes and overweight or obesity who were prescribed tirzepatide (Mounjaro/Zepbound, Eli Lilly) for at least 3 months at the Barbara Davis Center for Diabetes from June 2022 to November 2023 (mean age, 40 years; 83% women). Participants who were on intensive insulin treatment and using a CGM were included in the analysis. BMI, body weight, HbA1c, insulin dose and CGM metrics were collected at baseline and every 3 months for 1 year. Adults receiving tirzepatide were matched by age, duration of diabetes, BMI, gender and HbA1c with 37 controls not prescribed tirzepatide.
The findings were published in Diabetes Technology & Therapeutics.
Body weight, glucose improvements
Adults prescribed tirzepatide had a mean 9.6% reduction in body weight at 3 months and a mean 18.5% weight decrease at 1 year compared with no change in weight for the control group. Mean HbA1c decreased by 0.5% from baseline to 3 months and by 0.67% from baseline to 1 year for the tirzepatide group. Those prescribed tirzepatide had a greater HbA1c reduction than the control group at all time points.
Participants prescribed tirzepatide had reductions in total daily insulin dose, basal insulin dose and bolus insulin dose from baseline to 3, 6, 9 and 12 months. All of the insulin dose reductions were greater than the insulin dose changes observed for the control group.
Mean CGM glucose decreased by 16.8 mg/dL from baseline to 3 months and by 23.5 mg/dL from baseline to 1 year for the tirzepatide group. The control group had no change in mean CGM glucose. Time in range increased by 10.5% from baseline to 3 months for those prescribed tirzepatide compared with no change for the control group. Time above range decreased by 11% from baseline to 3 months for the tirzepatide group compared with no change for the control group. No change in time below range was observed.
There were no reports of severe hypoglycemia or diabetic ketoacidosis hospitalizations during the study.
More studies, guidance needed
Garg said the data show that randomized controlled trials are needed to properly evaluate the effects of tirzepatide for adults with type 1 diabetes.
“Randomized trials are needed in people with type 1 diabetes for several reasons,” Garg said. “One is that there’s a need in people with obesity, with or without diabetes. Second is [to assess] whether the GLP analogs actually help people with type 1 diabetes. We know the use of GLP analogs, whether GLP-1 or GLP-1 plus GIP, help in cardiovascular disease. People with type 1 diabetes are prone to get CVD. They also help with diabetes kidney disease. Third is [tirzepatide] helps with the glucose profile, especially in the post-prandial glucose excursion.”
Tirzepatide is not FDA-approved to treat type 1 diabetes, but Garg said some providers are still prescribing the medication off-label for their patients. In an editorial published in Diabetes Technology & Therapeutics in March, Garg and colleagues offered tips for how providers can safely use tirzepatide and other GLP-1 analogs in the type 1 diabetes population.
“Patients have to be closely monitored,” Garg said. “Ideally, these people should be followed in a metabolic type 1 diabetes clinic. Anytime we start somebody on semaglutide [Ozempic/Wegovy, Novo Nordisk] or tirzepatide, we will always have them comeback to the clinic in a month and closely monitor their CGM profile.”
Reference:
Garg SK, et al. Diabetes Technol Ther. 2024;doi:10.1089/dia.2024.0023.
For more information:
Satish K. Garg, MD, can be reached at satish.garg@cuanschutz.edu.
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