Tirzepatide significantly reduces HbA1c and weight in type 1 diabetes

Results from a recent proof-of-concept observational study provide insight into the potential efficacy and safety of tirzepatide in adults with type 1 diabetes (T1D).¹

Data from a single-center retrospective observational study revealed that tirzepatide, a GLP-1/GIP dual agonist, is associated with significant reductions in hemoglobin A1c (HbA1c) and body weight in adult patients with T1D.

“Randomized controlled trials are needed to establish the efficacy and safety of this drug in T1D,” said Virus N. Shah, M.D., professor of endocrinology and director of diabetes clinical research at the Indiana University School of Medicine. wrote the research team led by. At the IU Diabetes and Metabolic Disease Center.

In May 2022, the U.S. Food and Drug Administration (FDA) first approved tirzepatide (Mounjaro) as a diet and exercise adjunct to improve blood sugar control in adults with type 2 diabetes (T2D).² Approval was granted based on data from the SURPASS program showing that 15 mg of tirzepatide produced a 1.6% greater reduction in mean HbA1c compared to placebo as monotherapy and 1.5% greater reduction than placebo when combined with long-acting insulin It was shown that it brought about

In November 2023, the FDA approved tirzepatide (Zepbound) for chronic weight management in adults who are obese or overweight and have one or more weight-related conditions.³ In both the SURMOUNT-1 and SURMOUNT-2 trials, after 72 weeks of treatment, subjects treated with once-weekly tirzepatide 5 mg, 10 mg, or 15 mg showed statistically significant improvement compared to subjects who received placebo. showed significant weight loss.

With both Priority Review and Fast Track designations, this approval marks the first weight management approval for a GLP-1/GIP dual agonist.

In the current study, Shah et al. obtained data on HbA1c, weight, body mass index (BMI), and continuous glucose monitoring (CGM) from electronic health records at the time of initiation of tirzepatide in T1D patients.¹ The same measurements were collected at subsequent clinic visits over the course of 8 months in the study population.

The main outcomes of the analysis were reduction in HbA1c and percent change in body weight. Secondary outcomes then included changes in his CGM indicators and his BMI over 8 months from baseline. Of the 26 adults who participated in the study, 54% were female, mean age was 42 years, and mean BMI was 36.7 ± 5.3 kg/m2.

Shah et al.’s analysis showed that tirzepatide significantly reduced HbA1c by 0.45% at 3 months and 0.59% at 8 months. The findings also showed that body weight decreased significantly by 3.4%, 10.5%, and 10.1% after 3, 6, and 8 months after starting tirzepatide treatment.

Meanwhile, time-to-target range (TIR, 70-80 mg/dL) and time-to-target range (TITR, 70-140 mg/dL) were increased by tirzepatide treatment (TIR: +12.6%; P = .002; TITR, +10.7%; P = .0016). Results showed that time above range (TAR, >180 mg/dL) decreased by -12.6% at 3 months. P = .002) changes over 3 months and persists over 8 months.

Shah et al. suggested that tirzepatide was relatively safe and well tolerated during the study period. Only two patients in the study population discontinued medication during observation.

These results continue the growing body of evidence suggesting the utility of GLP-1 agonist-based agents for patients with T1D. In a recent study, off-label use of semaglutide, another GLP-1 agonist, eliminated the need for mealtime insulin in 10 people with newly diagnosed T1D, with 70% achieving baseline treatment within 6 months. It has been reported that insulin use can be eliminated.^Four

“We were certainly surprised by the findings, but very excited. If these findings are corroborated in large-scale studies with long follow-up periods, it will likely be the first in T1D since the discovery of insulin in 1921. This could be the most dramatic change in treatment yet,” said Paresh Dandona, MD, former director. Endocrinology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo.^Five

References

1. _{Akturk HK, Dong F, Snell-Bergeon JK, Karakus KE, Shah VN. Efficacy and safety of tirzepatide in adults with type 1 diabetes: a proof-of-concept observational study. Journal of Diabetes Science and Technology. 2024;0(0). doi:10.1177/19322968231223991}
2. _{Campbell P. Tirzepatide (Mounjaro) receives FDA approval for type 2 diabetes. HCP live. April 27, 2023. Accessed February 7, 2024. https://www.hcplive.com/view/tirzepatide-wins-fda-approval-for-type-2-diabetes.}
3. _{Campbell P. FDA approves tirzepatide (Zepbound) for chronic weight management. HCP live. November 8, 2023. Accessed February 7, 2024. https://www.hcplive.com/view/fda-approves-tirzepatide-zepbound-chronic-weight-management.}
4. _{Campbell P. Semaglutide may eliminate the need for insulin in type 1 diabetes. HCP live. October 3, 2023. Accessed February 7, 2024. https://www.hcplive.com/view/semaglutide-could-eliminate-need-for-insulin-in-type-1-diabetes.}
5. _{University of Buffalo. After treatment with semaglutide, the patient, newly diagnosed with type 1 diabetes, required little or no insulin. Yurek Alert. September 6, 2023. Accessed September 6, 2023. https://www.eurekalert.org/news-releases/1000574.}