We know that there are many gut hormones involved in diabetes control and weight management . GLP1 is one of these hormones, which has been developed into an entire class of medications for diabetes [most commonly used in Canada are dulaglutide (Trulicity), liraglutide 1.8mg (Victoza), and semaglutide (Ozempic)], and one of them is also approved for weight management in people with or without type 2 diabetes [liraglutide 3mg (Saxenda)].
Tirzepatide is a dual agonist of GLP1 and another gut hormone called GIP, which is also involved in glucose and weight regulation. The first phase 3 results of tirzepatide for the treatment of type 2 diabetes in the SURPASS clinical trial program were just revealed, as a press release of the SURPASS-1 study (French version here).
In this study, 478 people with inadequately controlled type 2 diabetes on no other diabetes medication were randomized to receive once weekly tirzepatide 5mg, 10mg, 15mg, or placebo (criteria for entry into the study included A1C 7-9.5% and BMI ≥23). The mean baseline A1C was 7.9%, and baseline weight of participants was a mean of 85.9kg. After 40 weeks, the highest dose of tirzepatide (15mg weekly) led to an A1C reduction of 2.1% (vs 0.0% change in placebo) and reduced weight by 11% (vs 0.9% weight loss in placebo). Impressively, more than half of patients on the 15mg dose achieved a normal range A1C by the American criteria of <5.7%. The overall safety profile was reported as similar to that of the GLP1 class, with gastrointestinal side effects being the most common (for the GLP1 class, this is most often nausea, constipation, sometimes diarrhea, heartburn, and occasionally vomiting).
These exciting results build on the published phase 2 data of tirzepatide that were released in 2018. While we await the peer-reviewed publication to really dig into these new data, the future certainly looks bright for tirzepatide as a new approach to treating type 2 diabetes. Tirzepatide is also being studied for weight management in people with obesity or overweight without type 2 diabetes in the SURMOUNT clinical trial program.
Disclaimer: I am an investigator in the SURPASS clinical trial program. The SURPASS and SURMOUNT trials are conducted by Eli Lilly, the makers of tirzepatide. I receive honoraria as a continuing medical education speaker and consultant from the makers of tirzepatide and dulaglutide (Eli Lilly), and liraglutide and semaglutide (Novo Nordisk).
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