Written by Babatunde Carew
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Tirzepatide significantly reduces body weight and the risk of progression to type 2 diabetes in individuals with obesity and prediabetes compared to placebo.
Reduces weight. Better outcomes. Will insurance pay for it?
This 3-year, phase 3 randomized controlled trial, an analysis of SURMOUNT-1, examined whether tirzepatide could induce long-term weight loss and prevent type 2 diabetes in individuals with obesity and prediabetes. 1,032 participants received weekly tirzepatide: 5 mg, 10 mg, or 15 mg, with corresponding weight loss of -12.3% to -18.7% -19.7%, respectively, vs. -1.3% with placebo and tirzepatide reduced diabetes progression vs placebo (1.3% vs. 13.3%, HR 0.07, 95%CI 0.0-0.1; p<0.001).
How does this change my practice?
Obesity increases the risk of chronic disease and mortality, but weight loss can significantly improve health outcomes: a weight loss of 5% or more can reduce health risks in individuals with impaired glucose tolerance, hypertension, or nonalcoholic fatty liver disease, while greater weight loss (16% on average) further reduces mortality. Tirzepatide, a dual GLP1 and GIP agonist, is one of the most effective FDA-approved weight loss medications on the market, offering cardiovascular protection in patients with T2DM and HFpEF, and has a reasonable safety profile. This study reinforces my current practice, as I already prescribe tirzeptide whenever possible for this population, given its weight loss efficacy, cardiovascular benefits, and safety. Unfortunately, it remains too expensive for the majority of patients, as insurance often will not cover it without a diagnosis of T2DM. The thing that struck me most about this study was not the effectiveness of tirzepatide, but that the placebo group’s mean change in body weight at 3 years was -1.3% despite all groups receiving regular lifestyle counseling, 500-kcal daily deficit, and ≥ 150 minutes of physical activity per week. This highlights the need for pharmacologic and/or surgical management of obesity whenever possible, especially when significant medical comorbidities are present.
Source
Tirzepatide for Obesity Treatment and Diabetes Prevention. N Engl J Med. 2024 Nov 13. doi: 10.1056/NEJMoa2410819. Epub ahead of print. PMID: 39536238
