Tirzepatide superior to ICC in metformin-resistant T2D

Treatment with tirzepatide yields robust reductions in HbA_1c, weight, and waist circumference in patients with early type 2 diabetes (T2D) uncontrolled with metformin, reports a study.

After 2 years, normoglycaemia (HbA_1c <5.7 percent) occurred in more patients on tirzepatide than intensified conventional care (ICC).

A total of 794 adults with at most 4 years of T2D history treated with metformin were included in this phase 4 trial conducted across 78 sites in 10 countries. Participants were randomized to receive either tirzepatide (15 mg or maximum tolerated dose) or ICC (including glucagon-like peptide-1 receptor agonists [GLP1-RAs] but excluding tirzepatide).

Tirzepatide demonstrated superiority to ICC for mean changes in HbA_1c from baseline to 2 years (‒1.99 percentage points, 95 percent confidence interval [CI], ‒2.12 to ‒1.87 vs ‒1.32 percentage points, 95 percent CI, ‒1.44 to ‒1.19; estimated treatment difference [ETD], ‒0.68 percentage points, 95 percent CI, ‒0.84 to ‒0.51; p<0.001).

Likewise, tirzepatide was superior to ICC in terms of reductions in weight (ETD, ‒8.0 kg, 95 percent CI, ‒9.39 to ‒6.50; p<0.001) and waist circumference (ETD, ‒6.2 cm, 95 percent CI, ‒7.54 to ‒4.93; p<0.001). Additionally, more participants achieved normoglycaemia with tirzepatide than ICC (60.2 percent vs 24.0 percent). Gastrointestinal events were the most common adverse events in the two treatment groups.

The study was limited by its open-label design, according to the authors.

“Initiation of treatment with tirzepatide, a once-weekly glucose-dependent insulinotropic polypeptide and GLP-1RA, early after a diagnosis of T2D may establish better and more durable glycaemic control than current treatment approaches per guidelines and clinical practice,” they said.