SURMOUNT-2: new advances for treating obese type 2 diabetes with tirzepatide

Obesity is the primary driver of developing type 2 diabetes and cardiovascular disease, and weight loss in people with type 2 diabetes is an effective means for improving glycaemic control and cardiovascular risk factors. 1 Lingvay I Sumithran P Cohen R V le Roux CW Obesity management as a primary treatment goal for type 2 diabetes: time to reframe the conversation. Lancet. 2022; 399: 394-405 Summary Full Text Full Text PDF PubMed Google Scholar In the 2022 consensus report by the American Diabetes Association and the European Association for the Study of Diabetes, 2 Davies MJ Aroda VR Collins BS et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022; 45: 2753-2786 Crossref PubMed Scopus (106) Google Scholar a conceptual change was introduced in the treatment of type 2 diabetes that focused on a weight-centric approach inspired by recent results with semaglutide and tirzepatide trials. 2 Davies MJ Aroda VR Collins BS et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022; 45: 2753-2786 Crossref PubMed Scopus (106) Google Scholar The DIRECT study, 3 Lean M Barnes A Brosnahan N Thoma G Primary care weight-management for type 2 diabetes: the cluster-randomised Diabetes Remission Clinical Trial (DiRECT). Lancet. 2018; 391: 541-551 Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar which used intensive lifestyle weight management in people with type 2 diabetes, reported a progressive improvement in glycated haemoglobin (HbA1c) and a reduced requirement of antidiabetic drugs with increasing weight reduction. A 15% weight loss-induced remission of diabetes in 31 (86%) of 36 participants was reported without use of antidiabetic drugs. 3 Lean M Barnes A Brosnahan N Thoma G Primary care weight-management for type 2 diabetes: the cluster-randomised Diabetes Remission Clinical Trial (DiRECT). Lancet. 2018; 391: 541-551 Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar Tirzepatide, a glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 (GLP-1) receptor agonist that is taken once weekly, has been shown to lower HbA1c by about 2·2%, with around 50% of participants reaching HbA1c less than 5·7% in phase 3 trials assessing efficacy and safety in type 2 diabetes (SURPASS), 4 Frías JP An update on tirzepatide for the management of type 2 diabetes: a focus on the phase 3 clinical development program. Expert Rev Endocrinol Metab. 2023; 18: 111-130 Crossref PubMed Scopus (0) Google Scholar and this outcome was accompanied by bodyweight reduction of 9·5% to 12·5%. Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trialIn this 72-week trial in adults living with obesity and type 2 diabetes, once-weekly tirzepatide 10 mg and 15 mg provided substantial and clinically meaningful reduction in bodyweight, with a safety profile that was similar to other incretin-based therapies for weight management. Full-Text PDF