Diabetes Dialogue: Tirzepatide in Type 1 Diabetes, with Viral Shah, MD

Tirzepatide, the first FDA-approved dual agonist of GLP-1/GIP, has captured the attention of both the medical community and the general public in the last 18 months. Driven by news and updates surrounding the agent’s use in type 2 diabetes and weight management, the agent was among the most discussed pharmacotherapies during 2023.

In 2024, the agent continues to make headlines, with a study in late January purporting the potential for use among patients with type 1 diabetes. Coming less than 6 months after a New England Journal of Medicine publication provided insight into the effects of semaglutide in type 1 diabetes, the proof-of-concept study examining use of tirzepatide, which Viral Shah, MD, of Indiana University, led, adds to the growing evidence base surrounding use of GLP-1 receptor agonists in management of type 1 diabetes.

A single-center, retrospective, observational study, Shah and colleagues identified a cohort of 26 adults with type 1 diabetes at initiation of tirzepatide for another indication from the Barbara Davis Center for Diabetes at University of Colorado Anschutz. The primary outcomes of interest for the study were the reduction in HbA1c and percent change in body weight at 8 months relative to baseline measurements. Investigators also assessed change in CGM metrics and BMI as secondary outcomes of interest.

Upon analysis, results pointed to significant reduction in HbA1c among the study cohort, with reductions of 0.45% and 0.59% observed at 3 and 8 months, respectively. When assessing body weight, reductions of 3.4%, 10.5%, and 10.1% were observed 3, 6, and 8 months after starting tirzepatide.

Analysis of secondary outcomes revealed both time in target range of 70-180 mg/dL (+12.6%; P=.002) and time in tight target range 0-140 mg/dL increased at 3 months (+10.7%, P=.0016) at 3 months, with these changes sustained through the duration of the 8-month follow-up. Similarly, improvements in time spent above range of 180 mg/dL were observed at 3 months and sustained out to month 8. When assessing safety outcomes, results suggested the drug was relatively safe and well tolerated as only 2 patient discontinued use during follow-up.

In this episode of Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives, hosts Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, and Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, are joined by Shah for a discussion on this study, the prospect of GLP-1 RA-based therapies in type 1 diabetes, and the potential role of tirzepatide in type 1 diabetes.

Relevant disclosures for Shah include Novo Nordisk, Dexcom Inc., Insulet Corporation, Tandem Diabetes Care, and others. Relevant disclosures for Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others.

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. J Diabetes Sci Technol. Published online February 5, 2024. doi:10.1177/19322968231223991}}
2. _{^{Campbell P. Tirzepatide (Mounjaro) wins FDA approval for type 2 diabetes. HCP Live. May 13, 2022. Accessed February 15, 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 15, 2024. https://www.hcplive.com/view/fda-approves-tirzepatide-zepbound-chronic-weight-management.}}
4. _{^{Dandona P, Chaudhuri A, Ghanim H. Semaglutide in Early Type 1 Diabetes. N Engl J Med. 2023;389(10):958-959. doi:10.1056/NEJMc2302677}}