Early Use of Tirzepatide Shows Strong Results in Type 2 Diabetes Study

Type 2 diabetes is a chronic and progressive disease, closely linked to excess weight. Achieving stricter and earlier diabetes control could change the outlook for the 5.3 million patients in Spain. These are the main conclusions of the two-year SURPASS-EARLY study on tirzepatide, published in the prestigious journal Annals of Internal Medicine.

This publication adds to the scientific evidence demonstrating the clinical relevance of tirzepatide, a drug recently funded by the French public health system, a request also made to the Spanish authorities by the main scientific societies in Spain.

“The main scientific societies involved in diabetes management in Spain have expressed their concern about the lack of public funding for tirzepatide in type 2 diabetes in our country. They believe that this situation limits patients’ equitable access to an innovative therapy whose differential efficacy has been widely demonstrated and corroborated by studies such as SURPASS-EARLY,” added Rocío Villar, a physician in the Endocrinology and Nutrition Department at the University Hospital Complex of Santiago de Compostela.

Comparison with standard clinical practice

SURPASS-EARLY is a Phase IV clinical trial evaluating the impact of early use of a GIP/GLP-1 inhibitor, such as tirzepatide, in type 2 diabetes, compared to intensified conventional treatment in adult patients who did not achieve glycemic control with diet, exercise, and metformin.

Intensified conventional treatment reflects real-world clinical practice by integrating all therapeutic strategies according to clinical guidelines and available treatments for early-stage type 2 diabetes. This research has a planned total follow-up of 4 years, and this analysis presents the results for the first 2 years, focusing on glycemic control and metabolic parameters.

The incidence of diabetes in people of normal weight is 2.7 cases per 1,000 person-years, while in people with obesity* it reaches 17.5 cases per 1,000 person-years. This is detailed in a sub-analysis of the di@abet.es study on the influence of obesity on the development of diabetes. The risk of developing type 2 diabetes in people with obesity is approximately 27 times higher than in people of normal weight, increasing progressively as BMI increases.

“Weight loss is one of the most effective interventions for preventing type 2 diabetes in high-risk individuals. When diabetes is already present, addressing obesity can significantly influence its progression. The SURPASS-EARLY study shows that a strategy focused on achieving significant weight loss from the early stages is accompanied by a very significant improvement in glycemic control and a high proportion of participants achieving normoglycemia. Reaching these goals from the early stages of the disease could translate into delaying the progression of diabetes and its complications,” explained Virginia Bellido, an endocrinologist at the Virgen del Rocío Hospital in Seville.

SURPASS-EARLY included 794 patients with early-stage type 2 diabetes, with a mean disease duration of 2.6 years and inadequate glycemic control and cardiometabolic risk factors (mean HbA1c 7.8%, obesity – mean weight ~100 kg; BMI ~35.4 kg/m² – and waist circumference ~114 cm, with similar characteristics between both groups).

At two years, tirzepatide demonstrated superiority over intensified conventional therapy in terms of diabetes control (with a mean reduction in HbA1c from baseline to two years [−1.99% vs −1.32%; p<0.001], achieving glycemic control (HbA1c <5.7%) in a greater number of patients [60.2% vs 24.0%]). This benefit was accompanied by a significantly greater weight loss (−13.8 kg vs −5.9 kg; p<0.001) and a notable reduction in waist circumference (the difference between treatments was -6.2 cm; p<0.001).

Furthermore, improvements were observed in key cardiometabolic parameters such as triglycerides and VLDL, which were greater in the treatment group compared to the control group. The safety profile was consistent with previous studies, with adverse events mainly gastrointestinal, mostly mild to moderate.

Tirzepatide is addressing the disease from its origin

“Excess dysfunctional fat is a root cause of type 2 diabetes. It makes perfect sense to treat the underlying problem with a molecule that offers superior weight loss results, such as tirzepatide. The sooner we do so, the sooner we can correct aspects that, if left untreated, promote the progression of the disease. We will be able to curb not only complications linked to poor glycemic control but also those related to the presence of this excess fat. It should be a preferred pharmacological option,”said Igotz Aranbarri, a family physician at the Landako Health Center in Durango.

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First published in GACETA MEDICA. A third-party contributor translated and adapted the article from the original. In case of discrepancy, the original will prevail.

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