Clinical outcomes of tirzepatide in a real-world follow-up cohort of patients with type 2 diabetes

Introduction: Tirzepatide, a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist (GLP-1RA), has demonstrated major metabolic benefits in clinical trials, but real-world evidence from secondary care remains limited. This study evaluated the metabolic impact, treatment persistence and subgroup differences in response to tirzepatide among adults with type 2 diabetes (T2D) managed in specialist services. Methods: This retrospective observational study included adults with T2D initiated on tirzepatide across three secondary-care diabetes centers between July 2024 and July 2025. Individuals with at least one follow-up visit were included. Outcomes assessed included glycated hemoglobin (HbA1c), weight, body mass index (BMI), blood pressure, lipid profile, alanine aminotransferase (ALT) and total daily insulin dose. Subgroup analyses examined the effects of prior GLP-1RA use, baseline HbA1c and baseline BMI using analysis of covariance models. Results: A total of 295 patients were included (mean age: 58.7 ± 11.7 years; 51.9% female), with a median follow-up of 6.7 months. At follow-up, the mean prescribed dose was 5 mg. Mean HbA1c decreased by 17.7 mmol/mol and body weight by 5.9 kg (both p<0.001). The proportion achieving HbA1c <58 mmol/mol rose from 15.3% to 47.5% (χ²=74.46; p<0.001). Weight-loss thresholds of >5%, >10%, >15% and >20% were achieved by 46.5%, 20.5%, 8.5% and 4.6% of participants, respectively. Insulin-treated individuals reduced their daily insulin dose by 13.5 units (p=0.001). Improvements were also observed in blood pressure, triglycerides, low-density lipoprotein cholesterol and ALT. Subgroup analyses showed broadly consistent benefits; GLP-1RA-naive status was associated with lower adjusted follow-up HbA1c and weight, while higher baseline BMI was associated with higher adjusted follow-up HbA1c. Conclusion: In routine secondary care, tirzepatide produced clinically meaningful improvements in glycemia, weight and cardiometabolic risk markers, with nearly half achieving HbA1c <58 mmol/mol. Benefits were consistent across key clinical subgroups, supporting its effectiveness in real-world practice.