Let’s Reflect Upon 94% Prevention of Diabetes with Tirzepatide

Yesterday, Eli Lilly and Company announced an impressive topline number from the results of a three-year study of tirzepatide in adults with obesity or overweight and prediabetes. That number was 94% prevention of progression from prediabetes to diabetes with tirzepatide.

No, it was not 100%. But this is awfully close.

Historical Context

We will have to wait for ObesityWeek in November to see a full presentation of these results. At about the same time, we can expect to see a publication in a peer-reviewed journal.

So right now, it makes sense to think about this big, impressive number in the context of how other options have done with preventing prediabetes from turning into diabetes. For that, we can turn back two decades to the Diabetes Prevention Program study in the New England Journal of Medicine. In this landmark study with 2.8 years of follow-up, intensive behavioral therapy delivered a 58% reduction in progression from prediabetes to diabetes. For metformin, the reduction was 31%.

In the case of behavioral therapy, this meant that only 4.8% percent of persons would progress to diabetes per year instead of 11% in the control group.

Another reference point is data from the SELECT study of semaglutide in people with cardiovascular disease and prediabetes. In that study, semaglutide reduced the risk of progression to diabetes by 73% over a three-year period. Of course, this is a different patient population. This is why it’s best to be careful about drawing conclusions without a head-to-head study.

Still, 94% is an impressive number.

Treating Obesity Prevents Chronic Disease

What we have here is one more observation from a carefully controlled study telling us that treating obesity prevents the harm of chronic diseases that result from obesity. In this case, we’re talking about diabetes prevention with tirzepatide. But we also have data on heart, liver, and kidney disease. Sleep apnea data are impressive, too. Some of the data is from semaglutide, other studies involve tirzepatide and even newer obesity medicines.

Taken together, these data are showing us how false the old construct of obesity treatment versus prevention really was. Treating obesity prevents chronic diseases.

Click here, here, and here for more on these new topline results. For perspective on the false dichotomy of obesity treatment versus prevention, click here.

Lake George (formerly Reflection Seascape), painting by Georgia O’Keeffe / WikiArt

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August 21, 2024