Achieving Normoglycemia With Tirzepatide: Analysis of SURPASS 1–4 Trials

OBJECTIVE: Tirzepatide is a novel single-molecule glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 receptor agonist, which demonstrated unprecedented improvements in glycemic control and body weight reduction, in the SURPASS phase 3 program. In this exploratory analysis, we aimed to characterize tirzepatide-treated participants who achieved HbA(1c) <5.7% and evaluate changes in clinical markers associated with long-term cardiometabolic health. RESEARCH DESIGN AND METHODS: Baseline characteristics and change from baseline to week 40 for several efficacy and safety parameters were analyzed according to HbA(1c) attainment category (<5.7%, 5.7–6.5%, and >6.5%) using descriptive statistics in participants taking ≥75% of treatment doses, without rescue medication, in the SURPASS 1–4 trials (N = 3,229). Logistic regression models with tirzepatide doses adjusted as a covariate were used to obtain odds ratios and assess the impact of patient characteristics achieving an HbA(1c) <5.7%. RESULTS: Tirzepatide-treated participants who achieved HbA(1c) <5.7% were slightly younger, with a shorter duration of diabetes and lower HbA(1c) value at baseline compared with those who did not achieve HbA(1c) <5.7%. In addition, they showed greater improvements in HbA(1c), body weight, waist circumference, blood pressure, liver enzymes, and lipid parameters without increasing hypoglycemia risk. CONCLUSIONS: Normoglycemia was unprecedently achieved in a significant proportion of participants in the SURPASS clinical program, without increasing hypoglycemia risk, and was associated with an overall improvement in metabolic health.