Diabetes Medication To Lose Weight

In a study of people who were overweight or had obesity, but did not have type 2 diabetes, the weekly injectable helped many lose an average of 50 pounds.

Tirzepatide is part of a new drug class that targets two hormones: glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide.Courtesy of Eli Lilly and Company; Canva

A once-weekly injectable recently approved to treat type 2 diabetes may hold major potential as a weight loss medication for people with obesity, too, a study suggests.

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Overweight or obese participants without type 2 diabetes who took the drug, called tirzepatide (sold as the diabetes drug Mounjaro), lost an average of nearly 21 percent of their body weight at the highest dose studied. Scientists presented their findings at the American Diabetes Association (ADA)’s annual meeting in New Orleans and published the study in The New England Journal of Medicine.

“Definitely, the weight loss in this study is far more what we had ever seen with other FDA-approved medications in term of the absolute amount of weight lost or percentage of weight lost, ” says Osama Hamdy, MD, PhD, an associate professor at Harvard Medical School and medical director of the obesity clinical program at the Joslin Diabetes Center in Boston. Dr. Hamdy wasn’t involved in the new trial; he has received funding from Eli Lilly, the maker of tirzepatide.

The trial enrolled 2, 539 adults who weighed an average of 231 pounds and had a body mass index (BMI) of 38 to start. A BMI of 30 or higher is considered obesity, and 95 percent had a BMI at least this high.

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Participants were randomly assigned to receive 72 weeks of once-weekly injections of placebo or one of three doses of tirzepatide — 5 milligrams (mg), 10 mg, or 15 mg.

At the highest dose, people lost an average of 20.9 percent of their body weight by the end of the trial, or about 52 pounds. Their average weight loss, 19.5 percent, was the equivalent of about 49 pounds, with the 10 mg dose, and 15 percent, or about 35 pounds, with the 5 mg dose.

Most side effects were mild to moderate, and most often involved gastrointestinal issues such as nausea, diarrhea, and constipation; roughly 4 to 7 percent of participants discontinued treatment due to drug-related side effects.

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This was a phase 3 clinical trial, which is typically the final stage of testing required to be considered for U.S. regulatory approval.

“These results are an important step forward in potentially expanding effective therapeutic options for people with obesity, ” says lead study author Ania Jastreboff, MD, PhD, an associate professor at Yale University School of Medicine and codirector of the Yale Center for Weight Management in New Haven, Connecticut.

“Notably, about 9 out of 10 individuals with obesity lost weight while taking tirzepatide, ” says Dr. Jastreboff, who has financial ties to several pharmaceutical companies, including Eli Lilly, maker of tirzepatide and funder of the new clinical trial.

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Tirzepatide is the first drug in a new family of medicines that target two hormones — glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) — that are involved in maintaining healthy blood sugar levels and sending signals from the gut to the brain when people are full.

The U.S. Food and Drug Administration (FDA) approved tirzepatide in May to help manage blood sugar in people with type 2 diabetes; the diabetes treatment is called Mounjaro.

A head-to-head clinical trial found tirzepatide in this setting to be more effective at controlling blood sugar and spurring weight loss in type 2 diabetes patients than semaglutide (Ozempic), an injected GLP-1 receptor agonist, or two commonly used forms of insulin, according to the FDA.

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In this earlier trial, tirzepatide reduced so-called hemoglobin A1C levels, which reflect average blood sugar levels over about three months, by 0.5 percent more than semaglutide and by about 1 percent more than insulin, the FDA said.

The 15 mg dose of tirzepatide helped type 2 diabetes patients with obesity lose 12 pounds more than semaglutide, and 27 to 29 pounds more than the two forms of insulin evaluated, the FDA noted.

One drawback of the new trial of tirzepatide for obesity is that it didn’t directly compare this drug with other treatment options. Hamdy says head-to-head tests against semaglutide and another similar drug, liraglutide, will be needed to confirm whether tirzepatide is indeed the best medication for obesity. Hamdy has also received funding from Novo Nordisk, maker of semaglutide.

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Results from the new trial do suggest that tirzepatide at the highest dose may work as well as bariatric surgery, Hamdy notes. But if tirzepatide wins FDA marketing approval, how much patients use this drug may ultimately come down to is price.

“Obesity is a serious disease that may lead to many costly complications, including diabetes, hypertension, and cardiovascular disease, ” Hamdy says. He doesn’t expect tirzepatide to be cheaper than other new targeted weight-loss drugs like semaglutide (Wegovy) or liraglutide (Saxenda), which retail for more than $1, 300 a month, according to prices on GoodRx.

Because of all the health risks of obesity, and how much many patients struggle to lose weight and keep it off, more treatment options are still needed, says Clifford Rosen, MD, a professor at Tufts University School of Medicine in Boston and Mainehealth Institute for Research in Scarborough, Maine, who wasn’t involved in the study and has no financial ties to companies.

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“Nothing is wrong with the other interventions including the current GLP-1R agonists, and bariatric surgery, ” Dr. Rosen says. “But if tirzepatide produces a similar magnitude of weight loss as bariatric surgery, that would be a huge advance and a great alternative to surgery.”

Eli Lilly didn’t immediately respond to a request for comment on how soon the company may seek FDA approval of tirzepatide for obesity.

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Given as daily or weekly injections, these drugs called GLP-1 RAs, help people produce insulin and lower the amount of sugar in the blood. First approved for use in type 2 diabetes patients in 2005 by the U.S. Food and Drug Administration, the medications were quickly noted to promote weight loss.

The FDA, in 2014, later approved a GLP-1 RA for chronic weight management. Additional drugs in the class have since been approved for weight loss.

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Of the nearly 35 million Americans with type 2 diabetes, more than one in 10 were estimated to be taking these drugs in 2019, according to the Journal of the American Medical Association.

I prescribe these medications 10 times per day, Dr. Amanda Velazquez, Director of Obesity Medicine at Cedars-Sinai Medical Center, told ABC News.

Obesity is a chronic relapsing disease, Velazquez added and said that the weight loss effects of the medications wear off after drug discontinuation.

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Novo Nordisk, the pharmaceutical company that makes Ozempic, Victoza and another drug called Wegovy -- which is specifically meant for weight loss -- said last December, While we recognize that some healthcare providers may be prescribing Ozempic for patients whose goal is to lose weight, it is up to the clinical discretion of each healthcare provider to choose the best treatment approach for their patients.

There is high demand overall, more awareness of the medications because of their efficacy, and shortages in the supply chain with making the drug from manufacturers, Velazquez said.

It is very frustrating for everyone, said Dr. Heather Sateia, Assistant Professor of Medicine at Johns Hopkins Hospital, told ABC News. Pharmacies are so short-staffed that they won't let people know when it is back in stock so it is like a scavenger hunt- time-consuming and anxiety-provoking for patients.

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