Early-onset type 2 diabetes and tirzepatide treatment: a post hoc analysis from the SURPASS clinical trial program

Objective: We evaluated baseline characteristics of participants with early-onset T2D from the SURPASS program and tirzepatide’s effects on glycemic control, body weight (BW), and cardiometabolic markers. Research Design and Methods: This post hoc analysis compared baseline characteristics and changes in mean HbA1c, BW, waist circumference (WC), lipids, and blood pressure (BP) in participants (N=3792) with early-onset vs later-onset T2D at Week 40 (SURPASS-1, SURPASS-2) or Week 52 (SURPASS-3). Analyses were performed by study on data from participants while on assigned treatment without rescue medication in case of persistent hyperglycemia. Results: At baseline in SURPASS-2, participants with early-onset vs later-onset T2D were younger with longer diabetes duration (9 vs 7 years, p<0.001) higher glycemic levels (8.5% vs 8.2%, p<0.001), higher BW (97 vs 93 kg, p<0.001) and BMI (35 vs 34 kg/m2, p<0.001), and a similarly abnormal lipid profile (e.g., triglycerides 167 vs 156 mg/dL). At Week 40, similar improvements in HbA1c (-2.6% vs -2.4%), BW (-14 vs -13 kg), WC (-10 vs -10 cm), triglycerides (-26% vs -24%), HDL (7% vs 7%), and systolic BP (-6 vs -7 mmHg) were observed in both subgroups with tirzepatide. Conclusions: Despite younger age, participants with early-onset T2D from the SURPASS program had higher glycemic levels and worse overall metabolic health at baseline vs those with later-onset T2D. In this post hoc analysis, similar improvements in HbA1c, BW and cardiometabolic markers were observed with tirzepatide, irrespective of age at T2D diagnosis. Future studies are needed to determine long-term outcomes of tirzepatide in early-onset T2D.