The Weight Loss Drug That Can Prevent Diabetes

The weight-loss drugs that have become so popular in recent years actually began as diabetes medications, and a new study shows that they continue to provide strong protection against that chronic disease.

Eli Lilly, the makers of tirzepatide—which they sell as Mounjaro for diabetes and Zepbound for weight loss—announced recently that in its longest study yet on tirzepatide, the drug reduced the risk of people with prediabetes moving on to develop diabetes by 94% compared to those taking a placebo.

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For nearly three years, the study followed more than 1,000 people who were overweight or obese and had prediabetes. By the end of the study, those on any of three doses of the drug lost up to nearly 20% of their body mass from the start of the study compared to those taking a placebo. The drug also contributed to a 94% lower chance of progressing from prediabetes to diabetes compared to placebo.

Tirzepatide targets two hormones related to appetite and weight: glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). In people with diabetes, the weekly injectable medication helps to modulate glucose levels before and after eating as well as lower weight, which in turn also regulates blood sugar levels. The study shows that people at higher risk for diabetes can use the drug to better control their blood sugar metabolism so they don’t develop the condition.

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“We don’t have any medication approved to treat prediabetes right now,” says Dr. Michael Weintraub, clinical associate professor of endocrinology at NYU Langone Health who was not involved in the study. Such a drug could allow doctors to start helping patients at risk of getting diabetes earlier, he says, and even help some people avoid the chronic condition as well as other health problems that usually come with it. “If we can intervene earlier and treat the underlying obesity before it leads to Type 2 diabetes or other complications, then that’s going to reduce the overall risk of the No. 1 killer of individuals with obesity, which is cardiovascular disease.”

According to the U.S. Centers for Disease Control and Prevention, about one in three people in the country has prediabetes, and many are not even aware of their condition. While rates vary, about 5% to 10% of people with prediabetes will progress to diabetes each year. The risk of developing diabetes is greatest among those who are overweight or obese, and the latest study targets this population and shows that medications can reduce that risk.

The findings build on previous results released in 2022 in the New England Journal of Medicine in the same population after a one-year follow-up that focused mostly on weight loss. But the longer time period of the current study allowed doctors to track patients’ diabetes trajectory as well.

Weintraub says that tirzepatide may be helping to reduce the likelihood of developing diabetes in several ways: by controlling weight, increasing insulin production to control blood sugar, and addressing inflammation, which can lead to insulin resistance and less efficient control of blood sugar in the body.

Doctors will need to do more research on how long patients need to take the drug, and how long the benefit in holding off diabetes endures. In the study, patients who stopped taking tirzepatide for 17 weeks began to regain weight, and their risk of developing diabetes was slightly lower, at 88%, compared to the 94% lower risk when patients continued to take the drug.

While the results aren’t surprising, they should provide more reassurance to people who are overweight and eager to address their risk of developing diabetes.