Among adults with type 2 diabetes (T2D), the use of tirzepatide along with GLP-1 RAs and SGLT2 inhibitors as glucose-lowering medication (GLM) has increased sharply, along with an increased use of tirzepatide and GLP-1 RAs as weight-lowering medication (WLM) among patients without diabetes, while the use of conventional GLMs and WLMs has declined during the same period, according to a new study published in Annals of Internal Medicine.

The population-based cohort study used claims data collected from January 2021 through December 2023 in the Optum's deidentified Clinformatics Data Mart Database to glean information on dispensing of any GLM in 1,830,876 adults with T2D (mean age 66, 49% women, 58% White) and incident GLM use in 1,279,544 adults with T2D. Researchers also identified 92,314 adults without diabetes with any WLM use (mean age 54 years, 79% women, 72% White) and 90,754 adults without diabetes with incident WLM use.

Results showed that among adults with T2D, the use of tirzepatide markedly increased from 4% to 12% of all GLM dispensed. Use of GLP-1 RAs and SGLT2 inhibitors rose as well, from 20% to 29% and 15% to 25%, respectively. This was paired with a decrease in dispensing of conventional GLMs such as metformin, sulfonylureas and insulin, although metformin and insulin were still the most initiated therapies.

Patterns were similar among incident users. Of note, in this population, one in five did not have evidence of another GLM dispensing claim in the previous year, which study authors John Ostrominski, MD, et al., note could signify a shift in first-line therapies. Tirzepatide uptake was driven by patients who were more likely to be young, female and White, from the South or Midwest, and with a higher BMI.

Trends in WLM dispensing were similar with those seen for GLM. Among individuals without diabetes, use of tirzepatide as WLM rose from 0% to 41%. Use of semaglutide 2.0 mg and semaglutide 2.4 mg rose from 38% to 46% and 0% to 32%, respectively. Use of all other WLMs decreased during the same period. Among incident users, by the end of 2023, tirzepatide surpassed all other WLMs at 31% of total dispensations.

Among individuals with T2D, incident use of tirzepatide was twofold higher and more sustained compared with GLP1 RAs throughout the 18 months after the drug was approved by the U.S. Food and Drug Administration.

"The rapid shifts in prescribing practice are likely multifactorial," write the authors, "potentially reflecting the combined influences of new evidence, increased recognition of the importance of excess or dysfunctional adiposity in T2D progression and guideline recommendations to individualize selection of GLMs according to patient profiles and priorities."

Tirzepatide had a similar uptake pattern for WLM, a shift the authors characterize as "rapid and profound," noting that it could "reflect increasing recognition of obesity as a disease."