Effects of the switch from dulaglutide to tirzepatide on glycemic control, body weight, and fatty liver: a retrospective study

Abstract

Objectives: Tirzepatide belongs to a new class of anti-diabetic agents that stimulate both glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide receptors, resulting in a greater blood glucose-lowering effect and body weight reduction than glucagon-like peptide-1 analogs. However, data on the effects of switching from glucagon-like peptide-1 analogs to tirzepatide on the blood glucose level, body weight, and liver functions are unavailable.

Methods: Data from 40 patients with type 2 diabetes who received a prescription change from dulaglutide to tirzepatide were retrospectively analyzed at the 3 and 6 months after the switch. The analyzed data included glycosylated hemoglobin, body weight, aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transpeptidase levels, and fibrosis-4 index.

Results: Six months after the treatment switch, average reductions of 1.2% and 3.6 kg were observed in the glycosylated hemoglobin and body weight, respectively. The change in glycosylated hemoglobin level was negatively correlated with the baseline glycosylated hemoglobin level. However, body weight reduction was observed regardless of the baseline characteristics. Moreover, the aspartate aminotransferase, alanine aminotransferase, and γ-glutamyl transpeptidase levels decreased 6 months after the switch. Reductions in alanine aminotransferase levels was greater in patients with higher baseline aspartate aminotransferase, alanine aminotransferase, and γ-glutamyl transpeptidase levels. Although the fibrosis-4 index did not improve during the study period, a trend toward a decrease was observed in patients with a higher baseline fibrosis-4 index.

Conclusions: Switching from dulaglutide to tirzepatide has a beneficial effect on the blood glucose level, body weight, and liver function in patients with type 2 diabetes.

Keywords: Dulaglutide; GIP; GLP-1; NAFLD; Tirzepatide; Type 2 diabetes.

Fig. 1

Changes in glycosylated hemoglobin levels (A) and body weight (B) 6 months after the switching from dulaglutide to tirzepatide. The P-values in this Figure are adjusted by the Bonferroni correction method. Data are shown as the mean ± standard error of the mean. ^*** P < 0.001

Fig. 2

Heat map summarizing the relation between the change in glycosylated hemoglobin, body weight, alanine aminotransferase, and fibrosis-4 index and baseline characteristics. Correlation coefficients (r) are shown in the relative boxes found at the intersection between the considered variables. Positive correlation coefficients are shown using red color, whereas negative correlations are shown using blue color. Darker colors represent greater correlation, and the lighter colors represent lesser correlation. ^* P < 0.05, ^** P < 0.01

Fig. 3

The main correlation factors between the change in each marker