Mounjaro for type 2 diabetes

According to a new study presented at the 2022 American Diabetes Association (ADA) Scientific Sessions and covered in an article at MedPage Today, persons with new-onset macroalbuminuria (protein in the urine) may benefit from the type 2 diabetes medication Mounjaro (tirzepatide) more effectively.

Mounjaro is an injectable prescription medicine used in adults with type 2 diabetes mellitus to improve blood sugar (glucose) levels along with diet and exercise.


Clinical trials

Researchers evaluated the effects of taking Mounjaro or daily insulin glargine (a long-acting insulin) in persons with type 2 diabetes who were thought to be at higher risk for heart disease due to risk factors such as obesity or high blood pressure in the current trial. Participants were allocated to one of two treatments at random and monitored for up to 104 weeks.

During a maximum 104-week follow-up, those who were taking this glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide (GLP-1/GIP) agonist had a 41% lower risk for a composite kidney outcome, which included an eGFR decline of 40% or more, Kidney death, progression to end-stage kidney disease (ESRD), or new-onset macroalbuminuria.


The outcome

Titzepatide, however, only appeared to significantly lower the risk for new-onset macroalbuminuria, which is indicated by a urine albumin-creatinine ratio (UACR) more than 300 mg/g, by 59% (HR 0.41, 95% CI 0.26-0.66). At the American Diabetes Association (ADA) annual meeting, Heerspink said that the odds for renal mortality or an eGFR fall of 40% or more from baseline individually weren't substantially decreased.

Albuminuria had increased 56.7% in individuals receiving insulin glargine by week 104, whereas it had decreased 4.4% in those receiving tirzepatide. Notably, throughout the first 42 weeks of therapy, the tirzepatide group's albuminuria reduced by around 20% before stabilizing.

The ADA recommends GLP-1 receptor agonist therapy for individuals with diabetes and CKD Chronic kidney disease who are also at risk for cardiovascular disease and have an eGFR of less than 60 mL/min/1.73 m2. Patients with ESRD or late-stage CKD have also been found to be safe to utilize this class of medications.


Approval of Tirzepatide by the FDA

The FDA approved tirzepatide, which is recommended for people with type 2 diabetes and is based on the SURPASS clinical trial. It should be injected once a week, comes in three dose levels (5 mg, 10 mg, and 15 mg), and is recommended as a supplement to diet and exercise.

Tirzepatide was the subject of a landmark trial that was also presented at the ADA meeting and examined the drug's potential as a therapy for overweight or obese patients.