Introduction and Objective: Treatment of obesity and insulin resistance in Type 1 diabetes (T1D) is challenging. Recent small studies have shown benefits of Tirzepatide. We looked at the effects of incretins on clinical, biochemical and ambulatory glucose profile (AGP) in obese T1D individuals on hybrid closed loop (HCL) continuous subcutaneous insulin infusion (CSII). Methods: This is a retrospective study of 26 adults with T1D on HCL CSII using Incretins at a University Hospital, United Kingdom. All patients had BMI 30kg/m2. Data was collected from clinic records at baseline, 6 and 12 months and analysed with paired sample T-test and one-way ANOVA (SPSS). Primary outcomes were changes in weight, total daily insulin dose (TDD) and HbA1c. Secondary outcomes were clinical parameters and cardiovascular risk factors. Results: There were 18 females (69%) and 8 males (31%). Mean weight at baseline was 106kg, BMI 36 kg/m2, HbA1c 61.3 mmol/mol and TDD 77.3 units. 42% were on Medtronic MiniMed™780G SmartGuard™, 31% on Tandem t:slimX2™, 15% on Omnipod®5 SmartAdjust™, 12% on Ypsomed CamAPS®FX pump. 42% were on metformin and 8% on Dapagliflozin. At the end of the study, 25 patients were on Tirzepatide and 1 on Semaglutide. There was no discontinuation. Weight (-7.49 kg; p0.001), BMI (-2.7kg/m2, p0.001), TDD (-19.3 units, p0.001) reduced significantly at 6 months, but GMI (p=0.07), TIR (p=0.265) remained unchanged. Most benefits noted at 6 months sustained at 12 months, with improvement in HbA1c (10.2 mmol/mol; p0.05). Renal function, lipid profile and ophthalmologic assessment remained unchanged at 12 months and there was no diabetic ketoacidosis (DKA), supporting safety of this therapy. Conclusion: The main benefits of Tirzepatide were weight loss and insulin resistance, with a smaller beneficial effect on HbA1c. There were no safety concerns. All adults being on HCL with good baseline glycaemic parameters may be an explanation. Disclosure M.T. Younas: None. P.B. Kahraman: None. S. Bibi: None. S. Tripathi: None. K. Than Yu: None. A. Jones: None. V. Wilkes: None. N. Basavaraju: None. P.K. Moulik: None.
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