Real-world effectiveness of tirzepatide among youth with type 2 diabetes and/or obesity: a multicenter analysis

Objectives Tirzepatide has demonstrated efficacy for adults and youth with type 2 diabetes (T2D) and adults with obesity, but real-world pediatric data remain limited. We evaluated clinical outcomes among youth prescribed tirzepatide across three academic centers. Methods We conducted a multicenter retrospective study of patients aged ≤21 years with T2D and/or obesity who initiated tirzepatide and had at least one follow-up visit. Primary outcomes were changes in hemoglobin A 1c (A 1C ), body mass index (BMI), BMI z-score, and weight at first and second follow-up. Results The cohort included 74 patients. Median age was 18.4 years, 45.9 % were female, 86.5 % had T2D, and 78.4 % had prior GLP-1 RA exposure. At first follow-up (median 102 days [IQR 74, 133]), BMI decreased from 42.7 to 42.0 kg/m 2 (n=69; p=0.003), BMI z-score from 2.9 to 2.8 (n=69; p<0.001), weight from 126.2 to 123.9 kg (n=69; p=0.001). In those with T2D, A 1C decreased from 8.0 % to 7.2 % (n=58; p<0.001) and basal insulin dose declined from 59.7 to 43.9 units/day (n=24; p=0.008). At second follow-up, A 1C , BMI, BMI z-score, and weight remained significantly lower than baseline. In multivariable regression analysis among patients with T2D, prior GLP-1 RA use and partial nonadherence were associated with smaller A 1C reductions, while higher baseline A 1C and higher tirzepatide dose were associated with greater A 1C reductions. Conclusions In this multicenter real-world cohort, tirzepatide use among youth with T2D and/or obesity was associated with reductions in BMI and, in those with T2D, reductions in A 1C despite prior GLP-1 RA exposure.