Real-world clinical outcomes of tirzepatide administration in older patients with type 2 diabetes, with a focus on the risk of hypoglycemia and weight loss-related parameters
Abstract
In an aging society, the establishment of safe and effective treatment strategies for older patients with type 2 diabetes is crucial. We performed a secondary analysis of the Hokkaido-TZP study (UMIN000056962), evaluating the real-world outcomes of tirzepatide in patients aged ≥65 years. Of 213 patients in the safety analysis set, 11 (5.2%) discontinued treatment because of adverse events, primarily gastrointestinal symptoms. In the effectiveness analysis set (n = 199; mean age 71.3 years, glycated hemoglobin [HbA1c] 7.79%), tirzepatide significantly reduced both HbA1c and body mass index over 6 months in the Young-old (65-74 years) and Old-old (≥75 years) groups. Notably, even among the 148 patients (74.4%) using agents associated with a risk of hypoglycemia (insulin, sulfonylureas, or glinides) at baseline, a substantial proportion (66.9%) achieved an HbA1c <7.0%. The physicians proactively adjusted these concomitant medications in 39.2% of users, but despite these preemptive reductions, this subgroup still achieved a reduction in HbA1c comparable to that of the entire cohort, and no severe hypoglycemia was reported. A significant reduction in body weight occurred, and this was more pronounced in glucagon-like peptide-1 receptor agonist-naïve patients and those taking fewer hypoglycemia-inducing agents. Furthermore, the tirzepatide dose tended to be lower in the patients who achieved greater weight loss. These findings suggest that although tirzepatide is highly effective, even in older adults, its safety must be optimized through preemptive reductions in the doses of concomitantly administered secretagogues and careful monitoring, to prevent excessive reductions in HbA1c and weight loss in this vulnerable population.
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BibTeX
@article{kitsunai2026realworld,
title = {{Real-world clinical outcomes of tirzepatide administration in older patients with type 2 diabetes, with a focus on the risk of hypoglycemia and weight loss-related parameters}},
author = {Hiroya Kitsunai and Fumika Maruyama and Yukie Miyano and Tomoe Abe and Hiroyoshi Kurihara and Ken Tsuji and Atsuko Abiko and Yoshihiro Miyamoto and Reiko Homma and Akinobu Nakamura and Hiroshi Nomoto and The Hokkaido-TZP Study Group},
journal = {Endocrine Journal},
year = {2026},
month = jul,
doi = {10.1507/endocrj.ej26-0246},
url = {https://www.jstage.jst.go.jp/article/endocrj/advpub/0/advpub_EJ26-0246/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Real-world clinical outcomes of tirzepatide administration in older patients with type 2 diabetes, with a focus on the risk of hypoglycemia and weight loss-related parameters
AU - Hiroya Kitsunai
AU - Fumika Maruyama
AU - Yukie Miyano
AU - Tomoe Abe
AU - Hiroyoshi Kurihara
AU - Ken Tsuji
AU - Atsuko Abiko
AU - Yoshihiro Miyamoto
AU - Reiko Homma
AU - Akinobu Nakamura
AU - Hiroshi Nomoto
AU - The Hokkaido-TZP Study Group
PY - 2026
DA - 2026/07/14
JO - Endocrine Journal
DO - 10.1507/endocrj.ej26-0246
UR - https://www.jstage.jst.go.jp/article/endocrj/advpub/0/advpub_EJ26-0246/_article
AB - In an aging society, the establishment of safe and effective treatment strategies for older patients with type 2 diabetes is crucial. We performed a secondary analysis of the Hokkaido-TZP study (UMIN000056962), evaluating the real-world outcomes of tirzepatide in patients aged ≥65 years. Of 213 patients in the safety analysis set, 11 (5.2%) discontinued treatment because of adverse events, primarily gastrointestinal symptoms. In the effectiveness analysis set (n = 199; mean age 71.3 years, glycated hemoglobin [HbA1c] 7.79%), tirzepatide significantly reduced both HbA1c and body mass index over 6 months in the Young-old (65-74 years) and Old-old (≥75 years) groups. Notably, even among the 148 patients (74.4%) using agents associated with a risk of hypoglycemia (insulin, sulfonylureas, or glinides) at baseline, a substantial proportion (66.9%) achieved an HbA1c <7.0%. The physicians proactively adjusted these concomitant medications in 39.2% of users, but despite these preemptive reductions, this subgroup still achieved a reduction in HbA1c comparable to that of the entire cohort, and no severe hypoglycemia was reported. A significant reduction in body weight occurred, and this was more pronounced in glucagon-like peptide-1 receptor agonist-naïve patients and those taking fewer hypoglycemia-inducing agents. Furthermore, the tirzepatide dose tended to be lower in the patients who achieved greater weight loss. These findings suggest that although tirzepatide is highly effective, even in older adults, its safety must be optimized through preemptive reductions in the doses of concomitantly administered secretagogues and careful monitoring, to prevent excessive reductions in HbA1c and weight loss in this vulnerable population.
SN - 1348-4540
SN - 0918-8959
ER -