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

Tirzepatide treatment was associated with modest reductions in BMI and, in those with type 2 diabetes, A1C in a real-world cohort of 74 youth seen at three academic centers, despite most having previously used a GLP-1 receptor agonist. The study was retrospective and uncontrolled, so confounding remains possible.

Journal article — Multicenter retrospective cohort study. Population: Youth ≤21 years with T2D and/or obesity at three academic centers who initiated tirzepatide. Sample size: 74 patients. Follow-up: Median 102 days to first follow-up (second follow-up timing not reported). Interventions: Tirzepatide.

At first follow-up (median 102 days), BMI decreased from 42.7 to 42.0 kg/m2 (n=69; p=0.003), BMI z-score decreased from 2.9 to 2.8 (n=69), and A1C decreased from 8.0% to 7.2% among patients with T2D (n=58). At second follow-up, A1C, BMI, BMI z-score, and weight remained significantly lower than baseline. In multivariable analysis among T2D patients, prior GLP-1 RA use and partial nonadherence were associated with smaller A1C reductions, while higher baseline A1C and higher tirzepatide dose were associated with greater A1C reductions.

This paper provides real-world evidence on tirzepatide in youth, supporting associations with short-term improvements in BMI and A1C even among those with prior GLP-1 RA exposure. It does not establish causal efficacy, long-term safety, or comparative effectiveness against other GLP-1 receptor agonists, and it gives no dosing recommendations.

Key findings

• BMI decreased from 42.7 to 42.0 kg/m2 at first follow-up (n=69; p=0.003).
• BMI z-score decreased from 2.9 to 2.8 (n=69).
• A1C decreased from 8.0% to 7.2% among patients with type 2 diabetes (n=58).
• At second follow-up, A1C, BMI, BMI z-score, and weight remained significantly lower than baseline.
• Among patients with T2D, prior GLP-1 RA use and partial nonadherence were associated with smaller A1C reductions, while higher baseline A1C and higher tirzepatide dose were associated with greater A1C reductions.
• The cohort included 74 patients; 86.5% had T2D and 78.4% had prior GLP-1 RA exposure.

Limitations

• Retrospective, uncontrolled design
• Small sample size (n=74) with missing data
• Limited generalizability (three academic centers)
• Short follow-up (median 102 days to first follow-up)

The record

• Journal: Journal of pediatric endocrinology & metabolism : JPEM
• Published: 2026-08-10
• PMID: 42576608 — DOI: 10.1515/jpem-2026-0335
• Author countries: USA

Peptide profiles: Tirzepatide.

All indexed evidence: Tirzepatide trials & papers.

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