European Journal of Cardiovascular Medicine

Obesity is a chronic disease that is becoming a major global health challenge.[1] It is now one of the most serious health concerns worldwide, associated with numerous medical and psychological conditions, including diabetes, which can increase disability and the risk of early death. [2,3]

Type 2 diabetes (T2DM) is a chronic and progressive metabolic disorder, making up 90–95% of all diabetes cases. It affects about 6059 per 100,000 diabetic patients, with men slightly more affected than women.[4] Being overweight or obese is a key risk factor for T2DM and has been linked to an increased risk of cardiovascular disease and mortality when compared to those with a healthy weight. Effective weight management can help lower the risk of heart-related complications and improve overall health outcomes. [5]

International guidelines now recommend a wide range of weight loss interventions to address obesity. [6-8] Several strategies are available from lifestyle modifications to surgical options.[2] The first-line approach involves behavioral changes, increased physical activity, and nutritional adjustments, such as following a low-calorie Mediterranean diet. [9,10] On the other end of the spectrum, bariatric surgery is a highly effective weight-loss method, but it is typically reserved for individuals with severe obesity (BMI ≥40 kg/m² or ≥35 kg/m² with obesity-related conditions), however, for Asian adults, the WHO recommends different BMI categories, including underweight (BMI < 18.5), normal weight (18.5–22.9), overweight (23.0–24.9), obesity class I (25.0–29.9), and obesity class II (BMI 30.0 and above).  [11,12,13] Despite its effectiveness, bariatric surgery carries risks and potential complications, and in many cases, is irreversible.[14,15]

Recently, a promising new drug called Tirzepatide (TZP) has emerged, which acts as a dual agonist of the glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptors. [16] Studies have shown that TZP can lead to a weight loss of up to 25% over 1.5 years. [16] Beyond weight reduction, Tirzepatide has been found to improve obesity-related conditions, including type 2 diabetes (T2DM), cardiovascular diseases (CVDs), non-alcoholic fatty liver disease (NAFLD), and obstructive sleep apnea syndrome (OSAS).[17-20]

However, TZP is not without adverse effects, primarily gastrointestinal issues such as nausea and diarrhea, which are the most commonly reported. [21] Additionally, when starting Tirzepatide, adjustments to insulin or insulin secretagogue doses (e.g., sulfonylureas) should be considered to avoid hypoglycemia. [22] With its strong weight loss potential and metabolic benefits, Tirzepatide is a great option for obesity management.

Therefore, in this study, we aimed to evaluate the impact of Tirzepatide on weight management, glycemic control, and cardiometabolic parameters in obese patients.

This retrospective observational study was conducted in the Department of Cardiology, Uttara Adhunik Medical College Hospital, Labaid Cancer Hospital & Super Speciality Centre, Labaid Diagnostics Center, Uttara, Dhaka, Bangladesh, from July 2024 to February 2025. In this study, we included 70 patients with obesity who attended the cardiology department of our institution.

These are the following criteria to be eligible for enrollment as our study participants: a) Patients aged above 18 years; b)Patients with obesity; c) Patients with DM, HTN, dyslipidemia, hypothyroidism & PCOS as comorbidity; d) Patients with Body Mass Index (BMI) ≥25 kg/m² along with obesity-related comorbidities) were included in the study and a) Patients with pregnancy; b) Patients showing any allergic reaction to study drug; c) Patients with any history of acute illness (e.g., renal or pancreatic diseases, ischemic heart disease, asthma etc.); d) Patients who were unwilling to participate were excluded from our study.

Drug Dosage: Patients received a Tirzepatide injection (Wikijet, manufactured by Aristopharma Ltd.) as follows: 2.5 mg pre-filled syringe once weekly for 4 weeks, followed by a 5 mg pre-filled syringe once weekly for another 4 weeks. Finally, a 7.5 mg pre-filled syringe was continued once weekly until the end of treatment.

Data Collection: Verbal consent was taken from the patients. Baseline Characteristics like age, sex, comorbidities, and medication history were collected by interviewing each patient, and the data of BMI, HbA1c, fasting blood sugar (FBS) & SGPT were collected from the blood test report of the patient.  The percentage change in body weight from baseline, reduction in HbA1c levels, changes in FBS, adverse effects, SGPT, and patients’ satisfaction levels after 8 months of treatment were evaluated.

Statistical Analysis: All data were recorded systematically in a pre-formatted data collection form. Quantitative data were expressed as mean and standard deviation; qualitative data were expressed as frequency distribution and percentage.  The data were analyzed using the t-test and chi-square (X²) test. A p-value <0.05 was considered significant. Statistical analysis was performed by using SPSS 22 (Statistical Package for Social Sciences) for Windows version 10. The study was approved by the ethical review committee of  Uttara Adhunik Medical College Hospital, Dhaka, Bangladesh.

Table 1: Baseline characteristics of our study subjects

Table 1 shows that the mean age of the participants was 31.73  ±10.24 years, with a majority being female (88.57%). The mean BMI of patients was 36.31±6.24 kg/m². Obesity classification shows that most participants fall into Class II obesity (58.57%), followed by Class I (41.43%). The mean SGPT level was 46.25 U/L (±26.47). Regarding comorbidities, 38.57% had hypertension, 31.43% had DM, 25.71% had hypothyroidism, 15.71% had dyslipidemia, and 10% had polycystic ovary syndrome (PCOS).  Most individuals (63.64%) had DM for over five years.

Table 2: Distribution of our study subjects by their treatment outcome

In Table 2, we found a significant reduction in body weight, with participants losing weight from 86.80 kg to 77.76 kg, reflecting an 8.7% decrease (p = 0.0001). BMI also decreased significantly, dropping from 36.31 kg/m² to 31.48 kg/m² (p < 0.0001). Fasting blood sugar decreased from 6.78 mmol/L to 5.63 mmol/L (p < 0.0001), and HbA1c levels dropped from 5.5% to 4.8% (p < 0.0001). Total cholesterol decreased from 181.7 mg/dL to 158.2 mg/dL (p = 0.0015), and LDL cholesterol showed a substantial reduction from 111.8 mg/dL to 82.8 mg/dL (p < 0.0001). HDL cholesterol elevated from 39.2 mg/dL to  48.4 mg/dL (p = 0.0005). Triglyceride levels also significantly reduced, dropping from 142.1 mg/dL to 119.2 mg/dL (p = 0.0426). There were 3(4.29%) patients with obstructive sleep apnea who got better after treatment.

Table 3: Distribution of our study subjects by adverse effects and their satisfaction level after treatment

Table 3 shows that the most common side effects were nausea and vomiting, experienced by 34.29% of participants, followed by itching at the injection site (30.00%), heartburn (27.14%), and general weakness (27.14%). Some participants also reported feeling feverish on the first day of injection (11.43%), while anorexia (5.71%), loose motion (5.71%), increased SGPT (5.71%), abdominal pain (4.29%), and body ache (4.29%) were less frequently observed. Despite receiving Wikijet (Tirzepatide) for their treatment, 6 cases (8.57%) still resulted in treatment failure.

Figure 1: Distribution of study patients by satisfaction level

This pie chart shows that most participants (62, 89%) reported being satisfied with the treatment. In contrast, a smaller portion, 8(11%) of participants expressed dissatisfaction.

In the present study, the mean age of the participants was 31.73  ±10.24 years, with a majority being female (88.57%). After receiving the treatment of TZP, we found the mean BMI of study patients was 31.48 ± 4.68 kg/m². A SURPASS J-mono study conducted in Japan by Yabe et al. included 48 participants with T2DM who received TZP at 5, 10, or 15 mg over a 52-week follow-up period. The study found that the mean age and BMI were 58.6 ± 7.5 years and 27.5 ± 3.5 kg/m², respectively. [23]

Gastaldelli et al. conducted a SURPASS-3 trial that included 296 T2DM participants who received TZP (5, 10, or 15 mg once a week ), and in their study, the mean age was 56.2 ± 9.8 years, and the mean BMI was 33.5 ± 4.8 kg/m². [19]

Zhao et al. conducted an RCT in China among 210 individuals with overweight or obesity who received subcutaneous 10 mg or 15 mg TZP or a placebo once a week, plus a lifestyle intervention, for 52 weeks. They found the mean age was 36.1 ± 9.1 years, and the mean BMI was 32.3 ± 3.8 kg/m². [24]

The weight loss observed in our study (8.7% reduction, p = 0.0001) is consistent with previous research. Yabe et al. reported significant reductions in fat mass across all TZP treatment groups in the SURPASS J-mono study, with the 10 mg and 15 mg doses demonstrating superior efficacy compared to dulaglutide.[23] Similarly, Jastreboff et al. showed that TZP treatment led to a greater reduction in waist circumference compared to placebo, with a 33.9% decrease in fat mass among participants receiving TZP versus an 8.2% reduction in the placebo group. [25] 

Akturk et al recently showed that tirzepatide use in adults with T1D led to a total body weight loss (TBWL) of 3.4%, 10.5%, and 10.1% at 3, 6, and 8 months of follow-up, respectively, with no further reduction in body weight after 6 months. [26]  Garg et al showed greater weight loss outcomes of 9.6%, 11.9%, 18.9%, and 18.5% at 3, 6, 9, and 12 months of follow-up, respectively, with a trend for a weight loss plateau after 9 months. [27] In general, the weight loss outcomes observed in the SURMOUNT-2 trial found that the proportions of participants achieving greater than 10%, 15%, and 20% TBWL at the end of the study were 65%, 48%, and 31%, respectively. [28] Gutierrez et al found that the proportions of patients achieving greater than 10%, 15%, and 20% TBWL are smaller because of the lower median time of follow-up. [29]

In the current study,  HbA1c levels dropped from 5.5% to 4.8% (p < 0.0001), with a decrease of 0.7% at 3 months of follow-up.  A study by Akturk et al found a decrease of HbA1c of 0.56% and 0.59% at 6 and 8 months of follow-up, respectively. [26] Garg et al reported a decrease of 0.8% and 0.7% at 9 and 12 months, respectively.[27] In comparison, Gutierrez et al show a higher decrease in HbA1c at 8 months of 0.9%. [29]

The metabolic benefits observed in our study align with findings from other randomized controlled trials. Gastaldelli et al. demonstrated a significant reduction in visceral adipose tissue (VAT) and subcutaneous adipose tissue (ASAT) in patients receiving TZP compared to those on insulin degludec, further supporting the role of TZP in improving body composition.[19] Additionally, Heise et al. found that participants on 15 mg TZP exhibited a significantly greater loss of fat mass compared to those receiving semaglutide or placebo, reinforcing TZP’s efficacy in reducing adiposity.[30]

Beyond weight loss, improvements in cardiovascular risk markers were also observed. In our study, total cholesterol, LDL cholesterol, and triglyceride levels showed substantial reductions, consistent with prior research. In a study by Gutierrez et al, Tirzepatide leads to a significant decrease in diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, and triglycerides. [29]

Despite its effectiveness, TZP treatment was associated with some adverse effects. The most common side effects reported were nausea (34.29%), itching at the injection site (30.00%), heartburn (27.14%), and general weakness (27.14%). However, all the adverse effects were mild and self corrected with no or little medication, paracetamol, ORS, and domperidone. Gutierrez et al found that 15(29.4%) patients reported at least one adverse effect, with the most common being nausea (13.7%). Three of 51 patients (5.9%) reported moderate to severe gastrointestinal symptoms that led to medication discontinuation, and 4 (7.8%) patients reported moderate gastrointestinal symptoms and also hypoglycemia; however, none required assistance or discontinuation. [29] Our findings align with those of Wadden et al., who noted similar gastrointestinal and injection-site reactions among participants. [31] However, the side effects of this study were generally mild to moderate and did not significantly impact treatment adherence, which resulted in an 89% satisfaction level among the participants.

Limitations of the study

This study had a small sample size due to the short study period. After evaluating those patients, we followed up with them for only 3 months and did not know other possible interference that may happen in the long term with these patients.

In this study, Tirzepatide has shown significant benefits in weight reduction, glycemic control, and lipid profile improvement among obese individuals. Participants experienced 8.7% decrease in body weight, along with some minor side effects, such as nausea, vomiting, and injection site reactions. Despite minor adverse effects, the majority of participants (89%) expressed satisfaction with the treatment. Therefore, Tirzepatide is an effective option for weight management and glycemic control in obese patients.

Further study with a prospective and longitudinal study design including a larger sample size and more duration of follow-up needs to be done to validate the findings of our study and also to maximize the clinical impact of  Tirzepatide.

Funding: Wikijet (Tirzepatide) manufactured by Aristopharma Ltd

Conflict of interest: The authors declare that this study was funded by Aristopharma Ltd., which provided support for the research through the use of Wikijet (Tirzepatide). However, the authors confirm that there are no other conflicts of interest related to this research.

Ethical approval: This study was approved by the ethical review committee

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