Can Weight-Loss Drugs Stop Prediabetes Becoming

How much did tirzepatide reduce progression from prediabetes to diabetes?

The extended SURMOUNT-1 trial provides direct evidence that treating obesity can delay diabetes in people already at elevated risk. The difference between groups was 12 percentage points. These results concern participants with both obesity and prediabetes; they should not be assumed to apply to everyone with mildly elevated blood sugar. [SURMOUNT-1 report](https://pubmed.ncbi.nlm.nih.gov/39536238/).

Durability remains an important question. After a further 17 weeks without assigned treatment, the proportions diagnosed with diabetes were 2.4% in the tirzepatide group and 13.7% in the placebo group. Protection therefore remained substantial over this short interval, but the findings do not establish lifelong prevention after stopping. The trial was funded by Eli Lilly, tirzepatide's manufacturer. [Trial findings and funding](https://pubmed.ncbi.nlm.nih.gov/39536238/).

Does semaglutide also lower the risk of developing diabetes?

SELECT studied adults aged 45 or older with overweight or obesity and established cardiovascular disease, without diabetes at enrollment. At week 156, biochemical diabetes had developed in 1.5% assigned to weekly semaglutide 2.4 mg versus 6.9% assigned to placebo. The analysis defined this outcome using HbA1c, a measure of longer-term blood glucose. [SELECT glycemia analysis](https://pubmed.ncbi.nlm.nih.gov/38907683/).

The distinction between lowering glucose and permanently changing disease progression matters. Researchers found that semaglutide initially lowered HbA1c, but subsequent upward glucose trends were similar between groups. Fewer people crossed the diabetes threshold during treatment, without evidence that the underlying rate of glycemic deterioration had slowed. SELECT and SURMOUNT-1 also enrolled different populations and used different outcome definitions, so their percentages cannot establish which drug prevents diabetes better. [Analysis and limitations](https://pubmed.ncbi.nlm.nih.gov/38907683/).

What should patients consider before using medication to reduce diabetes risk?

A diabetes-prevention finding is not itself a regulatory approval for treating prediabetes. When the FDA approved Zepbound, the tirzepatide brand for weight management, in November 2023, its adult indication covered obesity or overweight with at least one weight-related condition, alongside reduced-calorie eating and physical activity. Tirzepatide activates GIP and GLP-1 receptors to reduce appetite and food intake. [FDA approval announcement](https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management).

Benefits must be balanced against tolerability and medical history. Nausea, diarrhea, vomiting and constipation can occur; warnings also include pancreatitis and gallbladder problems. Tirzepatide should not be used by people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. A prescribing discussion should cover monitoring, dose escalation and an ongoing treatment plan. [FDA safety information](https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management).