Tirzepatide as adjunct therapy in patients with type 1 diabetes: a systematic review and meta-analysis

Tirzepatide, a dual agonist of the glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1R) receptors, has demonstrated efficacy in glycemic control and weight loss in patients with Type 2 diabetes mellitus (T2DM). Its role as adjunctive therapy in individuals with Type 1 diabetes mellitus (T1DM), particularly those who are overweight or obese, remains underexplored. This review aims to evaluate the efficacy of tirzepatide as an adjunct to insulin therapy in adults with Type 1 diabetes mellitus (T1DM) and overweight or obesity, focusing on changes in glycemic control, body weight, body mass index (BMI), and insulin dose requirements.

A systematic review and meta-analysis, registered in PROSPERO (CRD42025633998), were conducted in accordance with PRISMA guidelines. Databases searched included PubMed, EMBASE, Web of Science, Scopus, and ClinicalTrials.gov. Risk of bias was assessed using ROBINS-I, and certainty of evidence was rated using GRADE. A random-effects model was applied.

Six observational studies, comprising 248 adults with Type 1 diabetes mellitus (T1DM) and overweight or obesity, were included. Tirzepatide adjunct therapy resulted in significant improvements across all major outcomes. HbA1c decreased by 0.61% [95% CI: - 0.69, - 0.52], body weight by 9.9 kg [95% CI: - 10.46, - 9.35], and BMI by 8.3 kg/m² [95% CI: - 9.92, - 7.31] at 6 months. Total daily insulin requirements declined by 23.73 IU/day [95% CI: - 25.36, - 22.11], with basal and bolus doses reduced by 8.71 IU/day [95% CI: - 9.09, - 8.33] and 15.02 IU/day [95% CI: - 15.59, - 14.46], respectively. The most common adverse effects were gastrointestinal symptoms (nausea, vomiting, loss of appetite).

Tirzepatide adjunct therapy demonstrates meaningful improvements in glycemic control, weight, and insulin requirements among adults with T1DM and obesity, without major safety concerns. Despite promising findings, the evidence is limited by the observational design and overlapping patient cohorts. Larger randomized controlled trials are warranted to confirm these results and define optimal dosing and long-term safety.

The online version contains supplementary material available at 10.1007/s40200-026-01880-0.