Glycemia-based predictors of T2D development in adults with obesity and prediabetes: SURMOUNT-1 post hoc analysis

This post hoc analysis aimed to assess the predictive value of glycemia-based criteria for development of type 2 diabetes (T2D) among adults with obesity and prediabetes in the 3-year SURMOUNT-1 study.

We evaluated the sensitivity, specificity, and positive and negative predictive value of each of the following exploratory criteria for their ability to correctly identify incident T2D cases in the placebo group: oral glucose tolerance test (OGTT) 1-h glucose ≥155 mg/dL (≥8.6 mmol/L), fasting serum glucose (FSG) ≥ 110 mg/dL (≥6.1 mmol/L), and hemoglobin A1c (HbA1c) ≥ 6% (≥42.1 mmol/mol).

The OGTT 1-h glucose, FSG, and HbA1c based criteria, respectively, had a sensitivity of 0.83, 0.50, and 0.47; specificity of 0.25, 0.87, and 0.69; positive predictive value of 0.15, 0.37, and 0.19; and negative predictive value of 0.91, 0.92, and 0.90. Tirzepatide treatment was associated with a 90% to 99% reduction in new-onset T2D in the high-risk groups, vs 68% to 91% in the standard risk groups using the 3 different criteria.

In this post hoc analysis, we found that OGTT 1-h glucose ≥155 mg/dL (≥8.6 mmol/L) may be a useful criterion to better identify those at high risk of incident T2D. Tirzepatide treatment was highly effective in T2D prevention compared with placebo, regardless of the high-risk criteria used. These findings may guide in the identification of people in whom intensive therapies could be considered to prevent new-onset T2D.