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June 24, 2024 — In an encouraging development for patients with type 2 diabetes, new research indicates that the diabetes medication tirzepatide (Mounjaro, Eli Lilly) may significantly reduce the risk of developing diabetic peripheral neuropathy (DPN). Presented at the Peripheral Nerve Society (PNS) 2024 Annual Meeting, this research suggests tirzepatide’s dual action on gastric inhibitory polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) receptors could offer protective benefits beyond its established efficacy in diabetes and obesity.
The study, conducted by a team from Charleston Area Medical Center Institute for Academic Medicine and West Virginia University, analyzed data from the TrinetX Global Health Research Network, encompassing over 1.7 million patients with type 2 diabetes. This large-scale analysis revealed that patients taking tirzepatide experienced a significantly lower risk of developing DPN over two years compared to those on insulin or other diabetes medications.
“In our propensity score-matched patients, tirzepatide cumulatively decreased the risk of developing diabetic peripheral neuropathy over 2 years from 4.8% to 3%,” reported Dr. Balqees Ara, the study’s lead investigator. Conversely, insulin use was associated with an increased risk, from 4.9% to 6.3% over the same period.
Statistical Power and Study Design
The study utilized de-identified electronic health records from 83 healthcare organizations. Patients were matched based on age, sex, race, body mass index, glucose levels, and A1c levels, and were followed for the development of new-onset DPN at intervals of one month, one year, and two years. Results showed that tirzepatide reduced the risk for DPN by 0.6%, 1.1%, and 1.8% at these respective time points, while insulin increased the risk by 0.2%, 1.4%, and 1.4%.
Dr. James Russell, the study’s principal investigator and professor of neurology, emphasized the robustness of these findings due to the study’s large sample size. He acknowledged the potential concerns regarding insulin, suggesting that while it is a vital treatment, it may not be the best option for all patients with diabetic neuropathy.
Potential Mechanisms and Broader Implications
The research team hypothesizes that tirzepatide’s benefits might extend beyond glycemic control, potentially involving direct effects on neuronal health. “Medications that work on the GIP and GLP-1 receptors, particularly the GIP receptors, affect neurons,” explained Dr. Russell, highlighting the broader implications of these findings. There is growing evidence that such medications might aid in regenerating hippocampal neurons and could offer protective benefits in conditions like Parkinson’s disease and Alzheimer’s disease.
Dr. Arun Krishnan, a neurologist and head of the Neuromuscular Disease Research Group at the University of New South Wales, corroborated these findings. His research supports the efficacy of GLP-1 receptor agonists in improving nerve morphology, clinical symptoms, and nerve conduction parameters, reinforcing the notion that DPN could become a treatable condition.
Side Effects and Comparisons
While tirzepatide shows promise, it is not without side effects, including nausea, vomiting, diarrhea, constipation, and epigastric pain. Dr. Ara noted that while these side effects were more common at six months, they did not differ significantly from those associated with other diabetes medications by the two-year mark.
Conclusion
This research opens new avenues for the treatment of diabetic peripheral neuropathy, a condition that imposes a substantial global burden. With the potential to reduce neuropathy disability worldwide, tirzepatide’s role in diabetes management might extend far beyond glycemic control, offering hope for improved quality of life for millions of patients.
Sources:
- Peripheral Nerve Society (PNS) 2024 Annual Meeting
- Charleston Area Medical Center Institute for Academic Medicine
- West Virginia University
