1. BACKGROUND
Obesity is defined as excessive fat accumulation that adversely affects health. Body mass index (BMI) is commonly used to classify overweight (BMI ≥25) and obesity (BMI ≥30). Over one billion people worldwide are affected by obesity. 1 In the United Arab Emirates (UAE), 40.1% of adults are overweight and 27.8% are obese. 2 Among children, overweight and obesity prevalence is 22.3% and 18.9%, respectively. Excess weight is associated with cardiometabolic diseases, mechanical stress and psychosocial challenges. In the UAE, type 2 diabetes affects 19.3% of Emirati nationals and 12.4% of expatriates. 3 Weight loss through lifestyle changes, medication or surgery improves metabolic markers, with reductions >15% potentially leading to diabetes remission and lower mortality. 4 Recent advances in pharmacotherapy, particularly GLP‐1 receptor agonists (GLP‐1 RAs) and dual GLP‐1/GIP receptor agonists have led to significant weight loss. 5 Tirzepatide, a dual GLP‐1/GIP agonist, has demonstrated glycaemic efficacy and substantial weight loss in clinical trials. This study aims to assess weight changes, glycaemic effectiveness and cardiometabolic improvements in a multiethnic cohort using tirzepatide with and without type 2 diabetes in Dubai, UAE.
2. MATERIALS AND METHODS
2.1. Study design and eligibility criteria
This study was approved by the IRB of Mediclinic Middle East (MCME.CR.270.MCIT.2022) and the Dubai Health Authority (DSREC‐01/2023_15). Data were obtained retrospectively from the electronic medical records of five Mediclinic facilities (Parkview, City, Welcare, Dubai Mall, and Al Sufouh). We included adults (>18 years) who used tirzepatide between 1 August 2022 and 30 June 2024 and had at least 3 months of follow‐up. People under 18 or with type 1 diabetes were excluded.
2.2. Data collection
Demographic information (gender, nationality and age) and clinical parameters (height, weight, BMI, systolic and diastolic blood pressure, HbA1c, ALT, AST, LDL, HDL and triglycerides) were recorded. Comorbidities documented included type 2 diabetes, polycystic ovarian syndrome, metabolic dysfunction‐associated steatotic liver disease, obstructive sleep apnoea, hyperlipidaemia, high blood pressure, atherosclerotic cardiovascular disease and prediabetes. We also noted psychiatric medication use (anxiolytics, antidepressants and antipsychotics), history of bariatric surgery and previous use of any GLP‐1 agonists. The study also tracked the percentage of weight loss and adverse events during treatment.
2.3. Statistical analysis
Continuous variables are expressed as mean ± standard deviation and categorical variables as counts and percentages. Changes in outcomes (HbA1c, BP, BMI, LDL, HDL and triglycerides) were analysed using paired t tests, and associations between categorical variables were evaluated with chi‐squared tests. A two‐sided p value <0.05 was considered statistically significant. Data were analysed using SPSS 29.0.
2.4. Bias
Since only participants from selected Mediclinic Middle East branches were included, the findings may not be representative of all tirzepatide users in the UAE.
3. RESULTS
3.1. Baseline characteristics
In total, 3200 participants were assessed, and 532 participants (260 with diabetes, 272 without) were included for chart review. The mean age was 49.1 years (SD 10.3), and the mean BMI was 34.11 kg/m2. Our cohort was diverse, with 49.8% Arab, 17.5% South Asian, 11.1% African, 7.7% Caucasian, 5.5% Asian and 8.5% from other ethnic backgrounds. Common comorbidities included hypertension, hyperlipidaemia, ischaemic heart disease and metabolic dysfunction‐associated steatotic liver disease (Supplementary 1).
3.2. Primary end points
The baseline weight for all participants was 96.74 kg, with comparable weights between participants with and without diabetes (p = 0.157). At 6 months, the mean weight change across all participants was −10.7% (SD 7.8). Among those with diabetes, it was −7.9% (SD 6.6), compared to −13.8% (SD 7.9) in those without diabetes (p < 0.001) (Table 1).
TABLE 1.
Primary end points.
| All participants | Participants with diabetes | Participants without diabetes | Difference a | p‐Value | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| N = 532 | N = 260 | N = 272 | |||||||||
| Month 1 | Month 3 | Month 6 | Month 1 | Month 3 | Month 6 | Month 1 | Month 3 | Month 6 | |||
| Percentage change in weight from baseline, (%), mean (SD) | 3.7 (3.4) | 7.3 (5.9) | 10.7 (7.8) | 3.1 (3.3) | 5.7 (4.9) | 7.9 (6.6) | 4.2 (3.5) | 8.8 (6.4) | 13.8 (7.9) | 5.9 (0.7) | <0.001 |
| Participants with weight reduction ≥5%, (%) | 31.6 | 65.2 | 75.5 | 25.1 | 50.5 | 62.3 | 36.9 | 78.4 | 90.0 | 27.7 | <0.001 |
| Participants with weight reduction ≥10% (%) | 3.3 | 27.9 | 52.2 | 3.4 | 17 | 35.5 | 3.3 | 37.7 | 70.3 | 34.8 | <0.001 |
| Participants with weight reduction ≥15% (%) | 1.0 | 7.4 | 27.7 | 1.1 | 4.2 | 14.5 | 0.9 | 10.2 | 42.1 | 27.6 | <0.01 |
Data are the difference between parameters at month 6 between participants with and without diabetes.
Among people with diabetes, 35.5% lost ≥10% of weight, and 14.5% lost ≥15%, compared to 70.3% (p < 0.001) and 42.1% (p < 0.01) in people without diabetes, respectively. Overall, 62.3% of people with diabetes and 90.0% without diabetes achieved ≥5% weight loss (p < 0.001). The box plot illustrates the differences between both groups (Supplementary 2).
3.3. Secondary physiologic and metabolic marker end points
The baseline HbA1C of all participants was 6.46%, with a mean change in HbA1C in all participants of −1.02% (SD 1.28). There was a significant difference of 0.66% (SD 0.1, p < 0.001) at month 6 between people with and without diabetes (Table 2). The mean changes in systolic and diastolic blood pressure were −7.07 mmHg (SD 14.22) and −2.58 mmHg (SD 10.35), respectively, with no significant difference between people with and without diabetes.
TABLE 2.
Secondary physiologic and metabolic marker end points. a
| End point | All participants | Participants with diabetes | Participants without diabetes | Difference b | P‐Value | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| N = 532 | N = 260 | N = 272 | |||||||||
| Month 1 | Month 3 | Month 6 | Month 1 | Month 3 | Month 6 | Month 1 | Month 3 | Month 6 | |||
| Change in SBP from baseline (mmHg) | −5.17 (13.23) | −6.50 (14.04) | −7.07 (14.22) | −4.68 (13.95) | −6.31 (15.36) | −6.11 (15.58) | −5.56 (12.65) | −6.68 (12.75) | −8.13 (12.49) | 2.0 (1.3) | 0.141 |
| Change in DBP from baseline (mmHg) | −1.96 (10.23) | −2.36 (10.13) | −2.58 (10.35) | −1.86 (10.45) | −2.32 (10.07) | −2.88 (11.53) | −2.03 (10.08) | −2.39 (10.20) | −2.26 (8.89) | 0.62 (1.0) | 0.536 |
| Change in HbA1C from baseline (%) | NA | NA | −1.02 (1.28) | NA | NA | −1.19 (1.42) | NA | NA | −0.53 (0.49) | 0.66 (0.1) | <0.001 |
| Change in LDL from baseline (mmol/L) | NA | NA | −0.31 (1.23) | NA | NA | −0.19 (1.28) | NA | NA | −0.53 (1.10) | 0.330 (0.14) | 0.024 |
| Change in HDL from baseline (mmol/L) | NA | NA | 0.01 (0.24) | NA | NA | 0.03 (0.20) | NA | NA | −0.04 (0.29) | 0.069 (0.02) | 0.016 |
| Change in TG from baseline (mmol/L) | NA | NA | −0.33 (1.12) | NA | NA | −0.41 (1.26) | NA | NA | −0.19 (0.81) | 0.222 (0.13) | 0.098 |
| Change in ALT from baseline (IU/L) | NA | NA | −8.97 (20.99) | NA | NA | −8.86 (19.22) | NA | NA | −0.14 (23.54) | 0.281 (2.4) | 0.910 |
All parameters are presented as mean unless specified otherwise.
Data are the difference between changes in parameters at month 6 between participants with and without diabetes.
Other notable changes include mean change in LDL (−0.31 mmol/L, SD 1.23) in all participants with a significant difference of 0.33 mmol/L (SD 0.14) between both groups, p value of 0.024. HDL cholesterol increased by 0.01 mmol/L, SD 0.24 with a significant difference of 0.069 mmol/L between both groups, p value of 0.016.
Mean change in triglycerides was −0.33 mmol/L (SD 1.12), with no significant difference between people with and without diabetes, p value 0.098. Mean change in ALT levels was −8.97 U/L (SD 20.99), with no significant difference between the groups, p value 0.910.
3.4. Tirzepatide dosage
The mean weekly dose of tirzepatide incrementally increased monthly (Supplementary 3). At 6 months, people with diabetes received 7.3 mg (SD 4.4), and those without diabetes received 6.8 mg (SD 4.8), both below the recommended maximum dose (15 mg/week).
3.5. Subgroups—Post bariatric surgery and polycystic ovary syndrome
In participants with a prior history of bariatric surgery, the percentage change in weight from baseline was −13.8% (SD 7), with 47.1% achieving ≥15% weight loss. In participants with polycystic ovary syndrome, the percentage change in weight from baseline was −16.8% (SD 11.3), with 54.1% achieving ≥15% weight loss (Supplementary 4).
3.6. Adverse events
Few adverse events were recorded (Supplementary 5), with the most common being gastrointestinal symptoms. It is important to note that these data may be limited by incomplete documentation in clinical records.
4. CONCLUSIONS
Our study provides real‐world data on tirzepatide's effectiveness in a diverse multiethnic UAE cohort, including people with and without type 2 diabetes (T2DM). At 6 months, the average HbA1c reduction was 1.02%, with most participants on 5 or 7.5 mg doses (mean dose: 7.3 mg in people with type 2 diabetes, 6.8 mg in those without). This reduction is lower than the 1.9%–2.58% reported in the SURPASS trials, 6 , 7 which used higher doses and longer follow‐up periods. However, our findings align with other real‐world studies 8 and reinforce tirzepatide's effectiveness in glycaemic control. Weight loss in our cohort was substantial, with an overall average reduction of 10.7% at 6 months (7.9% in people with type 2 diabetes and 13.8% in those without), closely resembling results from the SURPASS trials. This suggests that tirzepatide remains effective in promoting weight loss, even at lower doses and over a shorter duration. The findings also support prior observational studies showing reductions of 10.1%–14.5% in 6 months, with some variations due to dosing differences. 9 Furthermore, meta‐analyses confirm tirzepatide's efficacy in diverse populations. Improvements in cardiometabolic parameters, including LDL, AST and ALT, were observed—findings that are consistent with results from recent clinical trials. 7 However, the reduction in systolic blood pressure was not statistically significant. These changes reflect broader findings from real‐world data and meta‐analyses. A subgroup analysis showed promising results in people with polycystic ovary syndrome, who experienced a 16.8% weight reduction despite 25.5% having type 2 diabetes. 10 Similarly, people with a history of bariatric surgery and weight regain lost 13.8% of their weight, supporting the use of GLP‐1 receptor agonists in managing weight regain. 11 Among users of psychiatric medications, weight loss was slightly lower (8.58%), consistent with prior studies suggesting a dampening effect of antidepressants on weight loss outcomes. 12 Our study strengthens the evidence for tirzepatide's role in weight and glycaemic management across a diverse population. However, its retrospective design, small sample size and short follow‐up period of 6 months limit long‐term conclusions. Further research is needed to assess sustainability, safety and the impact of tirzepatide on metabolic health over extended periods.
FUNDING INFORMATION
This research did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors.
CONFLICT OF INTEREST STATEMENT
MAS has served on ad‐hoc advisory boards and has received speaker honoraria from Eli Lilly.
PEER REVIEW
The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer‐review/10.1111/dom.16287.
Supporting information
Data S1. Supporting information.
ACKNOWLEDGEMENTS
The authors would like to thank MBRU for the financial support towards the article processing fee. [Correction added on 6 March 2025, after first online publication: An Acknowledgement statement has been added in this version.]
El Ghandour S, Akbarpoor F, Malik M, et al. Effect of tirzepatide on weight and metabolism in a multiethnic cohort with and without diabetes. Diabetes Obes Metab. 2025;27(5):2891‐2895. doi: 10.1111/dom.16287
Sara El Ghandour and Fatemeh Akbarpoor contributed equally to this study.
DATA AVAILABILITY STATEMENT
All the data collected in the study are included in the tables or supplementary material attached to the submission.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data S1. Supporting information.
Data Availability Statement
All the data collected in the study are included in the tables or supplementary material attached to the submission.