A Retrospective Chart Review of Tirzepatide and Semaglutide Use in Prediabetes Management and Cardiometabolic Outcomes in a Rural Primary Care Setting.

Background: Prediabetes and obesity are highly prevalent conditions associated with increased risk of progression to type 2 diabetes (T2DM) and cardiovascular disease. While clinical trials demonstrate the efficacy of glucagon-like peptide-1 and dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonists, limited evidence exists in routine primary care, particularly in rural populations. Objective: This review aimed to examine associations between tirzepatide and semaglutide use and changes in glycemic status and cardiometabolic risk factors among rural-dwelling adults with prediabetes treated in a single rural primary care clinic. Methods: A retrospective chart review was conducted among 40 adults with prediabetes and overweight or obesity treated for 3-24 months with semaglutide or tirzepatide. Primary outcomes included body mass index (BMI) and hemoglobin (A1c). Secondary variables included blood pressure (BP), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides. Results: Significant improvements were observed in A1c, BMI, systolic and diastolic BP, LDL, and triglycerides (p < .001). All participants achieved normoglycemic A1c levels. No significant changes were observed in HDL levels. Conclusions: In this rural primary care setting, treatment with tirzepatide or semaglutide was associated with improvements in glycemic control and cardiometabolic risk factors. Findings should be interpreted cautiously due to the observational design and potential confounding factors. Implications for Nursing: Nurse practitioners are positioned to advocate for and implement pharmacological therapies for early management of prediabetes. Providers can drive meaningful changes in T2DM prevention and cardiometabolic health optimization.