Clinical Feasibility of a Low-Dose Tirzepatide Strategy in Older Adults with Type 2 Diabetes: Persistence, Metabolic Benefit, and Treatment Simplification in a Real-World Cohort.

OBJECTIVE

To evaluate the clinical feasibility of a low-dose tirzepatide strategy in older adults with type 2 diabetes mellitus in routine outpatient practice.

METHODS

This single-center retrospective cohort included Japanese adults who initiated tirzepatide between April 2024 and December 2025 and received a maximum observed dose of ≤5 mg/week through week 28. The primary endpoint in adults aged ≥65 years combined treatment persistence, absence of adverse event (AE)-related discontinuation, and either ≥3% weight loss or an HbA1c reduction ≥1.0 percentage point (≥11 mmol/mol). Younger adults were contextual comparators using overlap weighting.

RESULTS

Among 122 tirzepatide initiators, 107 were included in the low-dose strategy cohort, including 37 older adults. The primary endpoint was achieved by 23/37 (62.2%); 33/37 (89.2%) remained on treatment, and 2/37 (5.4%) discontinued because of AEs. Median body weight change was -3.07%, median HbA1c change was -1.0 percentage point (-11 mmol/mol), and 19/37 (51.4%) achieved HbA1c <7.0% (<53 mmol/mol). Renal, hydration, and nutritional laboratory markers remained generally stable. Overlap-weighted comparisons showed no clear age-related attenuation.

CONCLUSION

In selected older adults, low-dose tirzepatide provided modest metabolic benefit with high persistence and infrequent AE-related discontinuation.