Persistence-dependent effectiveness of tirzepatide on the cardio-metabolic-kidney syndrome outcomes in obesity : real-world evidence from the United Arab Emirates

Rangraze, Imran (author), El-Tanani, Mohamed (author), Janež, Andrej (author), Maggio, Viviana (author), Rabbani, Syed Arman (author), Jensterle Sever, Mojca (author), Munda, Ana (author), Abbas, Elhadi Eltayeb (author), Ali, Humam Sami (author), Farooqi, Mohammad Rashid (author), Patni, Mohamed Anas Faruk (author), Rizzo, Manfredi (author)

Introduction: Tirzepatide has been associated with significant reductions in body weight in randomized clinical trials. However, real-world evidence evaluating the multisystemic effects of tirzepatide across the cardio-metabolic-kidney (CKM) continuum remains limited. The aim of this study was to assess the real-world persistence-driven cumulative benefits of tirzepatide beyond weight reduction in adults with obesity but without type 2 diabetes mellitus (T2DM). Methods: This single-center observational cohort study evaluated in the United Arab Emirates adults with obesity (body mass index [BMI] ≥ 30 kg/m2) treated with tirzepatide. Participants were stratified by treatment persistence: ≤ 1 year (short-term) and > 1 year (long-term). Anthropometric, glycemic, lipid, hepatic, and renal outcomes were assessed at baseline and follow-up. Results: One hundred participants (25 women; mean age 37.6 ± 10.0 years; baseline BMI 35.0 [33.0-39.0] kg/m2) were included. Median weight reduction was - 8.1% in the short-term group and - 22.6% in the long-term group (p < 0.001). 62% of long-term treated individuals achieved > 15% weight loss versus 20% among short-term users. Significant between-group differences were observed in BMI (- 8.3% vs. - 19.1%), waist circumference (- 4.0% vs. - 9.2%), and glycated hemoglobin (HbA1c) (- 5.0% vs. - 7.2%). Total cholesterol decreased by - 10.1% vs. - 18.7% (p = 0.005), low-density lipoprotein cholesterol (LDL-C) by - 9.6% vs. - 30.5% (p < 0.001), and triglycerides by - 11.2% vs. - 32.5% (p < 0.001). Liver enzymes, aspartate aminotransferase (SGOT) and alanine aminotransferase (SGPT) declined by - 11.3% and - 13.2%, respectively, in long term group with no significant improvement in short term group (between-groups p values for both liver enzymes < 0.05). Serum creatinine declined significantly in the long-term group (- 6.6%, p < 0.001), estimated glomerular filtration rate (eGFR) increasing by + 3.2% (p = 0.001), and blood urea nitrogen (BUN) decreasing by - 7.8% (p = 0.006) while microalbuminuria showed no meaningful changes. Weight loss correlated with improvements in LDL-C, triglycerides, and SGOT, and inversely with high-density lipoprotein cholesterol (HDL-C) changes. Conclusions: Tirzepatide showed greater cumulative benefits across CKM syndrome outcomes during the second treatment year, highlighting the need to overcome adherence barriers in real-world settings.

• Language: English
• Keywords: cardio-metabolic-kidney syndrome, obesity, tirzepatide
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2026
• Number of pages: Str. 873-884
• Numbering: Vol. 17, iss. 6
• PID: 20.500.12556/RUL-185408
• UDC: 616.4
• ISSN on article: 1869-6961
• DOI: 10.1007/s13300-026-01868-2
• COBISS.SI-ID: 276566275
• Publication date in RUL: 04.08.2026

Record is a part of a journal

• Title: Diabetes therapy
• Shortened title: Diabetes ther.
• Publisher: Springer Nature
• ISSN: 1869-6961
• COBISS.SI-ID: 520452889

Licences

• License: CC BY-NC 4.0, Creative Commons Attribution-NonCommercial 4.0 International
• Link: http://creativecommons.org/licenses/by-nc/4.0/
• Description: A creative commons license that bans commercial use, but the users don’t have to license their derivative works on the same terms.

Secondary language

• Language: Slovenian
• Keywords: kardiometabolni ledvični sindrom, debelost, tirzepatid