Who's Using Tirzepatide Without a Diabetes Diagnosis? A Look at 22,000 Americans

What the researchers found

Across two major US claims databases, 22,334 non-diabetic adults initiated tirzepatide between May 2021 and September 2023. Over 70% of users in both databases had at least one obesity-related complication (hypertension, dyslipidemia, or prediabetes). Most started at the 2.5 mg dose, with the most common doses at the sixth fill being 5 mg and 7.5 mg. Six-month persistence ranged from 60.6% to 75.7%, exceeding rates previously reported for GLP-1 receptor agonists. Among those who discontinued, 10-20% restarted during follow-up.

Why it matters

This study provides the first large-scale real-world snapshot of how tirzepatide is actually being used outside of diabetes. The high prevalence of obesity-related comorbidities suggests clinicians are prescribing it to patients with genuine cardiometabolic risk, not just for cosmetic weight loss. The strong persistence rates indicate patients are finding sustained benefit.

The numbers in context

22,334 total users; >70% with obesity complications; 60.6-75.7% persistence at 6 months; 10.2-19.5% restart rate; most common doses at 6th fill: 5 mg and 7.5 mg

How the study worked

Retrospective observational study using MarketScan Commercial and Optum Clinformatics claims databases. Included adults ≥18 with at least one tirzepatide claim, no type 2 diabetes diagnosis, and 12 months of continuous enrollment before first tirzepatide claim. Persistence and dosing patterns assessed at 6 months.

Who was studied

22,334 US adults without type 2 diabetes who initiated tirzepatide (15,534 from MarketScan, 6,800 from Optum CDM; >70% female; mean ages 46.2 and 55.9 years)

What this study cannot tell us

Claims data cannot capture clinical outcomes like actual weight loss or cardiometabolic improvements. The study period preceded FDA approval of tirzepatide for weight management (as Zepbound), so some use may have been off-label. Insurance claims may not reflect total use including self-pay patients. No comparison group.

How to read the evidence

A large retrospective claims analysis (n=22,334) from two major US databases. While the sample size is substantial, claims data cannot capture clinical outcomes, and the observational design limits causal conclusions.

When this study was published

Published in 2025 with data through September 2023. This captures early adoption patterns before tirzepatide's obesity-specific approval as Zepbound.

The bigger picture

Tirzepatide's rapid adoption for weight management — even before its obesity indication was approved — reflects the enormous demand for effective GLP-1-based weight loss drugs. This study confirms that most non-diabetic users have genuine cardiometabolic risk factors, and the high persistence suggests the drug is delivering on patient expectations better than earlier options.

Questions still open

• What actual weight loss and cardiometabolic outcomes are these non-diabetic tirzepatide users achieving in the real world?
• How do persistence rates change beyond 6 months, and what drives discontinuation?
• How has prescribing changed since Zepbound (tirzepatide for obesity) received FDA approval?

Common questions

Read the original research

Characteristics and Treatment Patterns of People Without Type 2 Diabetes Diagnoses Who Use Tirzepatide in the United States.

Clinical therapeutics, 47(8), 572-580

Citation

Gibble, Theresa Hunter; Hankosky, Emily R; Meeks, Alexandra; Liao, Birong; Ward, Jennifer; Huang, Ahong; Chinthammit, Chanadda. (2025). Characteristics and Treatment Patterns of People Without Type 2 Diabetes Diagnoses Who Use Tirzepatide in the United States.. Clinical therapeutics, 47(8), 572-580. https://doi.org/10.1016/j.clinthera.2025.05.003