Tirzepatide - Diabetes Mellitus

In March 2024, the Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approved tirzepatide, a long-acting dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist for treating type 2 diabetes in line with the recommendations made in NICE TA924.  It was given a GREEN traffic light status for this indication.

At the October 2025 APC, it was agreed to remove any recommendations relating to preferred GLP-1 mimetics.

Dose titration for weight loss in diabetes:

The Surrey Heartlands Integrated Care System Area Prescribing Committee agree the following for the GLP1s (semaglutide, tirzepatide and liraglutide), when used for diabetes:

• Continue at 6 months only if HbA1c has reduced by at least 11mmol/mol (1%) and weight reduction of at least 3%
• Further dose titrations after 6 months should be in line with glycaemic control only, unless the patient meets the cohort criteria for weight management for

o   Semaglutide: joint-position-statement-on-medical-therapies-for-obesity_final-resubmitted-sfe-211223.pdf

o   Tirzepatide: PRN01879-interim-commissioning-guidance-implementation-of-the-nice-technology-appraisal-ta1026-and-the-NICE-fu.pdf

o   Liraglutide: 1 Recommendations | Liraglutide for managing overweight and obesity | Guidance | NICE