Can Zepbound prevent diabetes?

Zepbound® has been in the spotlight recently for promoting weight loss results that rival bariatric surgery. 

But now there’s evidence it may offer even more health benefits, especially when it comes to diabetes risk in those who are overweight. 

Findings of a three-year clinical study suggest Zepbound improves blood sugar control in people with obesity and prediabetes, reducing the risk of type 2 diabetes and other health complications. 

And that could be a game changer since nearly 90% of people who have diabetes also have a BMI of 25 or higher. 

What causes diabetes? 

There are two types of diabetes: types 1 and 2. Both types affect blood sugar levels and can cause hyperglycemia or high blood sugar. However, the way each type affects blood sugar is different. 

Typically diagnosed in children and young adults, type 1 diabetes is a chronic autoimmune disease with genetic and environmental components. In those with type 1 diabetes, the pancreas doesn’t make insulin or makes very little of it. (Insulin is a hormone that helps blood sugar—glucose—enter the body’s cells to be used later for energy.) In type 1 diabetes, the body’s immune system attacks beta cells in the pancreas, which are the cells that produce insulin. People with type 1 diabetes have to take insulin every day. 

Type 2 diabetes most often develops in those age 45 or older with excess weight or obesity. However, children, teens, and young adults are also at risk. People with type 2 diabetes produce insulin, but their bodies don’t respond properly to insulin. This condition is called insulin resistance. 

Insulin resistance is more likely to develop in people who have excess weight or obesity, although the reasons aren’t fully understood. One theory is that increased fat in the muscle cells disrupts the normal insulin signaling pathways and reduces the body’s’ ability to move sugar out of the bloodstream and into the cells. 

Research also suggests that people who store fat in their muscles and liver may have an increased risk for insulin resistance compared to those who store fat under the skin. Inflammation, which increases with weight gain, may also affect insulin resistance, and belly fat can contribute to chronic inflammation in the body. 

What is prediabetes?

As its name suggests, prediabetes is a condition that puts you at higher risk of diabetes and is often a precursor to type 2 diabetes. 

More than 1 in every 3 American adults has prediabetes, according to the U.S. Centers for Disease Control and Prevention (CDC). An estimated 5%-10% of people with prediabetes become diabetic every year. And up to 70% of those with prediabetes will eventually develop diabetes. 

A person with prediabetes may have impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Having IFG means that your blood sugar levels are higher than the normal range when you haven’t eaten for several hours. IGT means that, after you eat, your sugar levels increase more than they should. In both cases, your cells aren’t responding to insulin, or your body isn’t producing enough insulin to manage your sugar levels. 

People may be diagnosed with prediabetes if blood tests show they have one or more of the following: 

• A fasting blood sugar level of 100 to 125 mg/dL (vs. the normal range of 70 to 99 mg/dL);
• A blood sugar level of 140 to 199 mg/dL after drinking 75 grams of glucose for an oral glucose tolerance test (vs. the normal range of less than 140 mg/dL) or 
• A hemoglobin A1C level of 5.7% to 6.4%. (The A1C is a longer-term reading of your average blood sugar.)

Results above these ranges qualify as type 2 diabetes. 

Did the study show that Zepbound prevents type 2 diabetes? 

Not exactly, but for people who have prediabetes or have risk factors for developing prediabetes or diabetes, the study indicates Zepbound may be helpful. 

Zepbound contains the active ingredient tirzepatide, a dual agonist medication that helps with weight loss by stimulating the body’s GLP-1 and GIP hormone receptors. Stimulating these receptors causes the pancreas to produce more insulin and the body to produce less glucagon, which helps lower blood sugar levels. In addition, Zepbound slows digestion, which makes people feel full sooner and for longer. 

Because of its impact on blood glucose management, the U.S. Food and Drug Administration (FDA) approved tirzepatide as a treatment for type 2 diabetes in 2022 under the brand name Mounjaro®. Tirzepatide’s approval as the weight management medication Zepbound followed in 2023. 

Research published in the New England Journal of Medicine (NEJM) in November 2024 followed people taking either tirzepatide or a placebo for 193 weeks (more than three years). This study looked specifically at people who were diagnosed with obesity and prediabetes at the beginning of the study. 

Over the course of the study, 13.7% of people receiving a placebo developed type 2 diabetes, but nearly 97% of those who received tirzepatide did not. In addition, 81% of the participants who took tirzepatide had normal blood glucose levels at the end of the study, meaning they no longer had a diagnosis of prediabetes. 

The results of this study found that Zepbound may help reverse prediabetes, which in turn may delay or prevent type 2 diabetes and other risks that come with prolonged high blood glucose. Some of this benefit may be the result of achieving a healthy weight; research has shown that losing weight can help reverse prediabetes, especially when combined with lifestyle changes like healthy eating and increased physical activity. 

The NEJM study found that participants continued to have normal blood sugar 17 weeks after they stopped taking the medication. More research is needed to determine how long this health benefit will continue once treatment stops. Studies have shown that Zepbound also helps reduce the risk for other health issues associated with obesity and excess weight, including high blood pressure, cholesterol, obstructive sleep apnea, and cardiovascular disease. 

So, can Zepbound cure diabetes? 

Type 2 diabetes is usually considered a chronic, long-term condition. However, there is evidence that successful weight management can enable a person diagnosed with type 2 diabetes to maintain normal glucose levels over time. 

Some studies have found that weight loss, such as that achieved through bariatric surgery, may put type 2 diabetes into remission and decrease the need for medications for glucose management. Zepbound helps people achieve weight loss results similar to those with bariatric surgery, so it may also help those with type 2 diabetes. However, to continue receiving the health benefits of Zepbound, providers may recommend that patients continue taking the drug long-term. 

The weight loss people can achieve with Zepbound may delay the onset of type 2 diabetes. However, further research is still needed to determine if tirzepatide can help those with type 2 diabetes achieve remission. 

Does Zepbound have side effects? 

Zepbound can cause gastrointestinal side effects, including nausea, vomiting, diarrhea, or constipation. These may be mild and temporary as people adjust to the drug, but tell your health care provider if your symptoms are severe or persistent, as these may be signs of gastroparesis (stomach paralysis). 

Importantly, people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 should not take Zepbound. Do not take Zepbound if you have ever had thyroid cancer. Zepbound can cause fetal harm. If you are pregnant, breastfeeding, or planning to become pregnant, do not take Zepbound.  Find detailed side effect and risk information on our dedicated Zepbound page. 

Is Zepbound approved for prediabetes? 

Currently, no medications are FDA-approved to treat prediabetes. However, health care providers may prescribe drugs used to treat type 2 diabetes for those with prediabetes to help prevent the development of type 2 diabetes. 

At their discretion, your health care provider may prescribe Zepbound off-label to prevent type 2 diabetes if they determine it’s a good fit for you. Along with healthy food choices and exercise changes, Zepbound may be an important part of your diabetes prevention program. 

About Found

Found is among the largest medically-supported telehealth weight care clinics in the country, having served more than 250,000 members to date. To discover your MetabolicPrint™ and start your journey with Found, take our quiz. 

Found is not affiliated with Eli Lilly and Co., the owner of the registered trademark Zepbound®. This content does not provide medical advice and does not substitute for a consultation with a doctor or health care provider. While tirzepatide is effective for weight loss, it is not clinically appropriate for everyone. Eligibility for these drugs is based on a provider’s evaluation of your medical history. If tirzepatide is not appropriate for you, our providers will work with you to determine an effective medication for your health profile.