Pharmacists Play Central Role in Optimizing Tirzepatide Use for Type 2 Diabetes

In a session at the American Pharmacists Association (APhA) Annual Meeting and Exposition 2026 in Los Angeles, California, Jennifer Goldman, PharmD, RPh, CDCES, BC-ADM, FCCP, a clinical pharmacist at Well Life Medical and professor of pharmacy practice at the Massachusetts College of Pharmacy and Health Sciences, emphasized the expanding role of pharmacists in helping patients with type 2 diabetes (T2D) initiate and succeed on tirzepatide (Mounjaro, Zepbound; Eli Lilly and Company) therapy, focusing on translating clinical trial data into real-world care.¹

Goldman’s session reviewed findings from the SURPASS clinical trial program while underscoring a key theme: pharmacists are uniquely positioned to improve outcomes through early intervention, patient education, and adverse effect management.¹

Early Intervention and Disease Progression

To begin the presentation, Goldman highlighted the progressive nature of T2D and the importance of timely treatment escalation. She highlighted that 36 million Americans have T2D, with its prevalence projected to increase further.¹

“[T2D]…is a progressive disease,” Goldman said. “We as pharmacists have an opportunity to make interventions, be it lifestyle or drug therapy.”¹

She noted that earlier treatment may help reduce long-term exposure to hyperglycemia and insulin resistance, which can drive complications over time. This aligns with guideline recommendations emphasizing individualized glycemic targets and early use of effective therapies to improve long-term outcomes.²

Emerging data from the ongoing SURPASS-EARLY trial (NCT05433584), which is evaluating patients within 4 years of diagnosis, suggest that earlier use of tirzepatide may result in greater reductions in hemoglobin A_1C (HbA_1C) and body weight compared with standard care.^1,3

Mechanism of Action Drives Clinical Outcomes

Tirzepatide is a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, a mechanism Goldman described as central to its clinical effects.¹

“When we are giving pharmacologic levels of GLP-1 and GIP with [tirzepatide], we are restoring the incretin effect. We slow gastric emptying. We tell the liver: ‘Don’t make glucagon anymore.’ So, we have improved insulin resistance and weight loss,” she explained.¹

By targeting both GIP and GLP-1 pathways, tirzepatide improves insulin secretion, reduces glucagon levels, and enhances satiety—mechanisms that contribute to both glycemic control and weight loss. Goldman emphasized that this dual mechanism may explain the consistent efficacy observed across the SURPASS program—specifically SURPASS-2 (NCT03987919)—where tirzepatide demonstrated significant reductions in HbA_1C and body weight compared with multiple comparators, including injectable semaglutide (Ozempic, Wegovy; Novo Nordisk).^1,4,5

SURPASS Program Demonstrates Consistent Efficacy, Tolerable Safety

Across SURPASS trials, tirzepatide showed robust improvements in glycemic control and weight outcomes. Goldman noted that reductions in HbA_1C exceeded 2% in some studies, with substantial weight loss observed across dose ranges.¹

In SURPASS-2, tirzepatide demonstrated greater reductions in HbA_1C and body weight compared with semaglutide, whereas SURPASS-5 (NCT04039503) showed that adding tirzepatide to basal insulin resulted in improved glycemic control and weight loss, despite insulin’s typical association with weight gain. She also highlighted pediatric data from the SURPASS-PEDS (NCT05260021) trial, in which tirzepatide significantly reduced HbA_1C and body mass index in patients 10 years and older.^1,4,6-9

Adverse Effect Management: A Key Pharmacist Role

Goldman stressed that gastrointestinal (GI) adverse effects (AEs) remain the most common barrier to treatment success, making pharmacist intervention critical.¹

“Don’t overeat…stop or go slow,” she said, describing how she counsels patients to adjust portion sizes to minimize nausea and other GI symptoms.¹

She emphasized a “start low, go slow” approach to dose escalation, along with proactive patient education on expected AEs such as nausea, diarrhea, and vomiting. These strategies are consistent with clinical recommendations for incretin-based therapies, where gradual titration improves tolerability and adherence.^1,2

Pharmacists can also identify and mitigate risks for hypoglycemia, particularly when tirzepatide is used in combination with insulin or sulfonylureas.¹

“This is something as pharmacists that we can have conversations with patients about,” Goldman explained. “Going slow is how we can mitigate some of those [adverse] effects.” Overall, she noted that the rates of treatment discontinuation in the SURPASS trials were low, which should give patients and pharmacists confidence about the tolerability of tirzepatide.¹

Practical Considerations for Initiation and Adherence

Beyond efficacy and safety, Goldman underscored the importance of hands-on patient education when initiating therapy, especially around injection counseling and ensuring patients are knowledgeable about the administration process.¹

“The one thing that I make sure, if I have a patient in front of me, is that they know how to use the device. If they mess this up, they can’t get another one,” she said, referring to the need for proper injection technique with the delivery device.¹

Pharmacists also play a key role in ensuring patients understand dosing schedules, titration, and administration steps, and in reinforcing adherence over time. Goldman highlighted counseling considerations such as managing missed doses, recognizing signs of serious adverse events (eg, pancreatitis), and addressing drug interactions, including the need for backup contraception when initiating therapy alongside oral contraceptives.¹

Translating Clinical Data Into Patient Care

As incretin-based therapies continue to evolve, Goldman emphasized that pharmacists can and must bridge the gap between clinical trial data and real-world patient care. From identifying appropriate candidates to managing adverse effects and supporting adherence, pharmacists are integral to optimizing outcomes with tirzepatide.¹

“Pharmacists are in a good position to help mitigate gastrointestinal [adverse] effects and help patients be successful,” Goldman said.¹

With the growing prevalence of T2D and increasing complexity of treatment options, these interventions may have a meaningful impact on long-term patient outcomes.¹

REFERENCES

1. Goldman J. Mounjaro (tirzepatide) presentation theater. Presented at: American Pharmacists Association Annual Meeting and Exposition 2026; March 29, 2026; Los Angeles, CA.

2. American Diabetes Association Professional Practice Committee. 9. Pharmacologic approaches to glycemic treatment: standards of care in diabetes—2025. Diabetes Care. 2025;48(suppl 1):S181-S206. doi:10.2337/dc25-S009

3. A study of tirzepatide compared with intensified conventional care in adult participants with type 2 diabetes (SURPASS-EARLY). ClinicalTrials.gov. Updated December 12, 2025. Accessed April 8, 2026. https://clinicaltrials.gov/study/NCT05433584

4. Lilly’s SURPASS-2 results published in the New England Journal of Medicine show tirzepatide achieved superior A1C and body weight reductions compared to injectable semaglutide in adults with type 2 diabetes. News release. Eli Lilly and Company. June 28, 2021. Accessed April 8, 2026. https://www.lilly.com/en-CA/news/press-releases/21.06.28-SURPASS-2-results-tirzepatide

5. A study of tirzepatide (LY3298176) versus semaglutide once weekly as add-on therapy to metformin in participants with type 2 diabetes (SURPASS-2). ClinicalTrials.gov. Updated February 14, 2022. Accessed April 8, 2026. https://clinicaltrials.gov/study/NCT03987919

6. A study of tirzepatide (LY3298176) versus placebo in patients with type 2 diabetes inadequately controlled on insulin glargine with or without metformin (SURPASS-5). ClinicalTrials.gov. Updated January 12, 2022. Accessed April 8, 2026. https://clinicaltrials.gov/study/NCT04039503

7. Dahl D, Onishi Y, Norwood P, et al. Effect of subcutaneous tirzepatide vs placebo added to titrated insulin glargine on glycemic control in patients with type 2 diabetes: the SURPASS-5 randomized clinical trial. JAMA. 2022;327(6):534-545. doi:10.1001/jama.2022.0078

8. A study of tirzepatide (LY3298176) in pediatric and adolescent participants with type 2 diabetes mellitus inadequately controlled with metformin or basal insulin or both (SURPASS-PEDS). ClinicalTrials.gov. Updated September 26, 2025. Accessed April 8, 2026. https://clinicaltrials.gov/study/NCT05260021

9. Hannon TS, Chao LC, Barrientos-Perez M, et al. Efficacy and safety of tirzepatide in children and adolescents with type 2 diabetes (SURPASS-PEDS): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2025;406(10511):1484-1496. doi:10.1016/S0140-6736(25)01774-X