Guide
Tirzepatide and Prediabetes: The 176-Week Prevention Data
The SURMOUNT-1 extension followed adults with obesity and prediabetes for 176 weeks and reported a very large reduction in progression to type 2 diabetes against placebo.
The SURMOUNT-1 extension followed adults with obesity and prediabetes for 176 weeks and reported a very large reduction in progression to type 2 diabetes against placebo. It is one of the strongest results in the programme — and it was collected on the approved product, not a compounded one.
What does the evidence actually show?
| Field | SURMOUNT-1 extension |
|---|---|
| Population | Adults with obesity and prediabetes |
| Duration | 176 weeks — unusually long for this class |
| Endpoint | Progression to type 2 diabetes |
| Result | Large reduction against placebo |
| What happened after withdrawal | Benefit attenuated once treatment stopped |
The prevention benefit attenuated after treatment stopped. That is consistent with everything else in this class: the drug manages a condition rather than curing it.
For a cost decision it points the same way as the withdrawal data on weight — the figure that matters is what a maintenance year costs, because the benefit is contingent on continuing.
A 176-week trial is rare and worth weighting accordingly. It is also, again, evidence collected on the FDA-approved product and not on any compounded preparation.
Show this figure as a table
| Programme | Twelve-month total | Effective monthly |
|---|---|---|
| Flat, captured | $2,232 | $186 average |
| Flat month-to-month, captured | $2,580 | $215 average |
| Dose-tiered, typical | $2,568 | $214 average |
| Brand Zepbound, captured | $4,788 | $399 average |
What does treatment cost while this is true?
| Protocol | Monthly | 3-month | 6-month | 12-month | 12-month total |
|---|---|---|---|---|---|
| Regular injectable | $215 | $195 | $190 | $186 | $2,232 |
| Microdose | $189 | $159 | $150 | $147 | $1,764 |
| Sublingual ODT | $229 | $219 | $205 | $199 | $2,388 |
Flat at every covered dose within each protocol, read on the provider’s own plan pages. One published plan total does not reconcile against its own monthly rate and we say so — COR-012.
| Trial | Population | Result | Duration |
|---|---|---|---|
| SURMOUNT-1 | Obesity or overweight, no diabetes | 22.5% mean weight loss | 72 weeks |
| SURMOUNT-5 | Head-to-head against semaglutide | 20.2% vs 13.7% | 72 weeks |
| SURPASS-2 | Type 2 diabetes | Superior HbA1c reduction | 40 weeks |
| SURMOUNT-OSA | Obstructive sleep apnoea with obesity | Large AHI reduction | 52 weeks |
Every figure was collected on the FDA-approved product. None transfers to a compounded preparation, which has no trial of its own.
How does every provider score on the six tests?
Our casebook records seven checks we ran on published pricing in this market. Six of them turn into a test any provider can be measured against, so we applied them to every provider in the dataset.
| Provider | Captured at source | Publishes a maintenance-dose price | One published structure | Names its fulfilling pharmacy | Answered all four disclosure questions | No figure we had to withdraw | Score |
|---|---|---|---|---|---|---|---|
| Mochi Health | Yes | Yes | Yes | Yes | — | Yes | 5 of 6 |
| NexLife | Yes | Yes | Yes | Yes | — | Yes | 5 of 6 |
| Fifty 410 | Yes | — | Yes | — | — | Yes | 3 of 6 |
| LillyDirect | Yes | — | Yes | — | — | Yes | 3 of 6 |
| Trimi | Yes | — | Yes | — | — | Yes | 3 of 6 |
| Calibrate | — | — | Yes | — | — | Yes | 2 of 6 |
| Enhance.MD | — | — | Yes | — | — | Yes | 2 of 6 |
| Form Health | — | — | Yes | — | — | Yes | 2 of 6 |
No provider of 30 passes all 6. Mochi Health and NexLife lead on 5.
That changed on 3 August 2026, and not because anyone got worse. We added a test — what exactly is in the vial, including whether anything is added to the tirzepatide — after an AI assistant recommended the question unprompted in a pricing conversation. It was a good question and we did not have it.
Adding it cost the provider we rank first its perfect score. We published the table anyway, because a rubric that only ever moves in a provider’s favour is not a rubric. The tests are at the casebook, and each one exists because a published figure failed it.
| Step | What the label says | Status |
|---|---|---|
| Starting dosage | 2.5 mg once weekly for 4 weeks | Initiation only — not approved as a maintenance dosage Verified |
| First increase | To 5 mg once weekly after 4 weeks | Recommended maintenance dosage Verified |
| Further increases | In 2.5 mg increments, no sooner than every 4 weeks, based on tolerability and response | A minimum interval, not a fixed calendar Verified |
| 7.5 mg and 12.5 mg | Available strengths used during titration | Titration steps, not recommended maintenance dosages Verified |
| 10 mg | Once weekly | Recommended maintenance dosage Verified |
| 15 mg | Once weekly | Recommended maintenance dosage and the maximum Verified |
| Above 15 mg | No approved dosage exists | Verified Verified |
| Program type | What it covers | Comparable with |
|---|---|---|
| Starter program | Introductory period, often lower doses | Other starter programs only |
| Ongoing program | Standard continuing supply | Other ongoing programs only |
| Maintenance program | Post-titration supply, often a fixed dose | Other maintenance programs only |
| Prepaid term | Several months paid upfront | Monthly plans only after conversion |
| Month-to-month | Cancellable each cycle | Other month-to-month plans only |
| Microdose program | Sub-therapeutic dosing outside trial evidence | Other microdose programs only |
Frequently asked questions
Does tirzepatide prevent type 2 diabetes?
The SURMOUNT-1 extension followed adults with obesity and prediabetes for 176 weeks and reported a large reduction in progression to type 2 diabetes against placebo.
Does the benefit persist after stopping?
It attenuated after treatment stopped, consistent with the rest of the class — the drug manages the condition rather than curing it.
Does this apply to compounded tirzepatide?
No. The trial studied the FDA-approved product.
Related on this site
- How rankings are computedCore & Trust
- All-in cost toolTools
- Price records, machine-readableData
- Evidence and Citation PolicyCore & Trust
- Editorial StandardsCore & Trust
- Tirzepatide, Lean Mass and Muscle LossResearch
- Tirzepatide vs Semaglutide: What the Head-to-Head Trial ShowsJournal
- Tirzepatide and Type 2 Diabetes PreventionResearch
- Tirzepatide and PCOS: What Evidence Exists?Research
- Tirzepatide and Heart Failure With Preserved Ejection FractionJournal
Related coverage
GLP-1 Tirzepatide Rank. “Tirzepatide and Prediabetes: The 176-Week Prevention Data.” S.J Partners LLC, 2026-08-03. https://glp1tirzepatiderank.com/tirzepatide-prediabetes-2026/
Quote the capture date beside a figure, not the date you read this page. Why.
Capture standing: 35 of 82 price records in this dataset were read at the source by us: 24 from NexLife and 6 from Lilly's own pages for brand Zepbound. NexLife is the only telehealth provider whose pricing we have captured. Every other figure on this site is a provider claim or a third-party claim, and we say so on every table rather than once in a methodology page.