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ForumsTirzepatide (Mounjaro / Zepbound)SURMOUNT-2: tirzepatide for T2DM + obesity — dual indication results Page 2

SURMOUNT-2: tirzepatide for T2DM + obesity — dual indication results

Dr.MetabolicMD Mon, May 25, 2026 at 6:35 AM 18 replies 466 viewsPage 2 of 4
quinn_sf
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San Francisco, CA
May 25, 2026 at 12:33 PM#6

Honestly lucas_SP_BR that's a pretty solid analogy. I'd add that one of the interesting things is that turning the GIP key really hard and constantly might actually be similar to breaking the GIP lock in certain tissues — which is the paradox Dr.MetabolicMD was asking about. But for a quick-and-dirty explanation, your version works great.

34 4tane_welly, Dr.PathRoch, mona_PHX and 31 others
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nancy_portland
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Aug 2024
Portland, ME
May 25, 2026 at 2:54 PM#7

Saving this entire thread for my pharmacology seminar presentation next month. This forum is better than half my textbooks tbh.

Thanks for that insight and everyone! 🧬

33 3KristenIndy, MarkLI_maint, Dr.PeteFamMed and 30 others
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DanielChem_CHI
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Mar 2024
Chicago, IL
May 25, 2026 at 5:16 PM#8

One additional point worth mentioning: tirzepatide isn't a 1:1 balanced agonist. It has approximately 5x greater affinity for GIPR vs GLP-1R. It's fundamentally a GIP agonist with meaningful GLP-1 activity, not the other way around. This was a deliberate design choice by Lilly's team based on the Finan et al. structure-activity relationship data.

The imbalanced agonism ratio is probably critical to the pharmacology — a perfectly balanced dual agonist might not produce the same results. Biology is about ratios, not just presence/absence.

This kind of rational drug design is what makes tirzepatide such a landmark molecule, regardless of how it compares to future drugs.

32 2patPC_UT, Dr.DermMIA, fiona_VT and 29 others
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