{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T04:30:43Z","timestamp":1786681843890,"version":"build-2736575974"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Laparoscopic sleeve gastrectomy is an effective metabolic surgery; however, some patients experience weight regain and worsening of type 2 diabetes mellitus (T2DM) over the long term. Tirzepatide (TZP), a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, has demonstrated potent weight loss and glucose-lowering effects. This study evaluated the clinical outcomes of TZP treatment in patients facing weight regain and insufficient glycemic control after LSG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We performed a retrospective clinical analysis of three male patients with obesity-associated T2DM who developed significant weight regain and suboptimal glycemic control several years after undergoing LSG. Despite repeated nutritional counseling and behavioral modification, their conditions remained refractory. Following the initiation of weekly TZP treatment, all three patients achieved substantial weight reduction and significant improvements in HbA1c levels. Specifically, Case 1 achieved a total weight loss (%TWL) of 14.0% from the pre-LSG baseline (13.2% weight loss specifically from TZP initiation) over 12 months. Case 2 achieved a %TWL of 13.2% from the pre-LSG baseline (8.5% weight loss from TZP initiation) over 6 months. Case 3 achieved a %TWL of 27.3% from the pre-LSG baseline (28.7% weight loss from TZP initiation) over 9 months. Notably, all patients reached HbA1c levels below 6.0% (range: 5.2%\u20135.6%), surpassing the glycemic control achieved in the immediate postoperative period. TZP was well-tolerated, with only mild constipation reported as an adverse event.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>TZP may serve as a promising therapeutic option for managing weight regain and insufficient glycemic control in patients after metabolic bariatric surgery, potentially delaying or eliminating the need for complex revisional surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1895420","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T04:22:34Z","timestamp":1786681354000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical efficacy of tirzepatide for weight regain and suboptimal glycemic control following laparoscopic sleeve gastrectomy: a case series of three patients with obesity-associated type 2 diabetes"],"prefix":"10.3389","volume":"17","author":[{"given":"Midori","family":"Fujishiro","sequence":"first","affiliation":[{"name":"Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine","place":["Tokyo, Japan"]},{"name":"Department of Internal Medicine, Nihon University Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Hagiwara","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Nihon University Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arisa","family":"Nemoto","sequence":"additional","affiliation":[{"name":"Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatsumi","family":"Kuroyanagi","sequence":"additional","affiliation":[{"name":"Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maiko","family":"Nosoko","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Nihon University Hospital","place":["Tokyo, Japan"]},{"name":"Division of General Medicine, Department of Internal Medicine, Nihon University School of Medicine","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoko","family":"Okamura","sequence":"additional","affiliation":[{"name":"Department of Nutrition Management, Nihon University Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Urara","family":"Kon","sequence":"additional","affiliation":[{"name":"Department of Nutrition Management, Nihon University Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroko","family":"Uchida","sequence":"additional","affiliation":[{"name":"Department of Nutrition Management, Nihon University Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuhiko","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Nihon University Hospital","place":["Tokyo, Japan"]},{"name":"Division of General Medicine, Department of Internal Medicine, Nihon University School of Medicine","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisamitsu","family":"Ishihara","sequence":"additional","affiliation":[{"name":"Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1017\/s0021932003245508","article-title":"Obesity: preventing and managing the global epidemic. Report of a Who consultation","volume":"894","year":"2000","journal-title":"World Health Organ Tech Rep Ser"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/(sici)1520-6300(1996)8:6<786::aid-ajhb11>3.0.co;2-i","article-title":"Physical status: the use and interpretation of anthropometry. Report of a Who expert committee","volume":"854","year":"1995","journal-title":"World Health Organ Tech Rep Ser"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1253\/circj.66.987","article-title":"New criteria for 'obesity disease' in Japan","volume":"66","year":"2002","journal-title":"Circ J"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.EJ23-0593","article-title":"Definition, criteria, and core concepts of guidelines for the management of obesity disease in Japan","volume":"71","author":"Ogawa","year":"2024","journal-title":"Endocr J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.amjmed.2008.09.041","article-title":"Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis","volume":"122","author":"Buchwald","year":"2009","journal-title":"Am J Med"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(21)00591-2","article-title":"Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174\u2009772 participants","volume":"397","author":"Syn","year":"2021","journal-title":"Lancet"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-019-04210-x","article-title":"Definitions of long-term weight regain and their associations with clinical outcomes","volume":"30","author":"Voorwinde","year":"2020","journal-title":"Obes Surg"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-019-03734-6","article-title":"Weight regain after bariatric surgery-a multicentre study of 9617 patients from Indian Bariatric Surgery Outcome Reporting Group","volume":"29","author":"Baig","year":"2019","journal-title":"Obes Surg"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-016-2152-x","article-title":"Weight regain following sleeve gastrectomy-a systematic review","volume":"26","author":"Lauti","year":"2016","journal-title":"Obes Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1007\/s11695-023-06913-8","article-title":"Ifso consensus on definitions and clinical practice guidelines for obesity management-an international Delphi study","volume":"34","author":"Salminen","year":"2024","journal-title":"Obes Surg"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-019-04280-x","article-title":"Is revisional gastric bypass as effective as primary gastric bypass for weight loss and improvement of comorbidities","volume":"30","author":"Abdulrazzaq","year":"2020","journal-title":"Obes Surg"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-013-0888-0","article-title":"Revisional laparoscopic Roux-en-Y gastric bypass following failed laparoscopic adjustable gastric banding","volume":"23","author":"Jennings","year":"2013","journal-title":"Obes Surg"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.soard.2022.11.004","article-title":"Weight loss specific to indication, remission of diabetes, and short-term complications after sleeve gastrectomy conversion to Roux-en-Y gastric bypass: a systematic review and meta-analysis","volume":"19","author":"Fehervari","year":"2023","journal-title":"Surg Obes Relat Dis"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603827","article-title":"Liraglutide and cardiovascular outcomes in type 2 diabetes","volume":"375","author":"Marso","year":"2016","journal-title":"N Engl J Med"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1607141","article-title":"Semaglutide and cardiovascular outcomes in patients with type 2 diabetes","volume":"375","author":"Marso","year":"2016","journal-title":"N Engl J Med"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(19)30249-9","article-title":"Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials","volume":"7","author":"Kristensen","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.soard.2016.02.013","article-title":"Effectiveness and tolerability of liraglutide in patients with type 2 diabetes mellitus and obesity after bariatric surgery","volume":"12","author":"Gorgojo-Mart\u00ednez","year":"2016","journal-title":"Surg Obes Relat Dis"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(19)30157-3","article-title":"Adjunctive liraglutide treatment in patients with persistent or recurrent type 2 diabetes after metabolic surgery (GRAVITAS): a randomised, double-blind, placebo-controlled trial","volume":"7","author":"Miras","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2023.2930","article-title":"Safety and efficacy of liraglutide, 3.0 mg, once daily vs placebo in patients with poor weight loss following metabolic surgery: the BARI-OPTIMISE randomized clinical trial","volume":"158","author":"Mok","year":"2023","journal-title":"JAMA Surg"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-023-06484-8","article-title":"Efficacy of the glucagon-like peptide-1 receptor agonists liraglutide and semaglutide for the treatment of weight regain after bariatric surgery: a retrospective observational study","volume":"33","author":"Jensen","year":"2023","journal-title":"Obes Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1056\/NEJMoa2416394","article-title":"Tirzepatide as compared with semaglutide for the treatment of obesity","volume":"393","author":"Aronne","year":"2025","journal-title":"N Engl J Med"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-025-04102-x","article-title":"Cardiovascular outcomes of semaglutide and tirzepatide for patients with type 2 diabetes in clinical practice","volume":"32","author":"Kr\u00fcger","year":"2026","journal-title":"Nat Med"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-024-07137-0","article-title":"Semaglutide and tirzepatide for the management of weight recurrence after sleeve gastrectomy: a retrospective cohort study","volume":"34","author":"Jamal","year":"2024","journal-title":"Obes Surg"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3182a5034b","article-title":"Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus","volume":"258","author":"Brethauer","year":"2013","journal-title":"Ann Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"196","DOI":"10.23736\/s2724-6507.21.03311-3","article-title":"Pharmacological treatment of non-responders following bariatric surgery","volume":"49","author":"Vinciguerra","year":"2024","journal-title":"Minerva Endocrinol (Torino)"},{"key":"B26","doi-asserted-by":"publisher","first-page":"998","DOI":"10.2337\/dc22-1710","article-title":"Tirzepatide reduces appetite, energy intake, and fat mass in people with type 2 diabetes","volume":"46","author":"Heise","year":"2023","journal-title":"Diabetes Care"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-025-08358-7","article-title":"Shaping the future of restrictive bariatric surgery: clinical, economic, and long-term perspectives on endoscopic and laparoscopic sleeve","volume":"35","author":"Tripathi","year":"2025","journal-title":"Obes Surg"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(22)00243-1","article-title":"Effects of tirzepatide versus insulin glargine on kidney outcomes in type 2 diabetes in the SURPASS-4 trial: post-hoc analysis of an open-label, randomised, phase 3 trial","volume":"10","author":"Heerspink","year":"2022","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-1773","article-title":"Tirzepatide associated with reduced albuminuria in participants with type 2 diabetes: pooled post hoc analysis from the randomized active- and placebo-controlled SURPASS-1-5 clinical trials","volume":"48","author":"Apperloo","year":"2025","journal-title":"Diabetes Care"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1895420\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T04:22:35Z","timestamp":1786681355000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1895420\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":29,"alternative-id":["10.3389\/fendo.2026.1895420"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1895420","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,14]]},"article-number":"1895420"}}