A multi-center, randomized, double-blind, placebo-controlled, parallel-group phase IV Study evaluating the effects of tirzepatide on atherosclerotic plaque progression assessed by coronary computed tomography angiography (CCTA) in participants with a diagnosis of type II Diabetes (T2DM) and atherosclerosis.

This is a multi-center study in which 120 male and female participants who meet the eligibility criteria will be randomized. Study will assess changes in coronary atheroma volume comparing tirzepatide 15 mg/week plus Standard of Care (SOC), as compared to placebo plus SOC. Potential eligible participants may be prescreened for eligibility prior to the screening visit and must have a diagnosis of atherosclerosis (as assessed by >10% atheroma on CCTA) and T2DM.

Patients must be on a stable medical regiment (>4 weeks on statin therapy and diabetes medications) and undergo screening CCTA to demonstrate coronary plaque. Participant eligibility will be assessed by the Imaging Core Lab.

If the participant meets all entry criteria during baseline visit, then consenting participants will be randomized 1:1 to receive tirzepatide on top of standard of care for treatment period of 12 months. Participants will be asked to maintain stable doses of statins and diabetes medications. Persistent hyperglycemia will be treated by primary physician or endocrinologist,

Inclusion Criteria:

1. Male or female 40 years to 80 years of age at signing of informed consent
2. Type 2 DM of minimum 5 years duration with HbA1c ≥7.0% to ≤10.5%
3. Body mass index (BMI) ≥25 kilograms per meter squared (kg/m²)
4. Presence of two discrete coronary artery plaques with visual diameter stenosis >20% on CCTA
5. At the baseline visit, participants must be on a stable (>4 weeks) regiment of diabetes medications.
6. Patients using oral hormonal contraceptives must switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation and for 4 weeks after each dose escalation

Exclusion Criteria:

1. Have had a major cardiovascular event within the last 60 days
2. Have type 1 diabetes mellitus
3. Current use of GLP1-RA
4. Have a history of severe hypoglycemia and/or hypoglycemia unawareness within the last 6 months
5. Are currently planning treatment for diabetic retinopathy and/or macular edema
6. Have history of, or currently planning a coronary, carotid, or peripheral artery revascularization (ie - stent, bypass)
7. Have a history of pancreatitis
8. Have a history of ketoacidosis or hyperosmolar state/coma
9. Have a known clinically significant gastric emptying abnormality, have undergone or currently planning any gastric outlet obstruction, or have undergone or currently planning any gastric bypass (bariatric) surgery or restrictive bariatric surgery
10. Have a history of an active or untreated malignancy or are in remission from a clinically significant malignancy for less than 5 years
11. Have a family or personal history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN-2)
12. Have had a blood transfusion or severe blood loss within 90 days prior to screening or have known hematological conditions that may interfere with HbA1c measurement
13. Planned or Prior Bypass surgery
14. Contradiction for CCTA (e.g. serious allergic reaction to the contrast dye) or CCTA not meeting entry standards after two attempts during the Baseline CCTA visit as assessed by the imaging core lab.
15. Uncontrolled severe hypertension: systolic blood pressure > 180 mmHg or diastolic BP > 100 mm Hg prior to randomization (assessed at the screening visit) despite antihypertensive therapy
16. Heart Failure NYHA Class III or IV at the screening visit
17. Renal insufficiency (eGFR <40 ml/min/1.73m2) as measured by the Modification of Diet in Renal Disease (MDRD) formula at the screening visit.
18. Hospitalization for major cardiovascular event including heart failure in the past 2 months

Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)