[Objectives] Using real‒time continuous glucose monitoring (rt‒CGM), we evaluated the effects of tirzepatide in patients with type 2 diabetes (T2D) undergoing hemodialysis (HD). [Subjects] Two male patients with T2D undergoing HD were included in this study. The first patient was a 75‒year‒old man (HD duration： 7 months, T2D duration： 33 years, BMI： 26.1 kg/m²). The second patient was a 60‒year‒old man (HD duration： 20 months, T2D duration： 5 years, BMI： 24.7 kg/m²). [Methods] We monitored blood glucose, glycated albumin (GA), and serum albumin (Alb) monthly before and after the initiation of tirzepatide. Additionally, rt‒CGM was utilized for four months to assess glycemic variability. [Results] Time in range (TIR) on rt‒CGM improved immediately after tirzepatide initiation without an increase in time below range (TBR). GA and insulin dosage also decreased. Furthermore, their BMI remained over 24 kg/m² and Alb was unchanged over the four‒month observation period. [Conclusion] In patients with T2D undergoing HD, tirzepatide demonstrated immediate glycemic benefits without compromising the nutritional status.