SURPASS-3: Tirzepatide proves better option than degludec for type 2 diabetes
medwireNews: The SURPASS-3 findings show that people with type 2 diabetes can obtain better glycemic control with tirzepatide than insulin degludec, while losing rather than gaining weight.
By the end of follow-up, after 52 weeks of treatment, people randomly assigned to take degludec had achieved a significant average 1.34 percentage point reduction in their glycated hemoglobin (HbA1c) level.
But those assigned to take tirzepatide had achieved average reductions of 1.93, 2.20, and 2.37 percentage points with the 5, 10, and 15 mg/week doses, respectively, all of which were significantly larger.
Up to 93% of participants taking tirzepatide achieved HbA1c levels below the 7.0% (53 mmol/mol) target, compared with 61% of those taking degludec, and the corresponding rates for the 5.7% (39 mmol/mol) target (ie, normalized glucose levels) were 48% versus 5%.
All 1437 participants of this study were taking metformin at baseline, with nearly a third also taking a sodium-glucose cotransporter 2 inhibitor, yet they had an average HbA1c level of 8.17% (66 mmol/mol). Their average diabetes duration was 8.4 years.
The 52-week follow-up included a 16-week insulin titration period and a tirzepatide dose-escalation period of up to 20 weeks, depending on the dose.
From an average starting bodyweight of 94.3 kg, people taking degludec gained an additional 2.3 kg during follow-up, but those taking tirzepatide 5, 10, and 15 mg lost 7.5, 10.7, and 12.9 kg, respectively.
Between 66% and 88% of people taking tirzepatide lost at least 5% of their baseline bodyweight, compared with 6% of those taking degludec, and 13–43% versus 0% lost at least 15%.
Furthermore, participants in the tirzepatide groups were significantly less likely to experience hypoglycemia (blood glucose <54 mgl/dL; 3.0 mmol/L) than those in the degludec group, at 1.1–2.2% versus 7.3%.
Tirzepatide is a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide (GLP)-1 receptor agonist. Consistent with the side-effect profile of GLP-1 receptor agonists, gastrointestinal complaints were the major issues in the tirzepatide groups, with nausea, diarrhea, and vomiting all occurring significantly more frequently than in the degludec group.
These occurred primarily during the dose-escalation phase, however, with the incidence being very low thereafter.
The SURPASS-3 findings were presented in the late-breaking poster session at the virtual ADA 81st Scientific Sessions, by Bernhard Ludvik (Karl Landsteiner Institute for Obesity and Metabolic Diseases, Vienna, Austria).
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