Comparison of cardiovascular outcomes between once‐weekly semaglutide and dulaglutide in adults with type 2 diabetes and established atherosclerotic cardiovascular disease in the United States
Main finding · 3-point MACEResult — go to the resultHazard ratio 0.78 95% CI 0.70–0.87Authors' conclusion
Among United States Medicare Optum CDM enrolees with T2D and ASCVD, semaglutide was associated with reduced risks of CV outcomes compared with dulaglutide. These results help to address an important evidence gap in selecting glucagon-like peptide-1 receptor agonists for this high-risk population.
Study context
- Population
- US adults ≥18 years with T2D and atherosclerotic cardiovascular disease (ASCVD), Optum CDM 2007–2024 (index 2018–2024); mean age 68.2 and 69.3 years (unweighted) in semaglutide and dulaglutide cohorts
- Participants
- 75,243 adults
- Exposure
- Once-weekly semaglutide vs dulaglutide
- Semaglutiden = 42,007
- Dulaglutiden = 33,236reference
- Outcome
- 3-point major adverse cardiovascular events (MACE):
- Stroke
- MI
- CV-related death
Methodological detailsentropy balancing, doubly robust Cox proportional hazards
- Entropy balancing
- Doubly robust Cox proportional hazards
Main finding
3-point MACE
Hazard ratio
0.78
95% CI 0.70–0.87
P < 0.001
By group
Semaglutidevs Dulaglutide
HR 0.78 (95% CI 0.70–0.87); P < 0.001
As reported in the abstract
Observational data: associations, not effects.
Original publication
Comparison of cardiovascular outcomes between once‐weekly semaglutide and dulaglutide in adults with type 2 diabetes and established atherosclerotic cardiovascular disease in the United States. Diabetes Obes Metab. Published 8 January 2026. doi:10.
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