Tirzepatide outcompetes long-acting insulin in managing type 2 diabetes: a meta-analysis of three phase 3 randomized controlled trials

Ala, M; Mohammad Jafari, R; Dehpour, AR; Poursalehian, M

doi:10.1038/s41366-024-01621-4

Type 2 & other diabetes

Tirzepatide outcompetes long-acting insulin in managing type 2 diabetes: a meta-analysis of three phase 3 randomized controlled trials

Int J Obes (Lond)Published 29 Aug 2024Systematic review and meta-analysis of randomised trials

Pooled result · HbA1cResultWMD −1.08 % 95% CI −1.37 to −0.78

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Authors' conclusion

Once-weekly tirzepatide can be a substitution for long-acting insulin in type 2 diabetes with a greater efficacy.

Study context

Population: Patients with T2D in RCTs (SURPASS-3, SURPASS-4, SURPASS-AP-Combo); PubMed, Web of Science, Scopus, Google Scholar searched to August 20, 2023
Participants: 4,339 patients3 RCTs

Comparison: Once-weekly tirzepatide vs daily long-acting insulin
Outcome: HbA1c

Pooled result

As reported in the abstract

WMD

−1.08 %

95% CI −1.37 to −0.78

Tirzepatidevs Insulin

WMD −1.08 % (95% CI −1.37 to −0.78)

Further pooled results

Outcome	← Lower with tirzepatide ←→ Higher with tirzepatide →	WMD (mg/dL) (95% CI)
2h-postprandial BS	−60−40−20020	−28.19 (−44.98 to −11.41)
Pre-meal BS	−60−40−20020	−11.86 (−22.83 to −0.9)
	−60−40−20020Difference, mg/dL (linear scale)

Outcome	← Lower with tirzepatide ←→ Higher with tirzepatide →	WMD (kg) (95% CI)
Body weight	−20−10010	−10.61 (−13.24 to −7.97)
	−20−10010Difference, kg (linear scale)

Outcome	← Lower with tirzepatide ←→ Higher with tirzepatide →	WMD (mmHg) (95% CI)
Systolic blood pressure	−10−505	−6.47 (−8.32 to −4.61)
Diastolic blood pressure	−10−505	−2.30 (−3.05 to −1.55)
	−10−505Difference, mmHg (linear scale)

Outcome	← Lower with tirzepatide ←→ Higher with tirzepatide →	WMD (%) (95% CI)
Total cholesterol	−20−10010	−4.78 (−7.05 to −2.50)
TG	−20−10010	−14.49 (−19.55 to −9.43)
LDL-C	−20−10010	−5.98 (−9.83 to −2.13)
VLDL cholesterol	−20−10010	−14.18 (−19.03 to −9.33)
	−20−10010Difference, % (linear scale)

Outcome	WMD (%) (95% CI)
HDL-CEstimate outside its printed CI	7.13 (−9.83 to −2.13)

Tirzepatide doses vs insulin

All doses of once-weekly tirzepatide (5 mg, 10 mg, 15 mg) were superior or non-inferior to insulin

Safety

Outcome	← Lower risk with tirzepatide ←→ Higher risk with tirzepatide →	RR (95% CI)
Hypoglycaemia (BS ≤ 70 mg/dL)	0.20.5125	0.46 (0.28–0.75)
	0.20.5125Relative risk (log scale)

Original publication

Tirzepatide outcompetes long-acting insulin in managing type 2 diabetes: a meta-analysis of three phase 3 randomized controlled trials. Int J Obes (Lond). Published 29 August 2024. doi:10.1038/s41366-024-01621-4

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