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Subgroup analysis finds tirzepatide superior to dulaglutide for HbA1c and weight in type 2 diabetesFor people struggling with diabetes on dulaglutide, could switching drugs help?

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Key Takeaway
Consider tirzepatide switch for T2D on dulaglutide, but interpret subgroup data cautiously.

This was a subgroup analysis of a phase IV, multicenter, multinational randomized controlled trial. The study population consisted of adults with type 2 diabetes (HbA1c 7.0% to 9.5%) who were on a stable dose of dulaglutide for at least 6 months. Participants were randomized to either switch to tirzepatide, escalated to 15 mg or maximum tolerated dose (MTD), or to continue and escalate dulaglutide to 4.5 mg or MTD, with follow-up at 40 weeks.

For the primary efficacy outcomes, reductions in HbA1c and body weight were significant and consistently greater with tirzepatide across all prespecified baseline subgroups, though specific effect sizes and absolute numbers were not reported. The analysis suggested HbA1c reduction was greater in subgroups with higher baseline HbA1c and lower baseline BMI, and weight reduction was greater in the non-Hispanic or non-Latino subgroup.

Regarding safety, nausea and diarrhea were the most frequently reported treatment-emergent adverse events across subgroups. The safety profile was similar across groups, and switching to tirzepatide was generally well-tolerated. Key limitations include the lack of reported specific effect sizes, p-values, confidence intervals, and sample sizes for the subgroup comparisons. The results are from a subgroup analysis, which is exploratory in nature.

Practice relevance is restrained; these results indicate switching to tirzepatide may be a clinical option across a range of baseline characteristics when treatment goals are not met with dulaglutide. Clinicians should await the full trial publication for precise efficacy and safety data to inform decision-making.

Imagine you're doing everything right with your weekly diabetes injection, but your blood sugar numbers still aren't where you want them to be. A new look at a clinical trial suggests that switching from one weekly drug, dulaglutide, to another, tirzepatide, could lead to better results. The analysis found that adults who made the switch saw greater reductions in their long-term blood sugar (HbA1c) and body weight after 40 weeks compared to those who stayed on and increased their dulaglutide dose. These benefits were seen across different groups of people, regardless of their starting weight or blood sugar level, though the improvement in blood sugar was a bit more pronounced for those who started with higher levels or a lower body mass index.

The study involved adults whose type 2 diabetes wasn't fully controlled on dulaglutide, even while taking other standard pills. They were randomly assigned to either switch to tirzepatide or continue with their current medication. It's important to note this is a 'subgroup analysis'—a deeper dive into existing trial data—and the report doesn't give us the specific numbers on how much better the improvements were. We don't know the exact drop in HbA1c percentage points or pounds lost for the average person.

In terms of safety, switching to tirzepatide was generally well-tolerated. The most common side effects were similar across all groups and included nausea and diarrhea, which is consistent with what's known about this class of drugs. The safety profile looked similar no matter a person's starting characteristics. This analysis points to switching as a potential next step when the first medication isn't hitting the mark, but patients and doctors will need the full picture, including precise benefit and risk numbers, to make the best individual decision.

What this means for you:
Switching diabetes drugs may improve blood sugar and weight, but the exact benefit isn't clear.

Study Details

Study typeRct
EvidenceLevel 2
Follow-up6.0 mo
PublishedMar 2026
View Original Abstract ↓
INTRODUCTION: In SURPASS-SWITCH, switching from dulaglutide to tirzepatide resulted in greater improvements in glycemic control and body weight in adults with type 2 diabetes (T2D). This study aimed to investigate the efficacy and safety of switching from weekly dulaglutide to weekly tirzepatide in adults with T2D in prespecified baseline subgroups from SURPASS-SWITCH. RESEARCH DESIGN AND METHODS: This phase IV, randomized, open-label, active-controlled, parallel-group, multicenter, multinational trial included adults with hemoglobin A1c (HbA1c) ≥7.0% to ≤9.5%, on a stable dose of dulaglutide for at least 6 months, on a stable dose of 0-3 oral antihyperglycemic medications for at least 3 months, with stable body weight, and body mass index (BMI) ≥25 kg/m at screening. Participants were randomly assigned 1:1 to continue with and escalate to dulaglutide 4.5 mg or maximum tolerated dose (MTD) or switch to tirzepatide with escalation to 15 mg or MTD. Changes from baseline in HbA1c and body weight at week 40 in baseline subgroups of age (<65, ≥65 years), HbA1c (≤8.5%, >8.5%), duration of T2D (≤5, >5 to ≤10, >10 years), baseline dulaglutide dose (0.75 mg, 1.5 mg), duration of dulaglutide dose (<1, ≥1 year), BMI (<27, ≥27; <30, ≥30 to <35, ≥35 kg/m), and ethnicity (Hispanic or Latino, non-Hispanic or non-Latino), and sex (female, male) were determined. RESULTS: Reductions in HbA1c and body weight at week 40 were significant and consistently greater with tirzepatide across all prespecified baseline subgroups. HbA1c reduction was greater in the subgroups with higher baseline HbA1c and low baseline BMI. Weight reduction was greater for participants in the non-Hispanic or non-Latino subgroup. The safety profile was similar across subgroups. Nausea and diarrhea were usually the most frequently reported treatment-emergent adverse events in each subgroup. CONCLUSIONS: In this subgroup analysis of SURPASS-SWITCH, switching to tirzepatide from dulaglutide was generally well-tolerated and associated with significant and consistent improvements in HbA1c and weight reductions versus dulaglutide across all baseline subgroups evaluated. These results indicate that switching to tirzepatide may provide a clinical option across a range of baseline characteristics when treatment goals are not being met with dulaglutide. TRIAL REGISTRATION NUMBER: NCT05564039.
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