JAMA

Tirzepatide vs. insulin lispro in poorly controlled T2DM: Trial results

October 12, 2023

Among patients with inadequately controlled type 2 DM treated with basal insulin glargine, adding weekly tirzepatide reduced HbA1c and body weight with less hypoglycemia compared with adding prandial insulin lispro.

• The open-label, phase 3b SURPASS-6 enrolled 1,428 adults with type 2 diabetes taking basal insulin glargine. Participants were randomized in a 1:1:1:3 ratio to receive once-weekly SC injections of tirzepatide (5 mg [n = 243], 10 mg [n = 238], or 15 mg [n = 236]) or prandial tid insulin lispro (n = 708). Of the 1,428 randomized participants (57.7% women; mean age, 58.8 years; mean HbA1c, 8.8% ), 1,304 (91.3%) completed the trial.
• At week 52, estimated mean change from baseline in HbA1c with tirzepatide (pooled cohort) was −2.1% vs. −1.1% with insulin lispro, resulting in mean HbA1c levels of 6.7% vs. 7.7%; results met noninferiority criteria and statistical superiority was achieved. Estimated mean change from baseline in body weight was −9.0 kg with tirzepatide and 3.2 kg with insulin lispro. The percentage of participants achieving HbA1c <7.0% was 68% with tirzepatide vs. 36% with insulin lispro (odds ratio, 4.2; 95% confidence interval, 3.2-5.5).
• The most common adverse events with tirzepatide were mild to moderate GI symptoms (nausea: 14%-26%; diarrhea: 11%-15%; vomiting: 5%-13%). Rates of hypoglycemia events (blood glucose <54 mg/dL or severe hypoglycemia) were 0.4 per patient-year with tirzepatide (pooled) vs. 4.4 per patient-year with insulin lispro.

Source:

Rosenstock J, et al. (2023, October 3). JAMA. Tirzepatide vs Insulin Lispro Added to Basal Insulin in Type 2 Diabetes: The SURPASS-6 Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/37786396/