People with type 2 diabetes who were increased to semaglutide 2 mg were as likely to achieve an HbA1c less than 7% and more likely to achieve greater than 5% weight loss than those who were switched to tirzepatide, in real-world data
New real-world evidence suggests that adults with type 2 diabetes (T2D) who increased their semaglutide dosage from 1 mg to 2 mg had similar success rates in achieving recommended blood glucose levels, and were more likely to lose weight compared to those who switched to tirzepatide. This analysis included over 64,000 US adults and aimed to compare the outcomes of those who escalated their semaglutide dosage with those who transitioned to tirzepatide, which can be adjusted up to 15 mg.
The study, conducted on data from January 2018 to September 2025, indicated that by one year, 74.7% of patients on semaglutide 2 mg attained an HbA 1c level of less than 7%, which was comparable to the 75.1% of those who switched to tirzepatide. However, patients who escalated to semaglutide 2 mg had a statistically significant higher event rate for achieving weight loss of at least 5% compared to those who switched to tirzepatide.
Dr. Michael Radin, Executive Medical Director at Novo Nordisk Inc., noted that the analysis highlights an important clinical consideration for patients already on semaglutide therapy. He emphasized that escalating the dose may help patients meet their treatment goals without changing medications. This aligns with the American Diabetes Association guidelines recommending that many adults with T2D aim for an HbA 1c under 7% along with a 5% to 7% reduction in body weight.
The findings will be presented at the 2026 Scientific Sessions of the American Diabetes Association on June 7. Kathryn S. Tierney from Middlesex Health MultiSpecialty Group acknowledged the implications of these results for clinical practice, noting that patients might prefer to continue with semaglutide rather than start a new medication, given the potential for improved blood glucose and weight loss outcomes.
While recognizing the value of real-world study data, the analysis also acknowledged limitations, including the potential for unmeasured confounding and the exclusion of certain patient populations due to retrospective claims data. The COMPETE SWITCH study specifically looked at patients who had been prescribed semaglutide 1 mg and later received semaglutide 2 mg or tirzepatide 2.5 mg or 5 mg, assessing treatment outcomes from a real-world perspective.