Effects of Tirzepatide Versus Basal Insulins in People With Type 2 Diabetes and Different Baseline Glycemic Patterns: Post Hoc Analyses of the SURPASS-3 and SURPASS-4 Trials

Abstract

Objective: This post hoc analysis assessed change from baseline to week 52 in glycemic parameters for tirzepatide (5, 10, 15 mg) versus insulin degludec (SURPASS-3 trial) and glargine (SURPASS-4 trial) in people with type 2 diabetes and different baseline glycemic patterns, based on fasting serum glucose (FSG) and postprandial glucose (PPG) values.

Research design and methods: Participant subgroups with low FSG/low PPG, low FSG/high PPG, high FSG/low PPG, and high FSG/high PPG were defined according to the median values of these measures.

Results: All tirzepatide doses and basal insulins were associated with decreased HbA1c, FSG, and PPG values from baseline to week 52 in all subgroups (P < 0.05). Within each subgroup, HbA1c and PPG decreases were greater with tirzepatide than insulin (P < 0.05). FSG decreases were generally similar. There were no differential treatment effects by FSG/PPG subgroup.

Conclusions: In this post hoc analysis, tirzepatide was associated with superior glycemic control compared with insulin, irrespective of baseline glycemic pattern.

Graphical abstract

Figure 1

Change from baseline in HbA_1c at 52 weeks by subgroups in (A) SURPASS-3 and (B) SURPASS-4. Data are presented as the mean at baseline and least-squares mean (SE) from the modified intent-to-treat population efficacy analysis set with both a PPG and FSG value at baseline. *P < 0.05 vs. baseline and †P < 0.05 vs. insulin degludec or glargine. PPG data are given as the 2-h postmeal daily mean. n, number of individuals in the population with baseline and postbaseline values at week 52.

Figure 2

Change from baseline in FSG at 52 weeks by subgroups in (A) SURPASS-3 and (B) SURPASS-4. Data are presented as the mean at baseline and least-squares mean (SE) from the modified intent-to-treat population efficacy analysis set with both a PPG and FSG value at baseline. *P < 0.05 vs. baseline and †P < 0.05 vs. insulin degludec or glargine. PPG data reported as 2-h postmeal daily means. n, number of individuals in the population with baseline and postbaseline values at week 52.

Figure 3

Change from baseline in PPG at 52 weeks by subgroups in (A) SURPASS-3 and (B) SURPASS-4. Data are presented as the mean at baseline and least-squares mean (SE) from the modified intent-to-treat population efficacy analysis set with both a PPG and FSG value at baseline. *P < 0.05 vs. baseline and †P < 0.05 vs. insulin degludec or glargine. PPG data are reported as the 2-h postmeal daily means. n, number of individuals in the population with baseline and postbaseline values at week 52.

Figure 4

Change from baseline in body weight at 52 weeks by subgroups in (A) SURPASS-3 and (B) SURPASS-4. Data are presented as the mean at baseline and least-squares mean (SE) from the modified intent-to-treat population efficacy analysis set with both a PPG and FSG value at baseline. *P < 0.05 vs. baseline and †P < 0.05 vs. insulin degludec or glargine. n, number of individuals in the population with baseline and postbaseline values at week 52.