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According to data released by the World Health Organization, in 2019, there were 1.
5 million direct deaths from diabetes
.
In recent years, the prevalence and mortality of diabetes has gradually increased, and it has become a major health issue worldwide
.
Type 2 diabetes is caused by the body's inability to use insulin effectively
.
GLP-1 receptor agonist treatment can achieve glycemic control similar to or even better than that of basal insulin.
Therefore, current guidelines recommend that GLP-1 receptor agonists are the first choice for the treatment of patients with type 2 diabetes
.
However, the use of GLP-1 receptor agonists alone can frequently cause gastrointestinal side effects
.
The treatment of type 2 diabetes thus opens up the combined use of GIP and GLP-1 receptor agonists
.
Tirzepatide, a new GIP and GLP-1 dual receptor agonist, is currently being developed for the treatment of type 2 diabetes
.
Compared with GLP-1 receptor agonists, Tirzepatide acts on pancreatic β cells to enhance insulin secretion, reduce glucagon secretion, and improve insulin sensitivity, thereby improving blood sugar control
.
In addition, Tirzepatide is related to the improvement of fat and lipoprotein metabolism, blood pressure and other cardiovascular protection markers
.
Tirzepatide can also significantly reduce appetite and weight loss
.
However, its long-term efficacy and safety are still unclear
.
Recently, Professor Stefano Del Prato from the Department of Clinical and Experimental Medicine at the University of Pisa in Italy and Professor Steven E Kahn from the University of Washington published a paper in The Lancet: Tirzepatide versus insulin glargine in type 2 diabetes and increasedcardiovascular risk (SURPASS-4): a randomised, open-label, parallel-group, multicentre, phase 3 trial
.
The team evaluated the efficacy and safety of insulin glargine and Tirzepatide and found that in people with type 2 diabetes and high cardiovascular risk, compared with long-term insulin glargine treatment, long-term treatment of Tirzepatide has a more significant and lower blood sugar control effect.
The incidence of blood sugar is lower and the safety is higher
.
DOI: https://doi.
org/10.
1016/S0140-6736(21)02188-7 Researchers conducted a randomized, open, controlled, parallel phase 3 clinical study in 187 cities in 14 countries on five continents
.
The study was launched on November 20, 2018 and completed on April 22, 2021
.
The included type 2 diabetes patients were adults with poor blood sugar control (glycated hemoglobin [HbA1c] 7.
5-10.
5% [58-91 mmol/mol]) and had a higher risk of cardiovascular events
.
The trial screened a total of 3045 patients, of which 2002 patients were randomly assigned to receive Tirzepatide or insulin glargine treatment
.
Tirzepatide is injected subcutaneously (5 mg, 10 mg, or 15 mg) once a week
.
Insulin glargine was injected subcutaneously once a day (3 mL, U100/mL), and was administered before going to bed
.
During the treatment, the dose is adjusted according to the situation
.
There were 329 cases in the Tirzepatide 5 mg group, 328 cases in the Tirzepatide 10 mg group, 338 cases in the Tirzepatide 15 mg group, and 1000 cases in the insulin glargine group
.
Among them, 1819 (91%) participants were still receiving study medication at 52 weeks
.
In total, 1801 (90%) of the 1995 participants completed the study, and 1706 (85%) completed the study treatment
.
At the end of the study, 109 participants had a MACE-4 event
.
Experimental design At 52 weeks, HbA1c decreased by 2.
24% in the Tirzepatide 5 mg group, 2.
43% in the 10 mg group, 2.
58% in the 15 mg group, and 1.
44% in the insulin glargine group
.
The HbA1c level in the Tirzepatide treatment group continued to decrease for 104 weeks
.
Compared with insulin glargine, the average daily, pre- and post-prandial blood glucose levels in the Tirzepatide group were lower than baseline
.
These results indicate that Tirzepatide is more effective than insulin glargine
.
In addition to blood sugar, the researchers found that at 52 weeks, the average systolic and diastolic blood pressure of the Tirzepatide group decreased, while the insulin glargine group increased
.
Serum triglycerides, low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol levels in the Tirzepatide group decreased in a dose-dependent manner
.
During the entire study period, 60 cases died, including 25 cases in the Tirzepatide group and 35 cases in the insulin glargine group; the researchers believed that they had nothing to do with the study drug
.
Compared with the insulin glargine group, the Trirzepatide group did not increase the risk of MACE-4 events (cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina)
.
The gastrointestinal side effects of patients in the Tirzepatide group, such as nausea, vomiting, and diarrhea, were mild to moderate
.
Moreover, compared with the dose escalation phase, the gastrointestinal side effects that occurred in the later stage of the study were less severe
.
In addition, 33-38% of Tirzepatide patients and 64% of insulin glargine patients developed severe hypoglycemia
.
Time of first appearance of MACE-4 Generally speaking, in people with type 2 diabetes and high cardiovascular risk, Tirzepatide has shown superiority and sustainability in overall blood sugar control and weight loss compared with insulin glargine
.
As the condition of type 2 diabetes continues to progress, evaluating the persistence of blood glucose and weight regulation of insulinotropic receptor agonists (such as Tirzepatide) is critical to the efficacy and prognosis
.
We hope that in the future, researchers will develop more drugs that are as safe, effective and affordable as Tirzepatide, which will benefit millions of diabetic patients
.
End Reference: [1]https://
5 million direct deaths from diabetes
.
In recent years, the prevalence and mortality of diabetes has gradually increased, and it has become a major health issue worldwide
.
Type 2 diabetes is caused by the body's inability to use insulin effectively
.
GLP-1 receptor agonist treatment can achieve glycemic control similar to or even better than that of basal insulin.
Therefore, current guidelines recommend that GLP-1 receptor agonists are the first choice for the treatment of patients with type 2 diabetes
.
However, the use of GLP-1 receptor agonists alone can frequently cause gastrointestinal side effects
.
The treatment of type 2 diabetes thus opens up the combined use of GIP and GLP-1 receptor agonists
.
Tirzepatide, a new GIP and GLP-1 dual receptor agonist, is currently being developed for the treatment of type 2 diabetes
.
Compared with GLP-1 receptor agonists, Tirzepatide acts on pancreatic β cells to enhance insulin secretion, reduce glucagon secretion, and improve insulin sensitivity, thereby improving blood sugar control
.
In addition, Tirzepatide is related to the improvement of fat and lipoprotein metabolism, blood pressure and other cardiovascular protection markers
.
Tirzepatide can also significantly reduce appetite and weight loss
.
However, its long-term efficacy and safety are still unclear
.
Recently, Professor Stefano Del Prato from the Department of Clinical and Experimental Medicine at the University of Pisa in Italy and Professor Steven E Kahn from the University of Washington published a paper in The Lancet: Tirzepatide versus insulin glargine in type 2 diabetes and increasedcardiovascular risk (SURPASS-4): a randomised, open-label, parallel-group, multicentre, phase 3 trial
.
The team evaluated the efficacy and safety of insulin glargine and Tirzepatide and found that in people with type 2 diabetes and high cardiovascular risk, compared with long-term insulin glargine treatment, long-term treatment of Tirzepatide has a more significant and lower blood sugar control effect.
The incidence of blood sugar is lower and the safety is higher
.
DOI: https://doi.
org/10.
1016/S0140-6736(21)02188-7 Researchers conducted a randomized, open, controlled, parallel phase 3 clinical study in 187 cities in 14 countries on five continents
.
The study was launched on November 20, 2018 and completed on April 22, 2021
.
The included type 2 diabetes patients were adults with poor blood sugar control (glycated hemoglobin [HbA1c] 7.
5-10.
5% [58-91 mmol/mol]) and had a higher risk of cardiovascular events
.
The trial screened a total of 3045 patients, of which 2002 patients were randomly assigned to receive Tirzepatide or insulin glargine treatment
.
Tirzepatide is injected subcutaneously (5 mg, 10 mg, or 15 mg) once a week
.
Insulin glargine was injected subcutaneously once a day (3 mL, U100/mL), and was administered before going to bed
.
During the treatment, the dose is adjusted according to the situation
.
There were 329 cases in the Tirzepatide 5 mg group, 328 cases in the Tirzepatide 10 mg group, 338 cases in the Tirzepatide 15 mg group, and 1000 cases in the insulin glargine group
.
Among them, 1819 (91%) participants were still receiving study medication at 52 weeks
.
In total, 1801 (90%) of the 1995 participants completed the study, and 1706 (85%) completed the study treatment
.
At the end of the study, 109 participants had a MACE-4 event
.
Experimental design At 52 weeks, HbA1c decreased by 2.
24% in the Tirzepatide 5 mg group, 2.
43% in the 10 mg group, 2.
58% in the 15 mg group, and 1.
44% in the insulin glargine group
.
The HbA1c level in the Tirzepatide treatment group continued to decrease for 104 weeks
.
Compared with insulin glargine, the average daily, pre- and post-prandial blood glucose levels in the Tirzepatide group were lower than baseline
.
These results indicate that Tirzepatide is more effective than insulin glargine
.
In addition to blood sugar, the researchers found that at 52 weeks, the average systolic and diastolic blood pressure of the Tirzepatide group decreased, while the insulin glargine group increased
.
Serum triglycerides, low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol levels in the Tirzepatide group decreased in a dose-dependent manner
.
During the entire study period, 60 cases died, including 25 cases in the Tirzepatide group and 35 cases in the insulin glargine group; the researchers believed that they had nothing to do with the study drug
.
Compared with the insulin glargine group, the Trirzepatide group did not increase the risk of MACE-4 events (cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina)
.
The gastrointestinal side effects of patients in the Tirzepatide group, such as nausea, vomiting, and diarrhea, were mild to moderate
.
Moreover, compared with the dose escalation phase, the gastrointestinal side effects that occurred in the later stage of the study were less severe
.
In addition, 33-38% of Tirzepatide patients and 64% of insulin glargine patients developed severe hypoglycemia
.
Time of first appearance of MACE-4 Generally speaking, in people with type 2 diabetes and high cardiovascular risk, Tirzepatide has shown superiority and sustainability in overall blood sugar control and weight loss compared with insulin glargine
.
As the condition of type 2 diabetes continues to progress, evaluating the persistence of blood glucose and weight regulation of insulinotropic receptor agonists (such as Tirzepatide) is critical to the efficacy and prognosis
.
We hope that in the future, researchers will develop more drugs that are as safe, effective and affordable as Tirzepatide, which will benefit millions of diabetic patients
.
End Reference: [1]https://
