Tirzepatide Versus Conventional Glucagon-Like Peptide-1 Receptor Agonists for Treatment Simplification in Type 2 Diabetes Mellitus: A Real-World Study

OBJECTIVE: Polypharmacy and complex insulin regimens increase the treatment burden of type 2 diabetes mellitus, highlighting the need for treatment simplification. Tirzepatide (TZP) is a novel antidiabetic agent that has demonstrated potent glucose-lowering and weight-reducing effects, possibly reducing the use of concomitant antidiabetic medications and insulin dose requirements. However, data regarding its effects on treatment simplification in real-world settings are limited. METHODS: This retrospective real-world study compared TZP with conventional glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for 12 months. The primary outcome measure was treatment simplification, defined as a reduction in the number of antidiabetic medications, insulin injections, or ≥50% reduction in total daily insulin dose. Propensity score overlap weighting and multiple imputations were performed. RESULTS: A total of 318 patients (TZP, n = 153; GLP-1 RAs, n = 165) were included. TZP was associated with a higher likelihood of treatment simplification than GLP-1 RAs (55% vs 25%; odds ratio: 3.69, 95% confidence interval: 2.21-6.16; P < .001), corresponding to an absolute risk difference of 30%. TZP also achieved greater reductions in hemoglobin A1C and body weight. These findings were consistent across sensitivity analyses. CONCLUSION: In a real-world clinical setting, TZP was associated with higher rates of treatment simplification while improving metabolic outcomes.