Skip to content

Study · Systematic review · 2026

11 results

Efficacy and Safety of Tirzepatide Versus Dulaglutide in Type 2 Diabetes With or Without Established Atherosclerotic Cardiovascular Disease: A Network Meta-Analysis of Randomized Clinical Trials.

Hageen AW, Gadelmawla AF, Saleh AO, Bahnasy S, Eladawi S, Abdelaziz M, Iyad K, Kandil AH, Zinhom K, Mohamed MR, Abdulhay H, Turkman M, Abdelazeem B, Fonarow GC

Endocrinology, diabetes & metabolism1 Sept 2026

PMID42706739 (opens in a new tab)PMCIDPMC13550879 (opens in a new tab)DOI10.1002/edm2.70313 (opens in a new tab)PepBankPUB-42706739
Download PDFPubMedAsk about this study
Jump to 11 results

Summary

Background and aimThis network meta-analysis addresses the limited dose-specific comparative evidence by evaluating different doses of tirzepatide (TZP) versus dulaglutide (DULA) for glycemic control, weight loss, and safety in type 2 diabetes mellitus (T2DM).MethodsFollowing PRISMA and Cochrane guidance, we searched major databases for RCTs comparing TZP and DULA in adults with T2DM. Efficacy outcomes included body weight change (Weeks 12 and 16) and mean HbA1c change (Weeks 12 and 24). Safety outcomes included mortality, cardiovascular events, and adverse events (AEs). SUCRA ranking was used and analysis performed in RStudio (v4.5.1).ResultsFour RCTs comprising 14,348 participants contributed to a seven-node network. However, Nicholls et al. 2025 had the majority of sample size (n = 13,165). TZP 15 mg achieved the greatest reduction in body weight at Week 16 (mean difference [MD] vs. TZP 5 mg: -2.68 kg; 95% CI -4.98 to -0.38), while TZP 1 mg (MD: 4.39 kg; 95% CI 1.28 to 7.51) and DULA 0.75 mg (MD: 3.10 kg; 95% CI 0.25 to 5.96) were associated with smaller reductions relative to TZP 5 mg. TZP 15 mg also produced the largest HbA1c reduction at Week 24 (MD vs. TZP 5 mg: -0.40%; 95% CI -0.62 to -0.19), compared with TZP 10 mg (MD: -0.23%; 95% CI -0.44 to -0.02) and DULA 1.5 mg (MD: 0.67%; 95% CI 0.25 to 1.09). No significant differences were observed between treatments for all-cause mortality or major cardiovascular events. Gastrointestinal AEs were more frequent with higher TZP doses, especially TZP 15 mg vs. TZP 5 mg for nausea, while serious AEs and severe hypoglycemia were similar across doses.ConclusionHigher TZP doses potentially improve efficacy, while lower TZP/DULA doses enhance tolerability, supporting individualized T2DM care. However, these findings should be interpreted cautiously because several comparisons are indirect, many participants had not reached their maintenance dose, several safety outcomes were based on limited event counts, and significant inconsistency was observed for early body-weight outcomes.
CC BYText from Europe PMC. Highlighted sentences are the source of results.

Results from this study11

11 results from studies that gave the peptide. 11 results from people.

  1. 01HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, tirzepatide 15 mg reduced body weight at Week 16 more than tirzepatide 5 mg (mean difference -2.68 kg).

    In plain wordsIn adults with type 2 diabetes, tirzepatide 15 mg led to more weight loss than tirzepatide 5 mg at Week 16.

    Peptide
    Tirzepatide
    Outcome
    DecreaseBody weight change at Week 16, tirzepatide 15 mg versus 5 mg
    Study

    n: not reported in source

    Comparator
    Tirzepatide 5 mg
    Outcome group
    Body weight · Metabolic and weight
    Studied dose
    15 mg · Week 16As given in this study (human).

    Measurements

    Mean difference in body weight
    −2.68 kg
    TZP 15 mg vs TZP 5 mg, Week 16

    Source sentences

    Summary
    TZP 15 mg achieved the greatest reduction in body weight at Week 16 (mean difference [MD] vs. TZP 5 mg: -2.68 kg; 95% CI -4.98 to -0.38)
    2 context sentences
    Summary · context
    Following PRISMA and Cochrane guidance, we searched major databases for RCTs comparing TZP and DULA in adults with T2DM.
    Summary · context
    Four RCTs comprising 14,348 participants contributed to a seven-node network.
  2. 02HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, tirzepatide 1 mg was associated with a smaller body weight reduction at Week 16 than tirzepatide 5 mg (mean difference 4.39 kg).

    In plain wordsIn adults with type 2 diabetes, tirzepatide 1 mg led to less weight loss than tirzepatide 5 mg at Week 16.

    Peptide
    Tirzepatide
    Outcome
    IncreaseBody weight change at Week 16, tirzepatide 1 mg versus 5 mg
    Study

    n: not reported in source

    Comparator
    Tirzepatide 5 mg
    Outcome group
    Body weight · Metabolic and weight
    Studied dose
    1 mg · Week 16As given in this study (human).

    Measurements

    Mean difference in body weight
    4.39 kg
    TZP 1 mg vs TZP 5 mg, Week 16

    Source sentences

    Summary
    while TZP 1 mg (MD: 4.39 kg; 95% CI 1.28 to 7.51)
    2 context sentences
    Summary · context
    Following PRISMA and Cochrane guidance, we searched major databases for RCTs comparing TZP and DULA in adults with T2DM.
    Summary · context
    Four RCTs comprising 14,348 participants contributed to a seven-node network.
  3. 03HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, tirzepatide 5 mg reduced body weight at Week 16 more than dulaglutide 0.75 mg (dulaglutide mean difference 3.10 kg versus tirzepatide 5 mg).

    In plain wordsIn adults with type 2 diabetes, tirzepatide 5 mg led to more weight loss than dulaglutide 0.75 mg at Week 16.

    Peptide
    Tirzepatide
    Outcome
    DecreaseBody weight change at Week 16, tirzepatide 5 mg versus dulaglutide 0.75 mg
    Study

    n: not reported in source

    Comparator
    Dulaglutide 0.75 mg
    Outcome group
    Body weight · Metabolic and weight
    Studied dose
    5 mg · Week 16As given in this study (human).

    Measurements

    Mean difference in body weight
    3.1 kg
    DULA 0.75 mg vs TZP 5 mg, Week 16

    Source sentences

    Summary
    DULA 0.75 mg (MD: 3.10 kg; 95% CI 0.25 to 5.96) were associated with smaller reductions relative to TZP 5 mg.
    2 context sentences
    Summary · context
    Following PRISMA and Cochrane guidance, we searched major databases for RCTs comparing TZP and DULA in adults with T2DM.
    Summary · context
    Four RCTs comprising 14,348 participants contributed to a seven-node network.
  4. 04HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, tirzepatide 15 mg lowered HbA1c at Week 24 more than tirzepatide 5 mg (mean difference -0.40%).

    In plain wordsIn adults with type 2 diabetes, tirzepatide 15 mg lowered HbA1c more than tirzepatide 5 mg at Week 24.

    Peptide
    Tirzepatide
    Outcome
    DecreaseHbA1c change at Week 24, tirzepatide 15 mg versus 5 mg
    Study

    n: not reported in source

    Comparator
    Tirzepatide 5 mg
    Outcome group
    Glycemic control · Metabolic and weight
    Studied dose
    15 mg · Week 24As given in this study (human).

    Measurements

    Mean difference in HbA1c
    −0.4%
    TZP 15 mg vs TZP 5 mg, Week 24

    Source sentences

    Summary
    TZP 15 mg also produced the largest HbA1c reduction at Week 24 (MD vs. TZP 5 mg: -0.40%; 95% CI -0.62 to -0.19)
    2 context sentences
    Summary · context
    Following PRISMA and Cochrane guidance, we searched major databases for RCTs comparing TZP and DULA in adults with T2DM.
    Summary · context
    Four RCTs comprising 14,348 participants contributed to a seven-node network.
  5. 05HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, tirzepatide 10 mg lowered HbA1c at Week 24 more than tirzepatide 5 mg (mean difference -0.23%).

    In plain wordsIn adults with type 2 diabetes, tirzepatide 10 mg lowered HbA1c more than tirzepatide 5 mg at Week 24.

    Peptide
    Tirzepatide
    Outcome
    DecreaseHbA1c change at Week 24, tirzepatide 10 mg versus 5 mg
    Study

    n: not reported in source

    Comparator
    Tirzepatide 5 mg
    Outcome group
    Glycemic control · Metabolic and weight
    Studied dose
    10 mg · Week 24As given in this study (human).

    Measurements

    Mean difference in HbA1c
    −0.23%
    TZP 10 mg vs TZP 5 mg, Week 24

    Source sentences

    Summary
    compared with TZP 10 mg (MD: -0.23%; 95% CI -0.44 to -0.02)
    2 context sentences
    Summary · context
    Following PRISMA and Cochrane guidance, we searched major databases for RCTs comparing TZP and DULA in adults with T2DM.
    Summary · context
    Four RCTs comprising 14,348 participants contributed to a seven-node network.
  6. 06HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, tirzepatide 5 mg lowered HbA1c at Week 24 more than dulaglutide 1.5 mg (dulaglutide mean difference 0.67% versus tirzepatide 5 mg).

    In plain wordsIn adults with type 2 diabetes, tirzepatide 5 mg lowered HbA1c more than dulaglutide 1.5 mg at Week 24.

    Peptide
    Tirzepatide
    Outcome
    DecreaseHbA1c change at Week 24, tirzepatide 5 mg versus dulaglutide 1.5 mg
    Study

    n: not reported in source

    Comparator
    Dulaglutide 1.5 mg
    Outcome group
    Glycemic control · Metabolic and weight
    Studied dose
    5 mg · Week 24As given in this study (human).

    Measurements

    Mean difference in HbA1c
    0.67%
    DULA 1.5 mg vs TZP 5 mg, Week 24

    Source sentences

    Summary
    DULA 1.5 mg (MD: 0.67%; 95% CI 0.25 to 1.09).
    2 context sentences
    Summary · context
    Following PRISMA and Cochrane guidance, we searched major databases for RCTs comparing TZP and DULA in adults with T2DM.
    Summary · context
    Four RCTs comprising 14,348 participants contributed to a seven-node network.
  7. 07HumanSystematic reviewSafety outcome

    In adults with type 2 diabetes, the network meta-analysis found no significant difference between treatments for all-cause mortality.

    In plain wordsIn adults with type 2 diabetes, the analysis found no clear difference in deaths between the tirzepatide and dulaglutide treatments.

    Peptide
    Tirzepatide
    Outcome
    No significant changeAll-cause mortality across treatments
    Study

    n: not reported in source

    Comparator
    Other treatments in the network
    Outcome group
    Mortality · Cardiovascular
    Studied dose
    Dose not stated

    Source sentences

    Summary
    No significant differences were observed between treatments for all-cause mortality
    2 context sentences
    Summary · context
    Following PRISMA and Cochrane guidance, we searched major databases for RCTs comparing TZP and DULA in adults with T2DM.
    Summary · context
    Four RCTs comprising 14,348 participants contributed to a seven-node network.
  8. 08HumanSystematic reviewSafety outcome

    In adults with type 2 diabetes, the network meta-analysis found no significant difference between treatments for major cardiovascular events.

    In plain wordsIn adults with type 2 diabetes, the analysis found no clear difference in major heart and blood vessel events between the treatments.

    Peptide
    Tirzepatide
    Outcome
    No significant changeMajor cardiovascular events across treatments
    Study

    n: not reported in source

    Comparator
    Other treatments in the network
    Outcome group
    Cardiovascular events · Cardiovascular
    Studied dose
    Dose not stated

    Source sentences

    Summary
    No significant differences were observed between treatments for all-cause mortality or major cardiovascular events.
    2 context sentences
    Summary · context
    Following PRISMA and Cochrane guidance, we searched major databases for RCTs comparing TZP and DULA in adults with T2DM.
    Summary · context
    Four RCTs comprising 14,348 participants contributed to a seven-node network.
  9. 09HumanSystematic reviewSafety outcome

    In adults with type 2 diabetes, gastrointestinal adverse events were more frequent with higher tirzepatide doses, especially nausea with 15 mg versus 5 mg.

    In plain wordsIn adults with type 2 diabetes, higher tirzepatide doses were linked to more stomach side effects, especially nausea at 15 mg versus 5 mg.

    Peptide
    Tirzepatide
    Outcome
    IncreaseGastrointestinal adverse events by tirzepatide dose
    Study

    n: not reported in source

    Comparator
    Tirzepatide 5 mg
    Outcome group
    Gastrointestinal adverse events · Gastrointestinal
    Studied dose
    higher tirzepatide doses, especially 15 mgAs given in this study (human).

    Source sentences

    Summary
    Gastrointestinal AEs were more frequent with higher TZP doses, especially TZP 15 mg vs. TZP 5 mg for nausea
    2 context sentences
    Summary · context
    Following PRISMA and Cochrane guidance, we searched major databases for RCTs comparing TZP and DULA in adults with T2DM.
    Summary · context
    Four RCTs comprising 14,348 participants contributed to a seven-node network.
  10. 10HumanSystematic reviewSafety outcome

    In adults with type 2 diabetes, serious adverse events were similar across tirzepatide doses.

    In plain wordsIn adults with type 2 diabetes, serious side effects were about equally common across tirzepatide doses.

    Peptide
    Tirzepatide
    Outcome
    No significant changeSerious adverse events across tirzepatide doses
    Study

    n: not reported in source

    Comparator
    Other tirzepatide doses
    Outcome group
    Adverse events · Whole body
    Studied dose
    Dose not stated

    Source sentences

    Summary
    while serious AEs and severe hypoglycemia were similar across doses.
    2 context sentences
    Summary · context
    Following PRISMA and Cochrane guidance, we searched major databases for RCTs comparing TZP and DULA in adults with T2DM.
    Summary · context
    Four RCTs comprising 14,348 participants contributed to a seven-node network.
  11. 11HumanSystematic reviewSafety outcome

    In adults with type 2 diabetes, severe hypoglycemia was similar across tirzepatide doses.

    In plain wordsIn adults with type 2 diabetes, severe low blood sugar was about equally common across tirzepatide doses.

    Peptide
    Tirzepatide
    Outcome
    No significant changeSevere hypoglycemia across tirzepatide doses
    Study

    n: not reported in source

    Comparator
    Other tirzepatide doses
    Outcome group
    Adverse events · Metabolic and weight
    Studied dose
    Dose not stated

    Source sentences

    Summary
    while serious AEs and severe hypoglycemia were similar across doses.
    2 context sentences
    Summary · context
    Following PRISMA and Cochrane guidance, we searched major databases for RCTs comparing TZP and DULA in adults with T2DM.
    Summary · context
    Four RCTs comprising 14,348 participants contributed to a seven-node network.

AI wrote and checked these results. AI can make mistakes, so check important results against the source.

Version history

PepBank keeps every version of the data on this study. Status changes from Retraction Watch, Europe PMC and Crossref are listed with their source.

  1. Version 3Current

    21 Oct 2026, 18:59 UTC

    Study data updated · source update from Europe PMC

  2. Version 2

    12 Oct 2026, 12:58 UTC

    Study results updated

  3. Version 1

    9 Oct 2026, 03:07 UTC

    First added · source update from Europe PMC

Subjects

Terms as the source lists them.

PepBank is a research reference. Talk to a doctor before you use any peptide.