CLINICAL OUTCOMES OF TIRZEPATIDE VERSUS DULAGLUTIDE ON TYPE 2 DIABETES WITH OBESITY AND HEART FAILURE
Author(s)
Septi Melisa, MBA1, Jason C. Hsu, PhD2;
1Taipei Medical University, Taipei, Taiwan, 2Taipei Medical University, New Taipei City, Taiwan
1Taipei Medical University, Taipei, Taiwan, 2Taipei Medical University, New Taipei City, Taiwan
OBJECTIVES: A prior study using real-world data found that tirzepatide conferred cardiovascular benefits for patients with type 2 diabetes mellitus (T2DM), obesity, and ischemic heart disease; however, its effects in patients with T2DM, obesity, and heart failure remain unexplored. Therefore, this study evaluated the effectiveness and safety of tirzepatide and dulaglutide in patients with T2DM, obesity, and heart failure in routine clinical practice, using real-world data.
METHODS: We conducted a target trial emulation using data from the TriNetX Global Collaborative Network (November 2022-November 2025). Adults aged ≥40 years with T2DM, defined by ICD-10 codes and HbA1c levels of ≥7.0% and ≤10.5%, obesity (BMI ≥25 kg/m²), and established heart failure were included. Outcomes of interest were all-cause mortality, hospitalization, and end-stage renal disease during a 36-month follow-up period after treatment initiation. Gastrointestinal (GI) symptoms were also evaluated as a safety outcome. Propensity score matching (1:1) was used to balance baseline characteristics between treatment groups. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). A sensitivity analysis was also performed for heart failure with preserved ejection fraction (HFpEF).
RESULTS: A total of 6,622 matched pairs of tirzepatide and dulaglutide users were identified. Compared to dulaglutide, tirzepatide was linked with significantly lower risks of all-cause mortality (HR 0.657; 95% CI 0.559-0.773), hospitalization (HR 0.862; 95% CI 0.808-0.919), and end-stage renal disease (HR 0.768; 95% CI 0.63,0.935). However, for gastrointestinal symptoms, tirzepatide showed a similar outcome to dulaglutide (HR 0.995; 96% CI 0.937-1.055). Similar results were observed for HFpEF.
CONCLUSIONS: In this real-world patient cohort with T2DM, obesity, and heart failure, tirzepatide showed improved clinical outcomes, such as reduced risks of all-cause mortality, hospitalization, and end-stage renal disease, with a safety profile comparable to dulaglutide.
METHODS: We conducted a target trial emulation using data from the TriNetX Global Collaborative Network (November 2022-November 2025). Adults aged ≥40 years with T2DM, defined by ICD-10 codes and HbA1c levels of ≥7.0% and ≤10.5%, obesity (BMI ≥25 kg/m²), and established heart failure were included. Outcomes of interest were all-cause mortality, hospitalization, and end-stage renal disease during a 36-month follow-up period after treatment initiation. Gastrointestinal (GI) symptoms were also evaluated as a safety outcome. Propensity score matching (1:1) was used to balance baseline characteristics between treatment groups. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). A sensitivity analysis was also performed for heart failure with preserved ejection fraction (HFpEF).
RESULTS: A total of 6,622 matched pairs of tirzepatide and dulaglutide users were identified. Compared to dulaglutide, tirzepatide was linked with significantly lower risks of all-cause mortality (HR 0.657; 95% CI 0.559-0.773), hospitalization (HR 0.862; 95% CI 0.808-0.919), and end-stage renal disease (HR 0.768; 95% CI 0.63,0.935). However, for gastrointestinal symptoms, tirzepatide showed a similar outcome to dulaglutide (HR 0.995; 96% CI 0.937-1.055). Similar results were observed for HFpEF.
CONCLUSIONS: In this real-world patient cohort with T2DM, obesity, and heart failure, tirzepatide showed improved clinical outcomes, such as reduced risks of all-cause mortality, hospitalization, and end-stage renal disease, with a safety profile comparable to dulaglutide.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
P7
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)