258-OR: Sustainability of HbA1c Control of Tirzepatide vs. Insulin Glargine in People with Type 2 Diabetes and Increased Cardiovascular Risk (SURPASS-4)

Tirzepatide (TZP) is a novel dual GIP/GLP-1 receptor agonist in development for glucose-lowering in T2D. The open-label SURPASS-4 trial examined TZP vs. insulin glargine (iGlar) in adults with T2D inadequately controlled on oral medications. Participants (N=1989) with baseline HbA1c 7.5-10.5% and BMI ≥25 kg/m² were randomized 1:1:1:3 to once weekly TZP (5, 10, 15 mg) or iGlar (100 U/mL) titrated to <100 mg/dL fasting glucose. This post hoc analysis evaluated the sustainability of glycemic control after the 52-week (wk) primary endpoint (last on-treatment visit post-52 wks, up to 1wks) , (median=85 wks) . After achieving the 52-wk HbA1c targets of <7%, ≤6.5%, or <5.7%, a participant was considered to have sustained long-term HbA1c control if the final, post-52-wk, on-treatment HbA1c measurement increased ≤0.2% from the 52-wk HbA1c target (Table) . More participants in all 3 TZP dose groups maintained each of the 3 HbA1c targets beyond 52 wks vs. iGlar (all TZP, p<0.05) . Thus, even for the lowest TZP dose (5 mg) , 59% of participants achieved an HbA1c ≤6.5% at 52 wks, with 75% of these having ≤0.2% increase at their last visit. In contrast, for iGlar, 29% achieved an HbA1c ≤6.5%, with 66% of these having ≤0.2% increase.

In conclusion, TZP treatment results in improved long-term HbA1c control for a significantly greater percentage of adults with T2D compared to iGlar.

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