Comparison of Dose Escalation Versus Switching to Tirzepatide Among People With Type 2 Diabetes Inadequately Controlled on Lower Doses of Dulaglutide : A Randomized Clinical Trial.

Summary

In adults with type 2 diabetes inadequately controlled on lower-dose dulaglutide, switching to tirzepatide achieved greater HbA1c reductions than escalating dulaglutide dose in a multicenter, open-label phase 4 RCT. Safety findings were consistent with known profiles, supporting a treatment sequencing strategy favoring tirzepatide switch.

Key Findings

• Switching from dulaglutide to tirzepatide produced greater HbA1c reduction than escalating dulaglutide dose.
• Multicenter, randomized, open-label, phase 4 design across 38 sites in 5 countries with 282 randomized participants.
• Safety profile was consistent with known class effects; open-label design noted as a limitation.

Clinical Implications

For patients with suboptimal control on dulaglutide, clinicians should consider switching to tirzepatide rather than dose escalation to achieve greater glycemic improvement and likely additional weight loss, while monitoring gastrointestinal adverse events.

Limitations

• Open-label design may introduce performance and detection bias
• Abstract does not report detailed effect sizes or duration

Future Directions

Report full efficacy and safety data including HbA1c and weight effect sizes, durability, patient-reported outcomes, and cost-effectiveness to inform treatment algorithms.