Should patients on semaglutide increase their dose or try tirzepatide? A real-world look at cardiovascular outcomes
When adults with type 2 diabetes are already being treated 1-mg doses of semaglutide, moving to a 2-mg dose is associated with better cardiovascular outcomes than switching to tirzepatide. That was the primary takeaway from new data presented at the European Association for the Study of Diabetes Annual Meeting 2026 in Milan, Italy.
Researchers explored real-world data from more than 600,000 adults with type 2 diabetes who were receiving once-weekly injections of semaglutide at 1 mg per dose. While 67.2% of patients stayed on that exact same dose, 29.2% made the move to a 2-mg dose of semaglutide. Another 3.6% of patients, meanwhile, switched to taking up to 15 mg of tirzepatide per dose. The number of patients moving to a stronger dose or switching to tirzepatide did increase over time.
Overall, the study’s authors found that the higher semaglutide dose was associated with a 6% lower risk of major adverse cardiovascular events—an outcome that includes heart attack, stroke and all-cause mortality—than tirzepatide.
“Treatment intensification is a common challenge we face in clinical practice, particularly for adults with type 2 diabetes who have not yet met their treatment goals, but are otherwise tolerating their current regimen well,” Kathryn S. Tierney, MSN, APRN, FNP-BC, FAANP, a endocrinology specialists with Middlesex Health MultiSpecialty Group in Middletown, Connecticut, said in a statement. “These real-world findings suggest that escalating to semaglutide 2 mg may be a meaningful option for appropriate patients, as intensification of treatment was associated with a lower risk of major adverse cardiovascular events than those who switched therapies. The analysis reinforces the importance of considering cardiovascular outcomes, alongside glycemic management, when making treatment decisions.”
“These data may help inform healthcare professionals facing a critical challenge: whether to increase the dosage or switch to another therapy for an adult with type 2 diabetes who is already treated with semaglutide,” added Michael Radin, MD, executive medical director of Novo Nordisk.
GLP-1 drugs taking the United States by storm
Semaglutide and tirzepatide are popular diabetes drugs that are now being used more and more for weight loss, even in patients without diabetes. These drugs have also been linked to significant reductions in certain cardiovascular outcomes, including heart attack and stroke. Semaglutide is a GLP-1 receptor agonist sold by Novo Nordisk under the brand names Wegovy and Ozempic. Tirzepatide is a popular dual GIP/GLP-1 receptor agonist sold by Eli Lilly and Company under the brand names Zepbound and Mounjaro.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.