Tirzepatide improves patient well-being compared with dulaglutide in type 2 diabetes

1. In this randomized controlled trial, switching from dulaglutide to tirzepatide was associated with greater improvements in patient-reported quality of life compared with escalating dulaglutide in adults with type 2 diabetes.

2. Participants who switched to tirzepatide reported improved mood, greater perceived control, and reduced fear and emotional burden.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Patient-reported outcomes (PROs) in individuals with type 2 diabetes (T2D) offer valuable insight into how treatments affect symptoms, daily functioning, and overall health-related quality of life (HRQoL). This study evaluated PROs from the SURPASS-SWITCH randomized controlled trial, which previously demonstrated that switching from dulaglutide to tirzepatide led to greater reductions in hemoglobin A1c (HbA1c) and body weight compared with escalating dulaglutide therapy. Compared with those who escalated dulaglutide, a greater proportion of participants who switched to tirzepatide reported feeling “much more” improvement in mood relative to their prior treatment. They were also more likely to feel “much more” in control of their diabetes, eating, and weight, and “much less” fear and frustration. While scores across four of five quantitative PRO instruments improved in both groups, the magnitude of improvement was consistently greater in the tirzepatide group. The generalizability of these findings is limited by the relatively few time points for PRO assessment, incomplete PRO data, and the open-label study design. Nonetheless, the results suggest that switching from dulaglutide to tirzepatide not only improves glycemic control and weight, but may also enhance HRQoL, indicating that clinical and quality-of-life benefits may occur in parallel.

Click to read this study in AIM

Relevant Reading: Patient-Reported Outcomes in People with Type 2 Diabetes Receiving Tirzepatide in the SURPASS Clinical Trial Programme

In-Depth [randomized controlled trial]: This study was conducted as part of the SURPASS-SWITCH trial, which compared switching to tirzepatide with escalating dulaglutide in adults with type 2 diabetes (T2D) who had not achieved glycemic control. Switching to tirzepatide (up to 15 mg or the maximum tolerated dose [MTD]) resulted in greater reductions in HbA1c and body weight than escalating dulaglutide (up to 4.5 mg or its MTD) in patients already receiving dulaglutide with 0 to 3 oral antihyperglycemic agents. The objective of this analysis was to evaluate health- and weight-related quality of life (QoL) in the SURPASS-SWITCH cohort using five patient-reported outcomes (PROs): Impact of Weight on Self-Perception (IW-SP), Impact of Weight on Quality of Life–Lite Clinical Trials Version (IWQOL-Lite-CT), Ability to Perform Physical Activities of Daily Living (APPADL), Emotional Impact of Diabetes Treatment Questionnaire–Comparison (EIDTQc), and Global Impression of Emotional Health (GIEH; 1-week recall and since study start). All PROs were assessed at randomization and study end, except for EIDTQc and GIEH (since study start), which were assessed only at study completion. Baseline demographics and PRO scores were generally comparable between groups, although the tirzepatide group included fewer women and had a higher mean baseline weight. EIDTQc responses indicated that most participants in the tirzepatide group felt “much more” hopeful, optimistic, happy, self-confident, and positive about themselves compared with their prior treatment. Relative to those who escalated dulaglutide, participants who switched to tirzepatide were also more likely to report feeling “much more” in control of their diabetes, eating, and weight, and “much less” fearful, frustrated, and worried. Both treatment groups demonstrated improvements from baseline in IW-SP, APPADL, IWQOL-Lite-CT, and GIEH (1-week recall) scores; however, gains were consistently greater in the tirzepatide group across all measures, including each IWQOL-Lite-CT domain (psychosocial, physical function, and physical). Overall, these findings suggest that switching from dulaglutide to tirzepatide may meaningfully improve mood, perceived control, and emotional burden in adults with T2D.

Image: PD

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