Hormonal
GLP-1 receptor agonists (semaglutide) and dual agonists (tirzepatide) are clinically effective for glycemic control and significant weight loss, with tirzepatide demonstrating superior magnitude of weight loss compared to semaglutide in head-to-head trials.
GLP-1 and dual agonists are highly effective for weight loss and blood sugar control. Tirzepatide generally produces greater weight loss than semaglutide. However, high costs and insurance restrictions (often requiring prior failure of other drugs like metformin) limit access. Discuss cardiovascular benefits if you have existing heart disease.
Tirzepatide achieved greater weight loss in individuals without diabetes in SURMOUNT-1 (average ∼15%–21% weight loss over 72 weeks across 5, 10, and 15 mg doses)... In SURPASS-2, among T2DM patients, tirzepatide 5–15 mg outperformed semaglutide 1 mg, reducing HbA1c by up to 2.3% and body weight by up to 11.2 kg
Why this rating
Based on multiple large-scale RCTs (SUSTAIN, SURPASS, SURMOUNT, SELECT) and meta-analyses cited.
Source
Cost-effectiveness of incretin therapies: a Canadian lens on diabetes, obesity, and emerging indications
Luke Awadalla et al. · Canadian Journal of Physiology and Pharmacology · 2026
DOI 10.1139/cjpp-2025-0248
More from this paper
- Incretin therapies reduce Major Adverse Cardiovascular Events (MACE) and all-cause mortality in patients with T2DM and/or established cardiovascular disease, independent of glycemic control.Good
- Current economic models often undervalue incretin therapies by excluding downstream benefits (e.g., reduced MACE, sleep apnea, osteoarthritis), leading to high ICERs that may exceed willingness-to-pay thresholds without price reductions.Moderate
Related findings · Hormonal
- Initial treatment for type 2 diabetes should be a combination of metformin and either an SGLT-2 inhibitor or a GLP-1 receptor agonist to achieve cardiorenal protection, rather than monotherapy or older agents like sulfonylureas.Strong
- For patients with specific monogenic obesity syndromes (leptin deficiency, POMC/PCSK1/LEPR mutations), targeted pharmacotherapy (recombinant leptin or setmelanotide) is highly effective and should be prioritized, unlike in polygenic obesity.Strong
- Continued weekly administration of 2.4 mg subcutaneous semaglutide prevents weight regain and promotes further weight loss in adults with overweight or obesity, whereas switching to placebo results in significant weight regain.Strong
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