Skip to content

A Study of Tirzepatide (LY3298176) in Participants With Type 2 Diabetes on Metformin With or Without Sulfonylurea (SURPASS-AP-Combo)

A Randomized, Phase 3, Open-label Trial Comparing the Effect of Tirzepatide Once Weekly Versus Titrated Insulin Glargine on Glycemic Control in Patients With Type 2 Diabetes on Metformin With or Without a Sulfonylurea

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT04093752
Enrollment
917
Registered
2019-09-18
Start date
2019-12-09
Completion date
2021-11-24
Last updated
2023-01-06

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Type 2 Diabetes

Keywords

T2DM

Brief summary

The main reason for this study is to compare the study drug tirzepatide to insulin glargine in participants with type 2 diabetes on metformin with or without a sulfonylurea.

Interventions

DRUGTirzepatide

Administered SC

DRUGInsulin Glargine

Administered SC

Sponsors

Eli Lilly and Company
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Type 2 diabetes mellitus * Treated with stable metformin with or without a sulfonylurea (metformin ≥1000 milligrams/day; sulfonylurea should be at least half the maximum dose) for at least 2 months * Are insulin-naive (except for the use of insulin for treatment of gestational diabetes or short-term use \[≤14 consecutive days\] for acute conditions) * HbA1c ≥7.5% to ≤11.0% at screening * Stable weight (±5%) ≥3 months, and agree to not initiate a diet and/or exercise program during the study with the intent of reducing body weight other than the lifestyle and dietary measures for diabetes treatment * Body mass Index (BMI) ≥23 kilograms per meter squared

Exclusion criteria

* Type 1 diabetes mellitus * Have history of chronic or acute pancreatitis * Have history of proliferative diabetic retinopathy; or diabetic maculopathy; or non-proliferative diabetic retinopathy that requires acute treatment * Have a history of severe hypoglycemia and/or hypoglycemia unawareness within the 6 months * Have a history of ketoacidosis or hyperosmolar state/coma * Have a known clinically significant gastric emptying abnormality, have undergone or plan to have during the course of the study, or chronically take drugs that directly affect GI motility * Have acute myocardial infarction (MI), stroke or hospitalization due to congestive heart failure (CHF) within 2 months * Have family or personal history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN-2) * Have been treated with prescription drugs that promote weight loss or similar other body weight loss medications including over the counter (OTC) within 3 months

Design outcomes

Primary

MeasureTime frameDescription
Mean Change From Baseline in Hemoglobin A1c (HbA1c) (10 mg and 15 mg)Baseline, Week 40HbA1c is the glycosylated fraction of hemoglobin A. HbA1c is measured primarily to identify average plasma glucose concentration over prolonged periods of time. Least Squares (LS) mean was determined by mixed model repeated measures (MMRM) model with covariates Baseline + Country + Baseline Oral Antihyperglycemic Medication (OAM) Use (Metformin (Met), Met plus Sulfonylurea (SU)) + Treatment + Time + Treatment\*Time (Type III sum of squares).

Secondary

MeasureTime frameDescription
Mean Change From Baseline in Body WeightBaseline, Week 40LS mean was determined by MMRM model with Baseline + Country + Baseline OAM Use (Met, Met plus SU) + Baseline HbA1c Group (\<= 8.5%, \>8.5%) + Treatment + Time + Treatment\*Time (Type III sum of squares) as covariates.
Percentage of Participants Achieving an HbA1c Target Value of <7.0%Week 40HbA1c is the glycosylated fraction of hemoglobin A. HbA1c is measured to identify average plasma glucose concentration over prolonged periods of time. Imputed data includes observed value and imputed value if endpoint measure is missing.
Percentage of Participants Achieving an HbA1c Target Value of <5.7%Week 40HbA1c is the glycosylated fraction of hemoglobin A. Imputed data includes observed value and imputed value if endpoint measure is missing.
Mean Change From Baseline in Fasting Serum GlucoseBaseline, Week 40Fasting serum glucose (FSG) is a test to determine sugar levels in serum sample after an overnight fast. LS mean was determined by MMRM model with Baseline + Country + Baseline OAM Use (Met, Met plus SU) + Baseline HbA1c Group (\<= 8.5%, \>8.5%) + Treatment + Time + Treatment\*Time (Type III sum of squares) as covariates.
Mean Change From Baseline in HbA1c (5 mg)Baseline, Week 40HbA1c is the glycosylated fraction of hemoglobin A. HbA1c is measured primarily to identify average plasma glucose concentration over prolonged periods of time. LS mean was determined by MMRM model with covariates Baseline + Country + Baseline OAM Use (Met, Met plus SU) + Treatment + Time + Treatment\*Time (Type III sum of squares).
Percentage of Participants Who Achieved Weight Loss ≥5%Week 40Imputed data includes observed value and imputed value if endpoint measure is missing.
Diabetes Treatment Satisfaction as Measured by the Diabetes Treatment Satisfaction Questionnaire, Change Version (DTSQc) Hyperglycemia, Hypoglycemia and Treatment Satisfaction ScoreBaseline, Week 40DTSQc, an 8-item questionnaire, assesses relative change in treatment satisfaction perceived frequency of hyperglycemia, and perceived frequency of hypoglycemia from baseline to week 40 or early termination. The treatment satisfaction score ranges from -18 to 18 where the higher the score the greater the improvement in satisfaction with treatment. The lower the score the greater the deterioration in satisfaction with treatment. The hyperglycemia and hypoglycemia scores range from -3 to 3 where negative scores indicate fewer problems with blood glucose levels and positive scores indicate more problems than before. LS mean was determined by ANCOVA model for endpoint measures with Baseline + Country + Baseline HbA1c Group (\<=8.5%, \>8.5%) + Baseline OAM Use (Met, Met plus SU) + Treatment (Type III sum of squares) as covariates.
Rate of Hypoglycemia With Blood Glucose < 54 mg/dL or Severe HypoglycemiaBaseline through end of safety follow-up (Up To Week 44)The hypoglycemia events were defined by participant reported events with blood glucose \< 54 mg/dL \[\<3.0 Millimole per Liter (mmol/L)\] or severe hypoglycemia. Severe hypoglycemia is defined as an episode with severe cognitive impairment requiring the assistance of another person to actively administer carbohydrate, glucagon, or other resuscitative actions. These episodes may be associated with sufficient neuroglycopenia to induce seizure or coma. The rate of post-baseline hypoglycemia was estimated by negative binomial model: Number of episodes = Country + Baseline OAM Use (Met, Met plus SU) + Baseline HbA1c Group (\<= 8.5%, \>8.5%) + Treatment, with log (exposure in days/365.25) as an offset variable.
Mean Change in Daily Glucose Average From Baseline in 7-Point Self-Monitored Blood Glucose (SMBG) ValuesBaseline, Week 40The SMBG data was collected at the following 7 time points: Morning Premeal - Fasting, Morning 2-hour Post-meal, Midday Premeal, Midday 2-hour Post-meal, Evening Premeal, Evening 2-hour Post-meal and Bedtime. LS mean was determined by MMRM model with Baseline + Country + Baseline OAM Use (Met, Met plus SU) + Baseline HbA1c Group (\<= 8.5%, \>8.5%) + Treatment + Time + Treatment\*Time (Type III sum of squares) as covariates.

Countries

Australia, China, India, South Korea

Participant flow

Participants by arm

ArmCount
5 mg Tirzepatide
Participants received 5 mg tirzepatide administered SC QW.
230
10 mg Tirzepatide
Participants received 10 mg tirzepatide administered SC QW.
228
15 mg Tirzepatide
Participants received 15 mg tirzepatide administered SC QW.
229
Insulin Glargine
Participants received insulin glargine administered QD SC. The starting dose of insulin glargine was 6 IU/day at bedtime, titrated to a FBG between 72-100 mg/dL, following a TTT algorithm.
220
Total907

Withdrawals & dropouts

PeriodReasonFG000FG001FG002FG003
Overall StudyAdverse Event719184
Overall StudyCovid 190001
Overall StudyDeath0012
Overall StudyLost to Follow-up2111
Overall StudyParticipant Could Not Continue Due to Work Related Reasons0101
Overall StudyParticipant Did Not Come for the Visit1000
Overall StudyParticipant Thought there were Too Many Adverse Events0010
Overall StudyParticipant was Reluctant to Follow-up1000
Overall StudyWithdrawal by Subject66820

Baseline characteristics

CharacteristicTotalInsulin Glargine15 mg Tirzepatide10 mg Tirzepatide5 mg Tirzepatide
Age, Continuous54.10 years
STANDARD_DEVIATION 11.38
55.60 years
STANDARD_DEVIATION 11.4
54.30 years
STANDARD_DEVIATION 11.65
53.50 years
STANDARD_DEVIATION 11.14
53.10 years
STANDARD_DEVIATION 11.25
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants0 Participants0 Participants0 Participants0 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
0 Participants0 Participants0 Participants0 Participants0 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
907 Participants220 Participants229 Participants228 Participants230 Participants
Hemoglobin A1c (HbA1c)8.71 Percentage of HbA1c
STANDARD_DEVIATION 0.956
8.68 Percentage of HbA1c
STANDARD_DEVIATION 0.934
8.67 Percentage of HbA1c
STANDARD_DEVIATION 0.96
8.70 Percentage of HbA1c
STANDARD_DEVIATION 0.955
8.77 Percentage of HbA1c
STANDARD_DEVIATION 0.976
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
892 Participants216 Participants226 Participants225 Participants225 Participants
Race (NIH/OMB)
Black or African American
0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
5 Participants0 Participants3 Participants0 Participants2 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
10 Participants4 Participants0 Participants3 Participants3 Participants
Region of Enrollment
Australia
15 participants4 participants3 participants3 participants5 participants
Region of Enrollment
China
756 participants184 participants190 participants192 participants190 participants
Region of Enrollment
India
32 participants7 participants9 participants7 participants9 participants
Region of Enrollment
South Korea
104 participants25 participants27 participants26 participants26 participants
Sex: Female, Male
Female
400 Participants102 Participants100 Participants102 Participants96 Participants
Sex: Female, Male
Male
507 Participants118 Participants129 Participants126 Participants134 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
deaths
Total, all-cause mortality
0 / 2300 / 2281 / 2292 / 220
other
Total, other adverse events
174 / 230201 / 228193 / 22983 / 220
serious
Total, serious adverse events
15 / 23014 / 22815 / 22920 / 220

Outcome results

Primary

Mean Change From Baseline in Hemoglobin A1c (HbA1c) (10 mg and 15 mg)

HbA1c is the glycosylated fraction of hemoglobin A. HbA1c is measured primarily to identify average plasma glucose concentration over prolonged periods of time. Least Squares (LS) mean was determined by mixed model repeated measures (MMRM) model with covariates Baseline + Country + Baseline Oral Antihyperglycemic Medication (OAM) Use (Metformin (Met), Met plus Sulfonylurea (SU)) + Treatment + Time + Treatment\*Time (Type III sum of squares).

Time frame: Baseline, Week 40

Population: All randomized participants belonging to the 10 mg, 15 mg Tirzepatide and Insulin Glargine arms who received at least one dose of study drug, had a baseline and at least one post-baseline value, excluding data after initiating rescue antihyperglycemic medication or stopping study drug (last dose date + 7 days).

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
10 mg TirzepatideMean Change From Baseline in Hemoglobin A1c (HbA1c) (10 mg and 15 mg)-2.44 Percentage of HbA1cStandard Error 0.073
15 mg TirzepatideMean Change From Baseline in Hemoglobin A1c (HbA1c) (10 mg and 15 mg)-2.49 Percentage of HbA1cStandard Error 0.072
Insulin GlargineMean Change From Baseline in Hemoglobin A1c (HbA1c) (10 mg and 15 mg)-0.95 Percentage of HbA1cStandard Error 0.073
95% CI: [-1.69, -1.29]
95% CI: [-1.74, -1.34]
Secondary

Diabetes Treatment Satisfaction as Measured by the Diabetes Treatment Satisfaction Questionnaire, Change Version (DTSQc) Hyperglycemia, Hypoglycemia and Treatment Satisfaction Score

DTSQc, an 8-item questionnaire, assesses relative change in treatment satisfaction perceived frequency of hyperglycemia, and perceived frequency of hypoglycemia from baseline to week 40 or early termination. The treatment satisfaction score ranges from -18 to 18 where the higher the score the greater the improvement in satisfaction with treatment. The lower the score the greater the deterioration in satisfaction with treatment. The hyperglycemia and hypoglycemia scores range from -3 to 3 where negative scores indicate fewer problems with blood glucose levels and positive scores indicate more problems than before. LS mean was determined by ANCOVA model for endpoint measures with Baseline + Country + Baseline HbA1c Group (\<=8.5%, \>8.5%) + Baseline OAM Use (Met, Met plus SU) + Treatment (Type III sum of squares) as covariates.

Time frame: Baseline, Week 40

Population: All randomized participants who received at least one dose of study drug, had a baseline and at least one post-baseline value, excluding data after initiating rescue antihyperglycemic medication or stopping study drug (last dose date + 7 days).

ArmMeasureGroupValue (LEAST_SQUARES_MEAN)Dispersion
10 mg TirzepatideDiabetes Treatment Satisfaction as Measured by the Diabetes Treatment Satisfaction Questionnaire, Change Version (DTSQc) Hyperglycemia, Hypoglycemia and Treatment Satisfaction ScoreHyperglycemia-1.8 Units on a scaleStandard Error 0.12
10 mg TirzepatideDiabetes Treatment Satisfaction as Measured by the Diabetes Treatment Satisfaction Questionnaire, Change Version (DTSQc) Hyperglycemia, Hypoglycemia and Treatment Satisfaction ScoreTreatment Satisfaction Score16.0 Units on a scaleStandard Error 0.27
10 mg TirzepatideDiabetes Treatment Satisfaction as Measured by the Diabetes Treatment Satisfaction Questionnaire, Change Version (DTSQc) Hyperglycemia, Hypoglycemia and Treatment Satisfaction ScoreHypoglycemia-1.9 Units on a scaleStandard Error 0.11
15 mg TirzepatideDiabetes Treatment Satisfaction as Measured by the Diabetes Treatment Satisfaction Questionnaire, Change Version (DTSQc) Hyperglycemia, Hypoglycemia and Treatment Satisfaction ScoreHyperglycemia-2.1 Units on a scaleStandard Error 0.12
15 mg TirzepatideDiabetes Treatment Satisfaction as Measured by the Diabetes Treatment Satisfaction Questionnaire, Change Version (DTSQc) Hyperglycemia, Hypoglycemia and Treatment Satisfaction ScoreTreatment Satisfaction Score15.8 Units on a scaleStandard Error 0.28
15 mg TirzepatideDiabetes Treatment Satisfaction as Measured by the Diabetes Treatment Satisfaction Questionnaire, Change Version (DTSQc) Hyperglycemia, Hypoglycemia and Treatment Satisfaction ScoreHypoglycemia-1.9 Units on a scaleStandard Error 0.12
Insulin GlargineDiabetes Treatment Satisfaction as Measured by the Diabetes Treatment Satisfaction Questionnaire, Change Version (DTSQc) Hyperglycemia, Hypoglycemia and Treatment Satisfaction ScoreHypoglycemia-2.0 Units on a scaleStandard Error 0.12
Insulin GlargineDiabetes Treatment Satisfaction as Measured by the Diabetes Treatment Satisfaction Questionnaire, Change Version (DTSQc) Hyperglycemia, Hypoglycemia and Treatment Satisfaction ScoreHyperglycemia-2.0 Units on a scaleStandard Error 0.12
Insulin GlargineDiabetes Treatment Satisfaction as Measured by the Diabetes Treatment Satisfaction Questionnaire, Change Version (DTSQc) Hyperglycemia, Hypoglycemia and Treatment Satisfaction ScoreTreatment Satisfaction Score15.9 Units on a scaleStandard Error 0.29
Insulin GlargineDiabetes Treatment Satisfaction as Measured by the Diabetes Treatment Satisfaction Questionnaire, Change Version (DTSQc) Hyperglycemia, Hypoglycemia and Treatment Satisfaction ScoreHyperglycemia-1.3 Units on a scaleStandard Error 0.12
Insulin GlargineDiabetes Treatment Satisfaction as Measured by the Diabetes Treatment Satisfaction Questionnaire, Change Version (DTSQc) Hyperglycemia, Hypoglycemia and Treatment Satisfaction ScoreTreatment Satisfaction Score14.2 Units on a scaleStandard Error 0.28
Insulin GlargineDiabetes Treatment Satisfaction as Measured by the Diabetes Treatment Satisfaction Questionnaire, Change Version (DTSQc) Hyperglycemia, Hypoglycemia and Treatment Satisfaction ScoreHypoglycemia-1.8 Units on a scaleStandard Error 0.12
Comparison: Hyperglycemiap-value: 0.00795% CI: [-0.81, -0.13]ANCOVA
Comparison: Hyperglycemiap-value: <0.00195% CI: [-1.11, -0.43]ANCOVA
Comparison: Hyperglycemiap-value: <0.00195% CI: [-1.05, -0.36]ANCOVA
Comparison: Hypoglycemiap-value: 0.38495% CI: [-0.46, 0.18]ANCOVA
Comparison: Hypoglycemiap-value: 0.30795% CI: [-0.49, 0.16]ANCOVA
Comparison: Hypoglycemiap-value: 0.18495% CI: [-0.55, 0.11]ANCOVA
Comparison: Treatment Satisfaction Scorep-value: <0.00195% CI: [1.03, 2.59]ANCOVA
Comparison: Treatment Satisfaction Scorep-value: <0.00195% CI: [0.84, 2.41]ANCOVA
Comparison: Treatment Satisfaction Scorep-value: <0.00195% CI: [0.89, 2.47]ANCOVA
Secondary

Mean Change From Baseline in Body Weight

LS mean was determined by MMRM model with Baseline + Country + Baseline OAM Use (Met, Met plus SU) + Baseline HbA1c Group (\<= 8.5%, \>8.5%) + Treatment + Time + Treatment\*Time (Type III sum of squares) as covariates.

Time frame: Baseline, Week 40

Population: All randomized participants who received at least one dose of study drug, had a baseline and at least one post-baseline value, excluding data after initiating rescue antihyperglycemic medication or stopping study drug (last dose date + 7 days).

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
10 mg TirzepatideMean Change From Baseline in Body Weight-5.0 kilograms (kg)Standard Error 0.32
15 mg TirzepatideMean Change From Baseline in Body Weight-7.0 kilograms (kg)Standard Error 0.33
Insulin GlargineMean Change From Baseline in Body Weight-7.2 kilograms (kg)Standard Error 0.33
Insulin GlargineMean Change From Baseline in Body Weight1.5 kilograms (kg)Standard Error 0.33
p-value: <0.00195% CI: [-7.4, -5.6]Mixed Models Analysis
p-value: <0.00195% CI: [-9.5, -7.6]Mixed Models Analysis
p-value: <0.00195% CI: [-9.6, -7.7]Mixed Models Analysis
Secondary

Mean Change From Baseline in Fasting Serum Glucose

Fasting serum glucose (FSG) is a test to determine sugar levels in serum sample after an overnight fast. LS mean was determined by MMRM model with Baseline + Country + Baseline OAM Use (Met, Met plus SU) + Baseline HbA1c Group (\<= 8.5%, \>8.5%) + Treatment + Time + Treatment\*Time (Type III sum of squares) as covariates.

Time frame: Baseline, Week 40

Population: All randomized participants who had received at least one dose of study drug, had a baseline and at least one post-baseline value, excluding data after initiating rescue antihyperglycemic medication or stopping study drug (last dose date + 7 days).

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
10 mg TirzepatideMean Change From Baseline in Fasting Serum Glucose-58.6 milligrams per deciliter (mg/dL)Standard Error 2.13
15 mg TirzepatideMean Change From Baseline in Fasting Serum Glucose-66.2 milligrams per deciliter (mg/dL)Standard Error 2.19
Insulin GlargineMean Change From Baseline in Fasting Serum Glucose-64.8 milligrams per deciliter (mg/dL)Standard Error 2.19
Insulin GlargineMean Change From Baseline in Fasting Serum Glucose-46.2 milligrams per deciliter (mg/dL)Standard Error 2.19
p-value: <0.00195% CI: [-18.3, -6.3]Mixed Models Analysis
p-value: <0.00195% CI: [-26.1, -13.9]Mixed Models Analysis
p-value: <0.00195% CI: [-24.6, -12.5]Mixed Models Analysis
Secondary

Mean Change From Baseline in HbA1c (5 mg)

HbA1c is the glycosylated fraction of hemoglobin A. HbA1c is measured primarily to identify average plasma glucose concentration over prolonged periods of time. LS mean was determined by MMRM model with covariates Baseline + Country + Baseline OAM Use (Met, Met plus SU) + Treatment + Time + Treatment\*Time (Type III sum of squares).

Time frame: Baseline, Week 40

Population: All randomized participants belonging to the 5 mg Tirzepatide and Insulin Glargine arms who received at least one dose of study drug, had a baseline and at least one post-baseline value, excluding data after initiating rescue antihyperglycemic medication or stopping study drug (last dose date + 7 days).

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
10 mg TirzepatideMean Change From Baseline in HbA1c (5 mg)-2.24 Percentage of HbA1cStandard Error 0.07
15 mg TirzepatideMean Change From Baseline in HbA1c (5 mg)-0.95 Percentage of HbA1cStandard Error 0.073
95% CI: [-1.49, -1.09]
Secondary

Mean Change in Daily Glucose Average From Baseline in 7-Point Self-Monitored Blood Glucose (SMBG) Values

The SMBG data was collected at the following 7 time points: Morning Premeal - Fasting, Morning 2-hour Post-meal, Midday Premeal, Midday 2-hour Post-meal, Evening Premeal, Evening 2-hour Post-meal and Bedtime. LS mean was determined by MMRM model with Baseline + Country + Baseline OAM Use (Met, Met plus SU) + Baseline HbA1c Group (\<= 8.5%, \>8.5%) + Treatment + Time + Treatment\*Time (Type III sum of squares) as covariates.

Time frame: Baseline, Week 40

Population: All randomized participants who have received at least one dose of study drug, had a baseline and at least one post-baseline value, excluding data after initiating rescue antihyperglycemic medication or stopping study drug (last dose date + 7 days).

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
10 mg TirzepatideMean Change in Daily Glucose Average From Baseline in 7-Point Self-Monitored Blood Glucose (SMBG) Values-77.0 milligrams per deciliter (mg/dL)Standard Error 2.09
15 mg TirzepatideMean Change in Daily Glucose Average From Baseline in 7-Point Self-Monitored Blood Glucose (SMBG) Values-83.4 milligrams per deciliter (mg/dL)Standard Error 2.16
Insulin GlargineMean Change in Daily Glucose Average From Baseline in 7-Point Self-Monitored Blood Glucose (SMBG) Values-84.6 milligrams per deciliter (mg/dL)Standard Error 2.18
Insulin GlargineMean Change in Daily Glucose Average From Baseline in 7-Point Self-Monitored Blood Glucose (SMBG) Values-42.8 milligrams per deciliter (mg/dL)Standard Error 2.18
p-value: <0.00195% CI: [-40.1, -28.3]Mixed Models Analysis
p-value: <0.00195% CI: [-46.7, -34.6]Mixed Models Analysis
p-value: <0.00195% CI: [-47.9, -35.8]Mixed Models Analysis
Secondary

Percentage of Participants Achieving an HbA1c Target Value of <5.7%

HbA1c is the glycosylated fraction of hemoglobin A. Imputed data includes observed value and imputed value if endpoint measure is missing.

Time frame: Week 40

Population: All randomized participants who received at least one dose of study drug, had a baseline and at least one post-baseline value, excluding data after initiating rescue antihyperglycemic medication or stopping study drug (last dose date + 7 days).

ArmMeasureValue (NUMBER)
10 mg TirzepatidePercentage of Participants Achieving an HbA1c Target Value of <5.7%14.91 Percentage of participants
15 mg TirzepatidePercentage of Participants Achieving an HbA1c Target Value of <5.7%20.72 Percentage of participants
Insulin GlarginePercentage of Participants Achieving an HbA1c Target Value of <5.7%27.68 Percentage of participants
Insulin GlarginePercentage of Participants Achieving an HbA1c Target Value of <5.7%0.00 Percentage of participants
p-value: 0.00295% CI: [5.13, 1327.81]Regression, Logistic
p-value: <0.00195% CI: [7.79, 1997.01]Regression, Logistic
p-value: <0.00195% CI: [11.59, 2950.73]Regression, Logistic
Secondary

Percentage of Participants Achieving an HbA1c Target Value of <7.0%

HbA1c is the glycosylated fraction of hemoglobin A. HbA1c is measured to identify average plasma glucose concentration over prolonged periods of time. Imputed data includes observed value and imputed value if endpoint measure is missing.

Time frame: Week 40

Population: All randomized participants who received at least one dose of study drug and had a baseline and at least one post-baseline value, excluding data after initiating rescue antihyperglycemic medication or stopping study drug (last dose date + 7 days).

ArmMeasureValue (NUMBER)
10 mg TirzepatidePercentage of Participants Achieving an HbA1c Target Value of <7.0%75.44 Percentage of participants
15 mg TirzepatidePercentage of Participants Achieving an HbA1c Target Value of <7.0%86.04 Percentage of participants
Insulin GlarginePercentage of Participants Achieving an HbA1c Target Value of <7.0%84.38 Percentage of participants
Insulin GlarginePercentage of Participants Achieving an HbA1c Target Value of <7.0%23.72 Percentage of participants
p-value: <0.00195% CI: [8.94, 23.64]Regression, Logistic
p-value: <0.00195% CI: [16.72, 49.49]Regression, Logistic
p-value: <0.00195% CI: [14.88, 42.95]Regression, Logistic
Secondary

Percentage of Participants Who Achieved Weight Loss ≥5%

Imputed data includes observed value and imputed value if endpoint measure is missing.

Time frame: Week 40

Population: All randomized participants who received at least one dose of study drug, had a baseline and had at least one post-baseline value, excluding data after initiating rescue antihyperglycemic medication or stopping study drug (last dose date + 7 days).

ArmMeasureValue (NUMBER)
10 mg TirzepatidePercentage of Participants Who Achieved Weight Loss ≥5%55.70 Percentage of participants
15 mg TirzepatidePercentage of Participants Who Achieved Weight Loss ≥5%71.62 Percentage of participants
Insulin GlarginePercentage of Participants Who Achieved Weight Loss ≥5%74.11 Percentage of participants
Insulin GlarginePercentage of Participants Who Achieved Weight Loss ≥5%5.58 Percentage of participants
p-value: <0.00195% CI: [11.63, 41.2]Regression, Logistic
p-value: <0.00195% CI: [22.96, 83.5]Regression, Logistic
p-value: <0.00195% CI: [25.34, 92.49]Regression, Logistic
Secondary

Rate of Hypoglycemia With Blood Glucose < 54 mg/dL or Severe Hypoglycemia

The hypoglycemia events were defined by participant reported events with blood glucose \< 54 mg/dL \[\<3.0 Millimole per Liter (mmol/L)\] or severe hypoglycemia. Severe hypoglycemia is defined as an episode with severe cognitive impairment requiring the assistance of another person to actively administer carbohydrate, glucagon, or other resuscitative actions. These episodes may be associated with sufficient neuroglycopenia to induce seizure or coma. The rate of post-baseline hypoglycemia was estimated by negative binomial model: Number of episodes = Country + Baseline OAM Use (Met, Met plus SU) + Baseline HbA1c Group (\<= 8.5%, \>8.5%) + Treatment, with log (exposure in days/365.25) as an offset variable.

Time frame: Baseline through end of safety follow-up (Up To Week 44)

Population: All randomized participants who received at least one dose of study drug, had a baseline and at least one post-baseline value, excluding data after initiating rescue antihyperglycemic medication or stopping study drug (last dose date + 7 days).

ArmMeasureValue (MEAN)Dispersion
10 mg TirzepatideRate of Hypoglycemia With Blood Glucose < 54 mg/dL or Severe Hypoglycemia0.0658 Episodes/participant/365.25 daysStandard Error 0.02603
15 mg TirzepatideRate of Hypoglycemia With Blood Glucose < 54 mg/dL or Severe Hypoglycemia0.0890 Episodes/participant/365.25 daysStandard Error 0.03196
Insulin GlargineRate of Hypoglycemia With Blood Glucose < 54 mg/dL or Severe Hypoglycemia0.0700 Episodes/participant/365.25 daysStandard Error 0.02273
Insulin GlargineRate of Hypoglycemia With Blood Glucose < 54 mg/dL or Severe Hypoglycemia0.0538 Episodes/participant/365.25 daysStandard Error 0.01594

Source: ClinicalTrials.gov · Data processed: Feb 17, 2026