772-P: Tirzepatide vs. Basal Insulins in People with T2D and Different Baseline Glycemic Patterns—Post Hoc Analyses of the SURPASS-3 and -4 Trials

Abstract

While basal insulins act primarily by reducing fasting serum glucose (FSG), the once-weekly GIP/GLP-1 receptor agonist tirzepatide targets both FSG and postprandial glucose (PPG). This post-hoc analysis assessed the efficacy of tirzepatide vs insulin degludec (SURPASS-3) and glargine (SURPASS-4) in people with T2D and different baseline glycemic patterns. We assessed change from baseline to Week 52 in HbA1c, FSG, and PPG across subgroup categories in participants on assigned treatment without rescue medication (efficacy estimand) using mixed-model repeated measures. Four subgroups were defined by different combinations of FSG and PPG (low FSG/low PPG, low FSG/high PPG, high FSG/low PPG, high FSG/high PPG). Low and high FSG and PPG were split based on median values of these parameters in SURPASS-3 (162 and 187 mg/dL) and -4 (164 and 197 mg/dL). While reductions in FSG were generally similar between tirzepatide and the basal insulins in both studies, decreases in PPG were greater with tirzepatide in all subgroups. This resulted in greater HbA1c reductions with tirzepatide vs basal insulin in all subgroups. The extent of reduction in FSG, PPG, and HbA1c in each subgroup was related to baseline values of these parameters. These data support previous observations of superior glycemic control with TZP compared with basal insulin, irrespective of baseline FSG and PPG levels. Disclosure F.Giorgino: Advisory Panel; Boehringer-Ingelheim, Amarin Corporation, Medtronic, Roche Diabetes Care, Sanofi, Bayer Inc., Novo Nordisk, Consultant; Novo Nordisk, Lilly, Research Support; Lilly, Roche Diabetes Care, AlfaSigma, Speaker's Bureau; Abbott, Boehringer-Ingelheim, Lilly, Sanofi, Medscape. D.R.Franco: Advisory Panel; Abbott, Eli Lilly and Company, Medtronic, Speaker's Bureau; Eli Lilly and Company, Boehringer Ingelheim and Eli Lilly Alliance, Medtronic, Sanofi, AstraZeneca, Roche Diabetes Care, Abbott Diabetes. C.Nicolay: Employee; Eli Lilly and Company. A.Hemmingway: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. Á.Rodríguez: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. R.Wiese: Employee; Eli Lilly and Company. Funding Eli Lilly and Company