A new analysis presented at the European Association for the Study of Diabetes suggests that increasing the dose of semaglutide to 2 mg may offer better cardiovascular protection for adults with type 2 diabetes compared to switching to tirzepatide, raising important treatment considerations for clinicians.
Novo Nordisk has reported new real-world evidence suggesting that adults with type 2 diabetes who increased their semaglutide injection to 2 mg had a lower risk of major adverse cardiovascular events than those who switched to tirzepatide. The analysis, presented at the European Association for the Study of Diabetes annual meeting in Milan, compared treatment intensification strategies in routine practice and found a 6% lower risk in the semaglutide dose-escalation group. Novo said the findings may help clinicians decide whether to raise the dose of an existing GLP-1 treatment or change therapy altogether.
The company’s COMPETE SWITCH CV analysis drew on US claims data, with linked laboratory results from Komodo Health’s Healthcare Map covering 636,525 adults with type 2 diabetes between January 2018 and September 2025. The cardiovascular analysis included 185,705 people who escalated to semaglutide 2 mg and 23,104 who switched to tirzepatide, with major adverse cardiovascular events defined as death from any cause, heart attack or stroke. Novo said the adjusted hazard ratio was 1.06, with a 95% confidence interval of 1.04 to 1.08, indicating the event rate was higher in the tirzepatide-switch group.
The study’s real-world design gives it broad practical relevance, but it also carries important limits. Novo and the researchers noted that unmeasured confounding could still affect the outcome, meaning the results cannot prove one treatment strategy causes better cardiovascular protection than the other. Even so, the direction of the findings is notable because it points to benefit from intensifying semaglutide rather than moving to another drug in patients already established on treatment.
The new results also sit alongside a mixed and fast-moving evidence base around tirzepatide and GLP-1 medicines. A June 2026 cohort study indexed in PubMed found tirzepatide was linked to a lower risk of major adverse cardiovascular events than GLP-1 receptor agonists in a cardiovascular-kidney-metabolic progression analysis, while a July 2026 systematic review and meta-analysis in PMC found tirzepatide was not associated with a statistically significant reduction in major adverse cardiovascular events versus GLP-1 receptor agonists in adults with overweight or obesity. Other real-world studies published this year have also reported cardiovascular advantages for tirzepatide in selected populations, underlining that results may vary depending on the patient group, comparison treatment and study design. Novo said the new data support semaglutide dose escalation as a meaningful option for appropriate patients, and company medical director Michael Radin said the findings may help inform the choice between increasing the dose and switching therapies.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
