Evidence synthesis · §4
Tirzepatide compared with semaglutide in type 2 diabetes — summary of findings
Outcome-by-outcome summary with effect, certainty and the reason for each downgrade.
§4Summary of findings
§4.1Summary of findings
Table 7. Summary of findings for Tirzepatide compared with semaglutide in type 2 diabetes.
| Outcome | Participants (studies) | Effect as reported | Certainty | Reason for downgrade |
|---|---|---|---|---|
| Change in HbA1c (%, mmol/mol)The outcome the Institute designates as anchor for this indication. | 31,552 (14) | High certainty evidence from one adequately powered double-blind head-to-head trial indicates greater glycaemic and weight effect with tirzepatide at… | High | no downgrade |
| Discontinuation for adverse eventsReported as a summary-of-findings row rather than in a tolerability annex, following a public submission. | 28,448 (13) | Reported per contributing trial; see the included-studies table | High | no downgrade |
| Serious adverse eventsEvent counts are low; the estimate is imprecise by construction. | 27,108 (14) | Reported per contributing trial; see the included-studies table | Moderate | inconsistency |
| Any adverse eventAscertained by spontaneous report in the contributing trials. | 25,634 (14) | Reported per contributing trial; see the included-studies table | Moderate | inconsistency |
| Proportion achieving HbA1c <7.0 % and ≤6.5 %A secondary outcome for this indication. Its hierarchical position within each contributing trial is recorded on that trial's abstract where the Institute holds it. | 22,216 (13) | Reported as a secondary outcome in a subset of contributing trials | Moderate | publication bias |
| Change in fasting serum glucoseA secondary outcome for this indication. Its hierarchical position within each contributing trial is recorded on that trial's abstract where the Institute holds it. | 18,444 (13) | Reported as a secondary outcome in a subset of contributing trials | Moderate | imprecision |
| Certainty ratings describe confidence in the effect estimate for the stated outcome. They are not recommendations and do not transfer between outcomes. | ||||
§4.2Forest plot
Study estimatePooled estimate
§4.3Certainty assessment for the anchor outcome
Table 8. Reasoning recorded against each certainty domain for the anchor outcome.
| Domain | Rating | Reasoning |
|---|---|---|
| Risk of bias | No concern | No serious concern identified in this domain. |
| Inconsistency | No concern | No serious concern identified in this domain. |
| Indirectness | No concern | No serious concern identified in this domain. |
| Imprecision | No concern | No serious concern identified in this domain. |
| Publication bias | No concern | No serious concern identified in this domain. |
| Overall: High certainty. The Institute is confident that the true effect lies close to the estimate. Further research is very unlikely to change confidence in the estimate. | ||
References cited on this page
References are numbered in order of first citation in this document. Each superscript in the text links to its entry below.
- Frías JP, Davies MJ, Rosenstock J, Pérez Manghi FC, Fernández Landó L, Bergman BK, Liu B, Cui X, Brown K. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. New England Journal of Medicine 2021;385(6):503–515. doi:10.1056/NEJMoa2107519 · PMID 34170647
Identifiers are reproduced only where the Institute holds them. Where a digital object identifier or PubMed identifier is not shown, the Institute has recorded the journal and year and has not constructed an identifier.
Compound Evidence Institute · CEI-ES-029/4 · https://compoundevidence.com/syntheses/tirzepatide-vs-semaglutide-t2d/summary-of-findings/ · retrieved 30 July 2026