Novo Nordisk: semaglutide 2 mg escalation matches tirzepatide for HbA1c <7% and yields greater ≥5% weight loss

Study design

COMPETE SWITCH is a retrospective cohort analysis using Komodo Health’s Healthcare Map with linked laboratory results (January 2018–September 2025). Adults with type 2 diabetes on semaglutide 1 mg who either escalated to semaglutide 2 mg or switched to tirzepatide (initial 2.5 mg or 5 mg with allowed titration) were evaluated. The HbA1c cohort included 64,888 adults; the weight‑loss cohort included 56,852 adults.

Glycaemic outcomes

By one year, 74.7% (95% CI 73.3%–76.2%) of those escalated to semaglutide 2 mg and 75.1% (95% CI 74.0%–76.2%) of those switched to tirzepatide achieved an HbA1c <7%. Time‑variable analysis produced an estimate of 0.98 (95% CI 0.94–1.02; P=0.343), indicating comparable glycaemic outcome rates between strategies.

Weight outcomes

In the weight cohort (baseline mean ~105–106 kg), 60.5% (95% CI 58.7%–62.3%) of patients escalated to semaglutide 2 mg achieved ≥5% weight loss by one year versus 55.3% (95% CI 53.9%–56.7%) who switched to tirzepatide. The hazard ratio for ≥5% weight loss favored semaglutide escalation (HR 1.19; 95% CI 1.15–1.24; P<0.001).

Titration and study limitations

After switching, clinicians could titrate tirzepatide; approximately 24% of the HbA1c cohort and 40% of the weight cohort reached doses >5 mg, and ~3%–5% reached 15 mg. Authors note limitations of retrospective claims analyses, including possible residual confounding, incomplete laboratory or weight data for some patients, exclusion of those with intermittent coverage or underserved populations, and inability to establish causality. Findings were presented at the American Diabetes Association Scientific Sessions on June 7, 2026.