- Adults with type 2 diabetes on semaglutide injection 1 mg, whose dose was increased to 2 mg, were associated with a statistically significant 6% lower risk of major adverse cardiovascular events (MACE), compared to switching to tirzepatide (up to 15 mg)1
- Retrospective real-world analysis of claims data for 636,525 adults living with type 2 diabetes compared outcomes for those escalated to semaglutide 2 mg versus switching to tirzepatide1
- Results from the COMPETE SWITCH CV study provide insights into GLP-1 RA treatment adjustment in adults with type 2 diabetes
PLAINSBORO, N.J. and BAGSVÆRD, Denmark, Sept. 29, 2026 /PRNewswire/ — Novo Nordisk today announced new retrospective real-world evidence in adults with type 2 diabetes treated with once-weekly semaglutide injection 1 mg. In the analysis, adults who escalated to semaglutide injection 2 mg were associated with a statistically significant 6% lower risk of major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction (heart attack), and stroke, than those who switched to tirzepatide up to 15 mg (Adjusted HR 1.06; 95% CI 1.04-1.08; P=0.005).1 These findings were presented at the European Association for the Study of Diabetes (EASD) Annual Meeting 2026 in Milan, Italy.
“For people with type 2 diabetes, switching therapies or adjusting dosages are often necessary to achieve glycemic control — still, cardiovascular risk should also remain an important consideration,” said Michael Radin, MD, executive medical director at Novo. “These data may help inform healthcare professionals facing a critical challenge: whether to increase the dosage or switch to another therapy for an adult with type 2 diabetes who is already treated with semaglutide. These real-world findings can help provide insights into how intensification strategies may affect cardiovascular outcomes as an important factor in patient care.”
In this analysis of 636,525 adults with type 2 diabetes receiving semaglutide 1 mg, 67.2% remained on semaglutide 1 mg, whereas 29.2% of patients had escalated their dose to semaglutide 2 mg, and 3.6% had switched to tirzepatide within 365 days after the index date (the date of the first prescription fill for semaglutide 1 mg). At the 720-day follow up, fewer patients remained on semaglutide 1 mg (57.4%), reflecting continued treatment intensification over time, with 36.9% escalating to semaglutide 2 mg and 5.7% switching to tirzepatide.1 After switching to an initial tirzepatide dose of either 2.5 mg or 5 mg, clinicians had the flexibility to titrate across the tirzepatide dosing regimen, where approximately 31% of patients who switched to tirzepatide reached ≥10 mg dose during follow-up.1 A subset of the study cohort evaluated patients with type 2 diabetes and more than one HbA1c and /or weight measurement at baseline and demonstrated consistent results (Adjusted HR, 1.07 [95% CI, 1.01-1.13], P<0.035).1 Safety outcomes were not assessed in this analysis.
“Treatment intensification is a common challenge we face in clinical practice, particularly for adults with type 2 diabetes who have not yet met their treatment goals but are otherwise tolerating their current regimen well,” said Kathryn S. Tierney, MSN, APRN, FNP-BC, FAANP, Middlesex Health MultiSpecialty Group in Middletown, CT. “These real-world findings suggest that escalating to semaglutide 2 mg may be a meaningful option for appropriate patients, as intensification of treatment was associated with a lower risk of major adverse cardiovascular events than those who switched therapies. The analysis reinforces the importance of considering cardiovascular outcomes, alongside glycemic management, when making treatment decisions.”
These findings build upon an earlier analysis of these data, which examined HbA1c and weight loss.2
Real-world study data can provide valuable insights into how treatments work outside of controlled clinical trial settings. Real-world data analyses also have several limitations; results may reflect residual unmeasured confounding, while associations can be demonstrated, causal relationships cannot be definitively established. Additionally, use of retrospective claims data may exclude patients with intermittent coverage or underserved populations, potentially limiting generalizability.3
It is important to note that semaglutide injection contains a Boxed Warning for possible thyroid tumors, including cancer, and should not be used in those with a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). The most common side effects include nausea, vomiting, diarrhea, stomach (abdominal) pain, and constipation.
About COMPETE SWITCH Cardiovascular (CV)
COMPETE SWITCH is a retrospective cohort study using Komodo Health’s Healthcare Map with linked laboratory results, a large US healthcare claims database (January 2018–September 2025). The study evaluated real-world treatment patterns among adults with type 2 diabetes receiving semaglutide 1 mg, specifically comparing outcomes after dose escalation to semaglutide 2 mg versus switching to tirzepatide.2 The cardiovascular component of COMPETE SWITCH assessed MACE using an intention-to-treat approach and included 185,705 adults who escalated to semaglutide 2 mg and 23,104 adults who switched to tirzepatide all of whom were followed from the point of either dose escalation or switching or end of study period.1 Overall, the collective COMPETE SWITCH analyses offer real-world insight into cardiometabolic outcomes associated with treatment strategies and decisions in adults with type 2 diabetes. Because treatment effects may vary across individuals (low or high responders), heterogeneity may have significant impact on studies of dose titration and multiple sequential dosing.
Novo is the global healthcare company that believes lasting health starts now. For over a century, we’ve combined leading scientific expertise with a deep understanding of people’s lives. We develop treatments and support that help millions of people make progress they can see, feel and sustain now and in the future. Every day, over 67,000 employees around the world advance our purpose to drive change for lasting health. Through our partnerships, programs and investments, we’re working to prevent disease, expand access to treatments and reduce our environmental impact to help even more people live healthier lives. In the United States, Novo has a 40-year presence, is headquartered in New Jersey and employs approximately 10,000 people. For more information, visit novonordisk.com and novonordisk-us.com and follow us on Instagram, LinkedIn, TikTok, Facebook, X and YouTube.
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References
- COMPETE SWITCH CV. Novo Nordisk Data on file.
- Fang G, Muhammad C, Swift C, et al. Cardiometabolic outcomes in adults with T2D treated with 1 mg semaglutide who titrate to 2 mg semaglutide vs switch to tirzepatide. Poster presentation at the American Diabetes Association Scientific Sessions; 5-8 June 2026, New Orleans, LA.
- Dang A. Real-world evidence: a primer. Pharm Med 37, 25–36 (2023). https://doi.org/10.1007/s40290-022-00456-6
