# No uncontested throne for glp1 king

> glp1 king examines SURPASS-2: tirzepatide achieved greater reductions, while semaglutide also improved blood sugar. What does a crown leave out?

**A contested crown**

Tirzepatide won the SURPASS-2 comparison. Semaglutide also lowered blood sugar. I want the achievement on each side left visible after the crown is awarded.

## SURPASS-2

In [SURPASS-2, tirzepatide reduced glycated haemoglobin and body weight more than semaglutide](https://pubmed.ncbi.nlm.nih.gov/34170647/) in adults with type 2 diabetes over 40 weeks. This was an open-label trial comparing tirzepatide with semaglutide 1 mg. I can applaud that result while leaving its population, comparator and measured outcomes attached.

The [estimated glycated-haemoglobin reductions were 2.01, 2.24 and 2.30 percentage points in the tirzepatide groups, versus 1.86 percentage points with semaglutide](https://pubmed.ncbi.nlm.nih.gov/34170647/). Tirzepatide was superior at all studied doses. Yet the semaglutide group also had a reduction. The winning margin sits between two improvements.

That is the awkward contest behind GLP-1 King. I enjoy a decisive result; I’m less satisfied when the runner-up disappears from the account. Superiority describes the difference between treatments in this trial. The reduction on the other side remains worth reporting. A crown can mark the ranking while leaving both achievements visible.

## A placebo victory

The [SELECT trial reported a 20% relative reduction in major adverse cardiovascular events](https://pubmed.ncbi.nlm.nih.gov/37952131/) with semaglutide versus placebo in adults with established cardiovascular disease and overweight or obesity, without diabetes. The composite covered cardiovascular death, nonfatal myocardial infarction and nonfatal stroke.

That finding gives semaglutide a different achievement against a different opponent. It concerns cardiovascular events in SELECT’s population. It leaves the direct SURPASS-2 result intact, just as that result leaves room for semaglutide’s cardiovascular evidence.

My enthusiasm for tirzepatide’s comparative win can coexist with respect for semaglutide’s results. Calling one medicine the winner of a specified contest is useful. Letting that title swallow the rest of the record is where the coronation loses me.

## Pick a comparison

- [Tirzepatide versus semaglutide](/head-to-head): the direct weight-loss contest and its group averages.
- [The placebo opponent](/placebo): an initial weight-loss result and a longer trial.
- [Clinical outcomes](/heart-and-kidney): cardiovascular events, kidney events and heart-failure symptoms.
- [Adverse effects](/side-effects): the unwelcome findings that share the record with benefits.

## Benefits beside adverse findings

The [SUSTAIN-6 finding of more diabetic-retinopathy complications alongside a cardiovascular benefit](https://pubmed.ncbi.nlm.nih.gov/27633186/) prevents any comfortable coronation. I refuse to file the unwelcome result in a separate mental drawer. Both outcomes deserve space in the assessment.

Likewise, a [favourable overall risk–benefit assessment in type 2 diabetes](https://pubmed.ncbi.nlm.nih.gov/34305810/) still includes digestive effects, increased biliary-disease risk and uncertainty about rarer outcomes. Admiration survives those details. A useful judgment needs them.

[Examine the direct contest](/head-to-head), or go straight to the [study list](/references).

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GLP-1 King is my spectator’s notebook on published research, an editorial site without a medical or retail business and without medical advice.