SURPASS-CVOT plus the 2026 ADA Standards: Rethinking your first GLP-1—and your next switch
Industry Buzz
These medications have truly been game changers in the cardiometabolic/kidney space. Their benefits in glycemic control, weight management, and cardiovascular health are clear and have the potential to improve the quality of life for countless patients.
—Joseph Ebinger, MD
This is a very important finding as it adds to the literature showing numerous beneficial effects of tirzepatide in several areas. It shows that tirzepatide can really help reduce cardiometabolic risk and should be considered in eligible patients.
—Nishant Shah, MD
The 2026 Standards of Care in Diabetes from the American Diabetes Association recommends a GLP-1 in a number of contexts.[]
But which GLP-1 is right for your patient? MDLinx examines the latest recommendations.
Results from the SURPASS-CVOT trial demonstrated that for patients with type 2 diabetes, tirzepatide is a cardiovascular safe alternative to dulaglutide.[]
“SURPASS-CVOT showed that tirzepatide provides cardiovascular benefit for patients with type 2 diabetes and established ASCVD at least comparable to an established GLP-1 RA, with significant reductions in major adverse cardiovascular events. Tirzepatide significantly reduced all-cause mortality by 16% vs dulaglutide. With its metabolic, renal, and weight loss superiority compared with dulaglutide, it is a preferred drug to prescribe,” David Maron, MD, Professor of Medicine and Cardiovascular Medicine at Stanford, told MDLinx.
Experts say the findings are significant and physicians should consider tirzepatide for appropriate patients.
“This is a very important finding as it adds to the literature showing numerous beneficial effects of tirzepatide in several areas. It shows that tirzepatide can really help reduce cardiometabolic risk and should be considered in eligible patients,” Nishant Shah, MD, Associate Professor of Medicine in Cardiology at Duke Heart Center and co-chair of the ACC Cardio-Metabolic Workgroup, told MDLinx.
Related: What docs can't afford to overlook amid the GLP-1 boomGLP-1, diabetes, and symptomatic heart failure
In the 2026 Standard of Care in Diabetes, a notable revision included the recommendation that in people with type 2 diabetes and symptomatic heart failure, a dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 RA should be used.[]
The recommendation has earned support from many working in cardiology.
“There is clear data that GLP/GIP medications improve heart failure outcomes, particularly among patients with type 2 diabetes. Heart failure is a chronic disease that requires adherence to a number of medications. Despite this, many patients suffer disease exacerbations and require hospitalizations. The cardiovascular community welcomes any agents that can help improve the quality and length of life of patients living with heart failure,” Joseph Ebinger, MD, MS, FACC, chair of the ACC’s Hypertension Working Group and a member of the ACC’s Prevention of CV Disease Section Leadership Council, told MDLinx.
“These medications have truly been game changers in the cardiometabolic/kidney space. Their benefits in glycemic control, weight management, and cardiovascular health are clear and have the potential to improve the quality of life for countless patients.”
Related: How to prepare your practice for growing demand of GLP-1 medicationsChoosing the best GLP-1 for patients
But when it comes to choosing the best GLP-1, Dr. Ebinger says that may depend on the patient.
“The ‘right’ GLP is the one that patients can take and tolerate,” he said. “Again, while some data has shown that tirzepatide may have slight superiority to other agents, the benefit obtained from improved glycemic and weight control is beneficial overall.”
As understanding of GLP-1 medications constantly evolves, the experts who spoke with MDLinx say this adds a challenge for physicians in prescribing.
“The challenges are many,” Dr. Maron said. “There is a rapidly expanding evidence base, with frequent publication of large clinical trial findings. There are a proliferating number of agents, divergent FDA-approved indications, and access barriers. Guidelines are updated frequently. There are important differences between agents in glycemic efficacy, weight loss, cardiovascular and renal outcomes, GI tolerability, and dosing frequency,” he said.
“The FDA-approved indications differ substantially across agents, creating confusion. The cost, insurance, and access barriers are a huge challenge and probably have the greatest impact on which drug is prescribed. Guidelines from major professional societies issue type 2 diabetes treatment recommendations that differ significantly on first-line therapy,” he said.