Incretin Drugs Compared for Weight Loss, Glycemic Control, and Blood Pressure

The global prevalence of obesity and type 2 diabetes (T2D) continues to rise, posing significant public health challenges. Incretin-based therapies, such as GLP-1 receptor agonists (GLP-1 RAs) and dual GIP/GLP-1 receptor agonists, have emerged as highly effective treatments for both conditions. However, clinicians often face challenges in selecting the optimal incretin drug due to varying efficacies across multiple metabolic parameters. This study addresses the crucial need for a comprehensive comparison of different incretin drugs to determine which agents offer superior benefits for glycemic control, body weight reduction, and blood pressure management in adults with overweight or obesity, with or without T2D.

The network meta-analysis revealed significant differences in efficacy among the incretin drugs across the measured outcomes. For body weight reduction, tirzepatide consistently demonstrated superior efficacy, achieving an average 15.2% reduction from baseline, significantly greater than semaglutide's 10.5% reduction (p<0.001). Regarding glycemic control, semaglutide showed the largest decrease in HbA1c, averaging -1.8%, closely followed by tirzepatide at -1.7% (p=0.04 for difference). All incretin drugs demonstrated modest but statistically significant reductions in blood pressure, with liraglutide showing a -3.2 mmHg reduction in systolic blood pressure. > Overall, tirzepatide emerged as the most effective incretin drug for comprehensive metabolic improvement, demonstrating superior weight loss and comparable glycemic control to semaglutide, alongside beneficial effects on blood pressure.