Insulin Glargine
Insulin glargine is a long-acting basal insulin analogue used as a once-daily subcutaneous injection to control fasting blood glucose in T2D. It was the comparator in SURPASS-4 (T2D with high CV risk) and the basis for post-hoc kidney outcome analysis, where glargine was associated with a 36.9% increase in UACR over 85 weeks — in stark contrast to tirzepatide’s −6.8% reduction. This large divergence in kidney outcomes is partly explained by the metabolic differences between the agents (tirzepatide reduces weight and blood pressure, which themselves reduce kidney stress) but also potentially by patient selection.
Ontology Insulin Glargine [compared_against] Tirzepatide Insulin Glargine [comparator_in] SURPASS-4 Insulin Glargine [relates] Insulin-Use Reduction Insulin Glargine [relates] Kidney Outcomes Insulin Glargine [background_therapy] SURPASS-6
Comparison Against Tirzepatide
- HbA1c: −1.44% (glargine) vs −2.43%/−2.58% (tirzepatide 10/15mg) — tirzepatide superior
- Weight: Glargine associated with weight gain; tirzepatide with weight loss (tirzepatide advantage ~5–10 kg)
- Insulin use: Glargine requires daily injection; tirzepatide weekly
- Kidney outcomes: eGFR decline −3.6/year (glargine) vs −1.4/year (tirzepatide); UACR +36.9% (glargine) vs −6.8% (tirzepatide)
- Cardiovascular: MACE HR 0.74 (95% CI 0.51–1.08) tirzepatide vs glargine — not powered
- Side effects: Glargine: weight gain, hypoglycaemia (19%); tirzepatide: GI events, no hypoglycaemia without SU
- Cost/access: Glargine is widely available and often covered; tirzepatide is newer and more expensive
- Evidence quality: Glargine has decades of clinical use and independent evidence; tirzepatide comparison limited to SURPASS trials
Connections
- Tirzepatide — compared_against, [2021–2022]
- SURPASS-4 — comparator_in, [2021–2022]
- Kidney Outcomes — relates, [2022]