ADA/EASD 2022 Consensus Report
The ADA/EASD 2022 Consensus Report (PMID 36148880, Davies MJ et al., co-published in Diabetes Care and Diabetologia) is the most widely referenced international T2D management document and represents a joint position of the two largest diabetes professional societies. It updates the 2018 and 2019 consensus reports and introduces several clinically relevant changes for tirzepatide positioning.
Tirzepatide specifically named: Unlike earlier consensus documents that predated tirzepatide’s approval, the 2022 report explicitly references tirzepatide as “the novel GIP and GLP-1 RA tirzepatide was associated with greater glycaemic and weight loss efficacy than semaglutide 1mg weekly” — directly referencing SURPASS-2. The document also notes the GIP/GLP-1 RA class (of which tirzepatide is the only member) as a distinct category with superior efficacy compared to single-mechanism GLP-1 RAs. SURPASS-CVOT was noted as ongoing at the time of publication; it has since reported (December 2025, NEJM).
Treatment decision framework by comorbidity:
- T2D + established CVD: GLP-1 RA (including tirzepatide) prioritised over SGLT2i — based on class-level CV outcomes evidence (LEADER, REWIND, SUSTAIN-6/PIONEER-6)
- T2D + heart failure: SGLT2i prioritised — based on heart failure hospitalisation reduction data (EMPA-REG, DAPA-HF, EMPEROR-Reduced)
- T2D + CKD: SGLT2i prioritised — based on kidney outcomes data (CREDENCE, DAPA-CKD, EMPA-KIDNEY); see also KDIGO 2022 CKD Diabetes Guideline
- T2D without specific comorbidities: agent choice guided by individual patient factors, weight management needs, tolerability, and cost
Weight management emphasis: The 2022 report placed greater emphasis on weight management as a core therapeutic target — not merely a secondary benefit — of T2D pharmacotherapy. This elevation of weight as a primary goal strengthens the positioning of tirzepatide (and GLP-1 RAs generally) over agents like sulfonylureas, TZDs, and most basal insulins that cause weight gain. The consensus notes evidence of greater weight reduction with subcutaneous semaglutide > other GLP-1 RAs, and explicitly acknowledges tirzepatide as providing even greater efficacy.
Combination with insulin: The consensus supports combining GLP-1 RAs (and by extension tirzepatide) with basal insulin for patients with inadequately controlled T2D — consistent with SURPASS-5 and SURPASS-6. The recommendation to consider reducing basal insulin dose when adding a GLP-1 RA is noted to prevent hypoglycaemia.
Ontology ADA EASD 2022 Consensus Report [guideline_for] Tirzepatide ADA EASD 2022 Consensus Report [guideline_for] Type 2 Diabetes ADA EASD 2022 Consensus Report [relates] ADA Standards of Care 2023-2024 ADA EASD 2022 Consensus Report [relates] KDIGO 2022 CKD Diabetes Guideline ADA EASD 2022 Consensus Report [relates] SGLT2 Inhibitors
Key Positioning Summary
| Clinical Context | Preferred Agent | Rationale |
|---|---|---|
| T2D + established CVD | GLP-1 RA (incl. tirzepatide) | CV outcomes class evidence |
| T2D + heart failure | SGLT2i | HHF reduction evidence |
| T2D + CKD | SGLT2i | Kidney outcomes evidence |
| T2D + obesity/overweight | GLP-1 RA/tirzepatide | Superior weight loss; weight as primary goal |
| T2D requiring low hypoglycaemia risk | GLP-1 RA/tirzepatide | Low intrinsic hypoglycaemia |
Connections
- Tirzepatide — recommended within GLP-1 RA tier (specifically named)
- ADA Standards of Care 2023-2024 — relates (ADA’s own 2023/2024 update)
- KDIGO 2022 CKD Diabetes Guideline — complements (CKD-specific)
- NICE Technology Appraisal TA924 — relates (UK-specific positioning)
- Cardiovascular Risk — relates (GLP-1 RA prioritised for T2D+CVD)
- SGLT2 Inhibitors — relates (HF/CKD preference)