Novo Nordisk (NYSE: NVO) presented new retrospective real-world evidence at the European Association for the Study of Diabetes Annual Meeting 2026 in Milan, Italy, comparing cardiovascular outcomes in adults with type 2 diabetes who escalated their semaglutide dose versus those who switched to tirzepatide.

The analysis of 636,525 adults initially treated with once-weekly semaglutide injection 1 mg found that patients who escalated to semaglutide 2 mg had a statistically significant 6% lower risk of major adverse cardiovascular events (MACE) — including all-cause death, heart attack, and stroke — compared with those who switched to tirzepatide at doses up to 15 mg (Adjusted HR 1.06; 95% CI 1.04-1.08; P=0.005).

Within 365 days of their first semaglutide 1 mg prescription, 67.2% of patients remained on semaglutide 1 mg, 29.2% escalated to semaglutide 2 mg, and 3.6% switched to tirzepatide. By the 720-day follow-up, 57.4% remained on semaglutide 1 mg, while 36.9% had escalated to semaglutide 2 mg and 5.7% had switched to tirzepatide. Approximately 31% of patients who switched to tirzepatide reached a dose of 10 mg or higher during follow-up.

The company noted that the analysis has limitations common to retrospective real-world studies, including potential residual unmeasured confounding, the inability to establish causal relationships, and possible limitations in generalizability due to reliance on claims data. Safety outcomes were not assessed in this analysis.

Semaglutide injection carries a Boxed Warning for possible thyroid tumors, including cancer, and is contraindicated in patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2. Common side effects include nausea, vomiting, diarrhea, abdominal pain, and constipation.