American College of Physicians, April 3-5

The annual meeting of the American College of Physicians (Internal Medicine Meeting) was held from April 3 to 5 in New Orleans and was attended by internal medicine physicians, adult medicine specialists, subspecialists, medical students, and allied health professionals. The conference highlighted recent advances in the prevention, detection, and treatment of illnesses in adults, with presentations focusing primarily on updates in neurology, oncology, infectious diseases, endocrinology, and cardiology.

As part of the SURPASS-SWITCH trial, Liana K. Billings, M.D., of Endeavor Health (NorthShore Hospitals) in Evanston, Illinois, and colleagues found that switching to tirzepatide leads to greater glycated hemoglobin (HbA1c) reduction and weight loss than simply increasing the dose of dulaglutide, without additional safety concerns.

The authors aimed to evaluate if switching adults with inadequately controlled type 2 diabetes from submaximal dulaglutide to tirzepatide offered additional efficacy compared with dulaglutide dose escalation. Enrolled in the study were 282 adults with type 2 diabetes and an HbA1c ≥7.0 to ≤9.5 percent who were on a stable dose of dulaglutide weekly (0.75 or 1.5 mg) for at least six months and zero to three oral antihyperglycemic medications for at least three months. Patients were randomly assigned to either an escalation of dulaglutide to the maximum tolerated dose/4.5 mg once weekly or a switch to tirzepatide and increasing to the maximum tolerated dose/15 mg once weekly for 40 weeks.

After 40 weeks, the researchers found that HbA1c reduction was −0.67 percent with dulaglutide and −1.44 percent with tirzepatide, while the final mean HbA1c was 7.1 percent in the dulaglutide arm and 6.2 percent in the tirzepatide arm. Weight loss was 3.6 kg in the dulaglutide arm versus 10.5 kg in the tirzepatide arm. The most common side effects were gastrointestinal, including nausea and diarrhea, in both groups.

“This study highlights the importance of considering alternative therapies rather than maximizing the dose of a current medication when patients are not meeting their treatment goals,” Billings said. “We now provide evidence to support the decision to switch to tirzepatide if a patient with type 2 diabetes has uncontrolled blood glucose on submaximal doses of dulaglutide.”

The study was funded by Eli Lilly, the manufacturer of tirzepatide.

Abstract

In another study, Zehavi Horowitz-Kugler, M.D., of K Health in New York City, and colleagues demonstrated the potential efficacy of artificial intelligence (AI) to better diagnose and manage common acute symptoms and improve clinical decision-making in primary care settings.