Up to 95.6% of US diabetes patients and 86.3% of UK patients preferred the tirzepatide medication profile over semaglutide 1mg, driven primarily by greater HbA1c and weight reductions.
95.6% preferred tirzepatide (US)When US diabetes patients were shown the clinical profiles of tirzepatide versus semaglutide 1mg based on head-to-head trial data, nearly all preferred the tirzepatide profile across all three doses.
What the researchers found
When presented with the clinical profiles of tirzepatide (5, 10, and 15mg) versus semaglutide 1mg based on head-to-head trial data, predicted preference for tirzepatide was 95.6% in the US and 86.3% in the UK.
The key drivers of preference differed between countries: US patients weighted HbA1c reduction most heavily (26.3% relative attribute importance), while UK patients prioritized avoiding hypoglycemia (32.8%). Both groups preferred greater HbA1c improvement, greater weight loss, lower nausea frequency, lower hypoglycemia risk, and the single-use pre-filled pen delivery system. Weight reduction and nausea frequency also significantly influenced preferences.
Why it matters
As tirzepatide and semaglutide compete in the diabetes and obesity markets, understanding what patients actually value helps guide treatment decisions and healthcare resource allocation. This study shows that when patients are informed about the clinical differences, they strongly prefer the dual-action tirzepatide profile — but the reasons vary by healthcare culture. The cross-cultural difference (US prioritizes efficacy, UK prioritizes safety) has implications for how these drugs are positioned and prescribed in different markets.
How the study worked
620 injection-naive adults with type 2 diabetes (301 US, 319 UK) completed a web-based discrete choice experiment — a validated survey method where participants choose between hypothetical treatment profiles that vary across defined attributes. Five treatment attributes were tested: delivery system, nausea frequency, hypoglycemia frequency, HbA1c reduction, and weight reduction. Attribute levels were derived from the SURPASS-2 head-to-head clinical trial comparing tirzepatide doses to semaglutide 1mg. Data were analyzed using multinomial mixed logit models separately by country.
What this study cannot tell us
The study was funded by Eli Lilly (tirzepatide's manufacturer), which introduces potential sponsorship bias in study design and attribute selection. Participants evaluated hypothetical profiles rather than experiencing the medications firsthand. Only injection-naive patients were included, limiting generalizability to those already on injectable therapy. Semaglutide was represented at only the 1mg dose — higher doses (2.4mg for obesity) could change the preference balance. The discrete choice format simplifies real-world decision-making.
How to read the evidence
This is a well-designed discrete choice experiment with 620 participants across two countries, using attributes derived from a head-to-head randomized clinical trial. The statistical methodology (multinomial mixed logit) is appropriate. However, the study measures stated preferences for hypothetical profiles rather than real-world treatment outcomes, and the industry sponsorship should be noted.
When this study was published
Published in 2023, this study captures early patient preference data in the tirzepatide vs. semaglutide comparison. Since then, both drugs have expanded their indications and market presence, and additional head-to-head data has emerged.
The bigger picture
Tirzepatide represents the next generation of incretin-based therapies — combining GIP and GLP-1 receptor agonism in a single molecule. This patient preference study adds a patient-centered perspective to the clinical trial data showing tirzepatide's superiority in HbA1c and weight endpoints. As healthcare systems increasingly incorporate patient preferences into formulary decisions and treatment guidelines, this type of evidence becomes influential in determining drug access and reimbursement.
Questions still open
- Would real-world medication experience (rather than hypothetical profiles) produce the same strength of preference for tirzepatide?
- How would preferences change if semaglutide 2.4mg (the obesity dose) were included in the comparison?
- Do the cross-cultural preference differences reflect healthcare system influences (NHS vs. private insurance) or genuine cultural variation in health values?
Common questions
What is the difference between tirzepatide and semaglutide?
What do diabetes patients care about most when choosing medications?
Read the original research
The Impact of Substantial Improvements in HbA1c and Weight Loss on the Medication Preferences of People with Type 2 Diabetes.
Patient preference and adherence, 17, 793-805
Citation
Gelhorn, Heather L; Osumili, Beatrice; Brown, Katelyn; Ross, Melissa M; Schulz, Andrea; Fernandez, Gabriela; Boye, Kristina S. (2023). The Impact of Substantial Improvements in HbA1c and Weight Loss on the Medication Preferences of People with Type 2 Diabetes.. Patient preference and adherence, 17, 793-805. https://doi.org/10.2147/PPA.S401465