Semaglutide 2 mg Linked to Lower Cardiovascular Risk in Diabetes

Novo Nordisk has reported new real-world data suggesting that adults with type 2 diabetes who increased their once-weekly semaglutide injection dose from 1 mg to 2 mg had a lower risk of major cardiovascular events than those who switched to tirzepatide.

The findings were presented at the 2026 Annual Meeting of the European Association for the Study of Diabetes (EASD) in Milan, Italy.

The retrospective analysis included 636,525 adults with type 2 diabetes who were receiving semaglutide 1 mg. Among these patients, 29.2% increased their dose to semaglutide 2 mg, while 3.6% switched to tirzepatide within 365 days of starting semaglutide 1 mg.

According to Novo Nordisk, patients who escalated to semaglutide 2 mg were associated with a statistically significant 6% lower risk of major adverse cardiovascular events (MACE) compared with those who switched to tirzepatide at doses of up to 15 mg. MACE included death from any cause, heart attack and stroke.

The analysis found that treatment patterns changed over time. At 720 days, 36.9% of patients had increased their semaglutide dose to 2 mg, while 5.7% had switched to tirzepatide. The proportion remaining on semaglutide 1 mg fell to 57.4%.

Among patients who switched to tirzepatide, doctors could increase the dose during follow-up. Around 31% of these patients eventually received a tirzepatide dose of at least 10 mg.

A separate analysis of patients who had more than one HbA1c or weight measurement at baseline showed similar results, according to Novo Nordisk.

The company said the new findings build on an earlier analysis that examined changes in HbA1c levels and body weight among the same patient population.

Michael Radin, executive medical director at Novo Nordisk, said the findings could provide healthcare professionals with additional information when deciding whether to increase the semaglutide dose or switch to another treatment.

However, the study was based on retrospective real-world claims data and does not establish that increasing semaglutide directly causes a lower cardiovascular risk. The researchers noted that unmeasured differences between patient groups could have influenced the results. The data may also not fully represent people with intermittent insurance coverage or underserved populations.

Safety outcomes were not assessed in this analysis.

Novo Nordisk also noted that semaglutide injection carries a Boxed Warning concerning the potential risk of thyroid C-cell tumors. The treatment should not be used by people with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2.