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Exposure assessment relied on prescription records rather than direct adherence measurements, and crucial confounders like smoking, duration of diabetes, and optic disc shape were not accounted for

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The key findings were: Tirzepatide met the primary goal of cardiovascular non-inferiority , confirming it is at least as safe for the heart as dulaglutide It did not quite meet statistical superiority over dulaglutide for MACE, although results trended in favour of tirzepatide Tirzepatide produced significantly greater reductions in HbA1c and body weight than dulaglutide Importantly, because SURPASS-CVOT used an active comparator with established cardiovascular benefit rather than a placebo, demonstrating superiority was inherently more difficult than in earlier placebo-controlled GLP-1 outcome trials