Heart Health

GLP-1 with type 2 diabetes

How strong is the cardiovascular evidence for someone like you? Type 2 diabetes

Recommendationglp1-diabetesNo one has reached this rule yet

Outcome benefit across the class; SURPASS-CVOT tested tirzepatide against an active comparator

Clinical review

All reviewers

No clinician has signed off this rule yet. It reflects our reading of the guidelines cited below, which has not been independently checked.

What someone who reaches this rule is told

Word for word, as generated for the example person below. Figures in the text are theirs.

  • Strongly recommended

    With type 2 diabetes, a GLP-1 receptor agonist is one of the two drug classes that lower cardiovascular risk beyond their effect on blood sugar — and guidelines now favour it for that reason.

    Semaglutide, liraglutide and dulaglutide each reduced cardiovascular events in people with type 2 diabetes at raised risk, and oral semaglutide reproduced it in SOUL. Tirzepatide was tested differently and more informatively: SURPASS-CVOT compared it head-to-head against dulaglutide — an active drug, not placebo — in people with diabetes and cardiovascular disease, and met non-inferiority for major events while producing markedly more weight loss and better A1c, blood pressure and lipids. Which of these suits you depends on your kidney function, whether weight loss is a goal, and cost.

    Outcome-provenTested in randomised trials measuring heart attacks, strokes, or death, not a stand-in for them.· Class I· Level A· checked 2026-09-12

    SURPASS-CVOT — tirzepatide vs dulaglutide, active-comparator cardiovascular outcomes trial · Class I in diabetes at raised cardiovascular risk

An example person who reaches it

Diabetes, already on a statin” — an illustrative profile, not a real user.

54-year-old womanBP 134/84LDL 96diabetes, A1c 7.2%on a statin10-yr PREVENT-ASCVD 5.4%

Their path through weight and glp-1 medication

  1. BMI ≥27 kg/m², or type 2 diabetes?Yes
  2. How strong is the cardiovascular evidence for someone like you?Type 2 diabetes ← this rule
  3. Applies to anyone starting oneAlways

Where it sits

Asked after: BMI 27 or above, or type 2 diabetes

Sources

Cited by the recommendations above.

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Runs in lib/engine/glp1Pathway.ts as glp1-diabetes.