CagriSema Against Tirzepatide in Type 2 Diabetes: What REIMAGINE 5 Shows
Published: October 7, 2026 · 3 min read · By Grey Peptides News Desk · ✓ Sourced
Novo Nordisk reports that in REIMAGINE 5, CagriSema produced more weight loss than tirzepatide in people with type 2 diabetes, 12.4% against 9.1% over 60 weeks, and lowered HbA1c about as much. Two details matter: the comparator was tirzepatide 5 mg, its lowest maintenance dose, and CagriSema was at 1.0 mg of each component, not the 2.4 mg used in the obesity trials. The figures are the company's and not yet published.
The trial
REIMAGINE 5 is the head-to-head in CagriSema's type 2 diabetes programme. Its registration on ClinicalTrials.gov describes a randomised, open-label phase 3 trial that enrolled 1,023 adults whose diabetes was inadequately controlled on metformin, an SGLT2 inhibitor or both. They took weekly CagriSema, the combination of cagrilintide, an amylin analogue, with semaglutide, or weekly tirzepatide, for 60 weeks. The two primary endpoints were the change in HbA1c and the percentage change in body weight.
What Novo Nordisk reported
In its September 21 announcement, the company reported weight loss of 12.4% on CagriSema against 9.1% on tirzepatide, which it calls superior, and HbA1c falls of 1.71 against 1.67 percentage points, which it calls non-inferior. The figures use the efficacy estimand, which describes people who stayed on treatment. The release describes CagriSema as well tolerated, with a safety profile consistent with earlier studies, but gives no adverse event rates or participant numbers.
The doses are the story
The comparison was CagriSema at 1.0 mg of each component against tirzepatide 5 mg, which is tirzepatide's lowest maintenance dose. That makes this a result about these two doses, not a general ranking of the two drugs. It is also the opposite of February's REDEFINE 4 in obesity, where Novo reported that CagriSema did not meet its primary endpoint against tirzepatide. The trial was open-label, so participants knew which drug they took.
Where this leaves CagriSema
The same release reported REDEFINE 9, in which CagriSema lowered weight 21.0% against 2.0% on placebo over 68 weeks in adults with overweight or obesity. Novo filed its obesity application with FDA in December 2025 and expects a decision in the fourth quarter of 2026. REIMAGINE 5 is a diabetes trial and is not part of that application. Until it is published, the figures above are the company's own summary.
Related on Grey Peptides
The rest of CagriSema's diabetes programme, published earlier. CagriSema encyclopedia entry
The REDEFINE trials, the filing and the regulatory timeline. Tirzepatide encyclopedia entry
The comparator, and its approved doses.
ClinicalTrials.gov - REIMAGINE 5 (NCT06534411)
Trial design read on ClinicalTrials.gov on October 7, 2026. The results are Novo Nordisk's, from its September 21, 2026 announcement, read in full the same day; they have not been published in a journal.