A Study of Daily Oral Orforglipron (LY3502970) Compared With Insulin Glargine in Participants With Type 2 Diabetes and Obesity or Overweight at Increased Cardiovascular Risk

Study Overview
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Brief Summary
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The main purpose of this study is to determine safety and efficacy of orforglipron compared with insulin glargine in participants with type 2 diabetes and obesity or overweight at increased cardiovascular risk. The study will last approximately 2 years may include up to 27 visits.

Official Title
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A Phase 3, Open-Label Study of Once Daily LY3502970 Compared With Insulin Glargine in Adult Participants With Type 2 Diabetes and Obesity or Overweight at Increased Cardiovascular Risk

Conditions
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Chronic Kidney Disease, Type 2 Diabetes, Obesity, Overweight or Obesity, Overweight, Cardiovascular Diseases

Intervention / Treatment
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* Drug: Orforglipron
* Drug: Insulin Glargine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Have been diagnosed with type 2 diabetes mellitus (T2DM) Are at least 18 years of age or legal age of consent in the jurisdiction in which the study is taking place, whichever is older. Have HbA1c at screening ≥7.0% and ≤10.5% if background diabetes medication does not include a sulfonylurea, or ≥7.5% and ≤10.5% if background diabetes medication includes a sulfonylurea. Are on stable treatment of at least 1 and no more than 3 oral antihyperglycemic drugs for at least 90 days before screening. Antihyperglycemic drugs may include metformin, SGLT-2 inhibitors, and/or sulfonylureas Have increased risk for cardiovascular (CV) events due to: Coronary heart disease Peripheral arterial disease, presumed to be of atherosclerotic origin Cerebrovascular disease, presumed to be of atherosclerotic origin Chronic kidney disease (CKD) Congestive heart failure (CHF) New York Heart Association (NYHA) functional classification II to III Are of stable weight (± 5%) for at least 90 days prior to screening Have a BMI ≥25 kilograms per meter squared (kg/m2) at screening Exclusion Criteria: Have type 1 diabetes mellitus Have had chronic or acute pancreatitis any time prior to screening Currently receiving or planning to receive treatment for diabetic retinopathy and/or macular edema (e.g. laster photocoagulation or intravitreal injections of anty-VEGF inhibitors Have a known clinically significant gastric emptying abnormality Have acute or chronic hepatitis, signs and symptoms of any other liver disease, or blood alanine transaminase (ALT) or aspartate aminotransferase (AST) enzyme level ≥5.0 times the upper limit of normal (ULN) for the reference range, as determined by the central laboratory Have had any of the following within 60 days prior to screening: acute myocardial infarction, cerebrovascular accident (stroke), or hospitalization for congestive heart failure Have an eGFR <15 mL/min/1.73 m2 as determined at screening Have a family (first-degree relative) or personal history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 Have been taking any other diabetes medicines other than metformin, SGLT-2 inhibitors, and/or sulfonylureas during the last 90 days Have used any weight loss drugs, including herbal or nutritional supplements, within 90 days of screening

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Orforglipron<br>Participants will receive escalated doses of orforglipron orally. | Drug: Orforglipron<br>* Administered orally once daily<br>* Other names: LY3502970;|
| Active Comparator: Insulin Glargine<br>Participants will receive insulin glargine subcutaneously (SC). Doses will be individualized and titrated according to a treat-to-target algorithm. | Drug: Insulin Glargine<br>* Administered SC once daily<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to First Occurrence of Any Major Adverse Cardiovascular Event (MACE-4) [Myocardial Infarction (MI), Stroke, Hospitalization for Unstable Angina, or Cardiovascular (CV) Death] | Time to First Occurrence of Any MACE-4 (Myocardial Infarction (MI), Stroke, Hospitalization for Unstable Angina, or Cardiovascular [CV] Death) | Baseline to End of the Study (Approximate Maximum 104 Weeks) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to First Occurrence of Any MACE-3 Event (MI, Stroke, or CV death) | Time to First Occurrence of Any MACE-3 Event (MI, Stroke, or CV death) | Baseline to End of the Study (Approximately 104 Weeks) | 
| Change from Baseline in Hemoglobin A1c (HbA1c) | Change from Baseline in HbA1c | Baseline, Week 52 | 
| Change from Baseline in Fasting Serum Glucose | Change from Baseline in Fasting Serum Glucose | Baseline, Week 52 | 
| Change from Baseline in Daily Average 7-point Self-monitoring Blood Glucose (SMBG) Profile | Change from Baseline in Daily Average 7-point SMBG | Baseline, Week 52 | 
| Percentage of Participants with HbA1c Target Values Less Than (<)7.0% (53 mmol/mol) | Percentage of Participants with HbA1c Target Values <7.0% (53 mmol/mol) | Week 52 | 
| Change from Baseline in Body Weight | Change from Baseline in Body Weight | Baseline, Week 52 | 
| Percent Change from Baseline Body Weight | Percent Change from Baseline Body Weight | Week 52 | 
| Change from Baseline in Short Form 36 Version 2 (SF-36v2) Acute Form Domain Score | The SF-36v2 acute form is a 36-item generic, participant completed measure designed to assess 8 domains: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Scores of each domain are measured by T-scores, with a mean of 50 and standard deviation of 10; higher scores indicate better levels of function and/or better health. | Baseline, Week 52 | 
| Pharmacokinetics (PK): Plasma Serum Concentrations of Orforglipron | PK will be estimated based on the population PK model. | Baseline through Week 52 |