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Compared with daily insulin glargine and degludec, once-weekly tirzepatide significantly decreased HbA1c (WMD 1.08%, 95% CI (1.37, 0.78)), 2h-posprandial blood sugar (BS) (WMD 28.19 mg/dL, 95% CI (44.98, 11.41)), pre-meal BS (WMD 11.86 mg/dL, 95% CI (22.83, 0.9)), body weight (WMD 10.61 kg, 95% CI (13.24, 7.97)), systolic blood pressure (WMD 6.47 mmHg, 95% CI (8.32, 4.61)), diastolic blood pressure (WMD 2.30 mmHg, 95% CI (3.05, 1.55)), total cholesterol (WMD 4.78%, 95% CI (7.05, 2.50)), triglyceride (WMD 14.49%, 95% CI (19.55, 9.43)), LDL cholesterol (WMD 5.98%, 95% CI (9.83, 2.13)), and VLDL cholesterol (WMD 14.18%, 95% CI (19.03, 9.33)) and increased HDL cholesterol (WMD 7.13%, 95% CI (9.83, 2.13)), with a lower risk of hypoglycemia defined as BS 70 mg/dL (RR 0.46, 95% CI (0.28, 0.75))