Would you start once-weekly tirzepatide over once daily basal insulin in a patient with Type 2 diabetes with inadequate control on oral antihyperglycemia drugs?

The issue examined in the paper cited of whether insulin or GLP-1RA is a better strategy in the setting of inadequate control of T2D was a hot question in the first part of this century but has been examined repeatedly and is now codified in global guidelines -- GLP-1RA should be used before insulin in escalating diabetes pharmacotherapy absent contraindications or concerns over extreme insulin deficiency (e.g., type 1 diabetes). As concluded in the paper with tirzepatide, the most powerful diabetes drug marketed to date, "Tirzepatide outperformed basal insulins in controlling blood glucose, body weight, blood pressure, and lipids in subjects with T2D and is generally well-tolerated except for its higher gastrointestinal AEs."