Has anyone dealt with novo nordisk vs eli lilly?

This one has a reasonably settled answer, so here it is. The gap between trial results and real-world results is consistent and it is not fraud. Trial participants get titration by protocol, scheduled contact, free drug and dietetic support; removing that infrastructure costs a few percentage points every time it has been measured. When your own curve sits below the published mean, that is the likeliest explanation before anything about you or your material.

BariatricNurseD said:

The gap between trial results and real-world results is consistent and it is not fraud.

BariatricNurseD said:

...regarding the trial evidence...

I think this is an underappreciated point. To expand on it with some data:

A recent meta-analysis of 18 RCTs (n=15,600) found that the trial evidence was associated with a robust effect size across diverse patient populations[1].

The NNT was 15, which is comparable to antihypertensives for stroke reduction. That's a strong clinical argument for this approach.

tom_AK said:

I keep finding that the number in the press summary and the number in the paper are not the same number, and the difference is always in the same…

Same position here, arrived at the long way round. Read four things before the headline number. The population, because trial populations are selected and supported in ways that real cohorts are not. The comparator, because "better than placebo" and "better than the current standard" are different claims and get reported identically. The primary endpoint as pre-registered, because a secondary endpoint promoted after the fact is a hypothesis rather than a finding. And the completion rate, because a large effect in the half of participants who finished is a different result from a large effect in everybody enrolled.

From the other side of the consultation, briefly.

Propensity score matching studies and the trial evidence: when RCTs aren't available for a specific question, propensity score-matched observational studies can provide useful evidence.

A recent PSM study of 12,000 GLP-1 users vs matched controls showed reduced heart failure hospitalization (HR 0.74) over 3 years of follow-up[1].

These results complement the RCT data and suggest the benefits translate to real-world populations.