In insulin-naive patients with type 2 diabetes on metformin (± sulfonylureas), once-weekly semaglutide significantly reduced HbA1c and promoted weight loss more effectively than daily insulin glargine, with a lower incidence of hypoglycaemia, though gastrointestinal side effects were more common.
PICO Summary
Population:
Insulin-naive adults with type 2 diabetes (n=1089), with insufficient glycaemic control on metformin (± sulfonylureas).
Intervention:
Once-weekly semaglutide (0.5 mg or 1.0 mg), over 30 weeks.
Comparison:
Once-daily insulin glargine, titrated to reach pre-breakfast glucose targets.
Outcome:
- Efficacy: At 30 weeks, semaglutide 0.5 mg and 1.0 mg reduced HbA1c by 1.21% and 1.64%, respectively, compared to a 0.83% reduction with insulin glargine.
- Safety and Tolerability: Fewer hypoglycaemic episodes were reported with semaglutide compared to insulin glargine. Common side effects for semaglutide included gastrointestinal symptoms like nausea, while insulin glargine users experienced skin reactions.
Clinical Summary
Main Finding:
Once-weekly semaglutide achieved greater HbA1c and weight reductions than insulin glargine in type 2 diabetes patients inadequately controlled on oral therapy.
Clinical Relevance:
Semaglutide offers a promising alternative to insulin glargine for patients needing improved glycaemic and weight management, with the added benefit of reduced hypoglycaemia risk.
Study Overview:
- Type of Study: Open-label, randomised, multicentre, multinational, phase 3a trial.
- Sample Size & Population: 1089 adults with type 2 diabetes.
- Intervention Duration & Doses: 30 weeks, with semaglutide (0.5 mg or 1.0 mg) compared to insulin glargine.
- Comparison: Insulin glargine, daily dosing.
Outcomes:
- Primary Measure (HbA1c): Semaglutide achieved reductions up to 1.64%, superior to insulin glargine’s 0.83%.
- Secondary Measure (Body Weight): Semaglutide resulted in weight losses of up to 5.17 kg, in contrast to a 1.15 kg weight gain with insulin glargine.
- Safety Profile: Semaglutide showed fewer hypoglycaemic events and was associated with gastrointestinal symptoms; insulin glargine users experienced more skin-related side effects.
Considerations:
The open-label design may have influenced participant perception. Longer studies are needed to evaluate durability and long-term safety.
Reference:
Aroda, V. R., et al. (2017). The Lancet Diabetes & Endocrinology, 5(5), 355-366. doi:10.1016/S2213-8587(17)30085-2
Disclosure: This article on Hormone Insight was created with both human and AI assistance. The human expert editor reviewed the article before publication to ensure accuracy, quality, and clarity.
