Adding semaglutide to an SGLT2 inhibitor shows benefit in T2D

  • Zinman B & al.
  • Lancet Diabetes Endocrinol
  • 1 Mar 2019

  • International Clinical Digest
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Takeaway

  • Adding once weekly glucagon-like peptide-1 receptor agonist (GLP-1RA) semaglutide (Ozempic) for patients with type 2 diabetes (T2D) not at goal with a sodium-glucose cotransporter-2 inhibitor (SGLT2i) further reduces glycemia and weight. 

Why this matters

  • GLP-1RAs and SGLT2is have been recommended after metformin for patients with T2D and cardiovascular disease, but few data address their concomitant use.  

Study design

  • Double-blind, international, parallel-group trial, 294 patients with T2D, HbA1c 7.0%-10.0% despite use of metformin and SGLT2i.
  • Participants randomly allocated to addition of 1.0 mg semaglutide or placebo injection once weekly for 30 weeks.
  • Funding: Novo Nordisk.

Key results

  • From baseline to week 30, HbA1c change:
    • semaglutide, −1.5% points vs
    • placebo, −0.1% points (P<.0001>
  • Body weight changes: 
    • semaglutide, −4.7 kg vs 
    • placebo, −0.9 kg (P<.0001>
  • Proportions achieving HbA1c
  • semaglutide, 78.7% vs 
  • placebo, 18.7% (P<.0001>
  • Proportions achieving HbA1c ≤6.5%:
    • semaglutide, 56.1% vs
    • placebo, 3.9% (P<.0001>
  • Most without concomitant weight gain or hypoglycemia.
  • Proportions with mean weight reductions ≥5%:
    • semaglutide, 49.9% vs 
    • placebo, 8.2% (P<.0001>
  • Proportions with mean weight reductions ≥10%:
    • semaglutide, 15.1% vs 
    • placebo, 1.4% (P=.0004).
  • Serious adverse events: 4.7% semaglutide vs 4.0% placebo.
  • Gastrointestinal adverse events: 37.3% with semaglutide vs 13.2% placebo.
  • Limitations

    • Relatively short.
    • No subgroup analyses.
    • Cardiovascular biomarkers not assessed.