Comparing semaglutide and canagliflozin for patients with Type 2 diabetes

This study compared the safety and effectiveness of semaglutide (Ozempic) and canagliflozin (Invokana) for patients with uncontrolled type 2 diabetes (T2D). The authors found that semaglutide more effectively reduced blood glucose levels and body weight than canagliflozin.

Often, patients with T2D are given metformin (Glucophage) to treat initial symptoms. However, some patients develop uncontrolled diabetes. This means that a patient’s blood glucose levels remain high after treatment. HbA1c is a measure of blood glucose for the previous 3 months, where above 7% is considered uncontrolled. A second anti-diabetes drug is usually recommended if blood glucose levels remain uncontrolled.

Options for the second treatment include glucagon-like peptide 1 (GLP-1) agonists like semaglutide. This drug stimulates the production of insulin, which then lowers blood glucose. Another treatment option is canagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor. This drug works by promoting glucose secretion through the urine, which lowers the amount of glucose in the blood. It is unclear which of these agents is more effective for patients with uncontrolled T2D receiving metformin.

739 patients with uncontrolled T2D following metformin treatment were divided into 2 groups. 367 patients received semaglutide and 372 patients received canagliflozin. Patients were followed for 52 weeks.

At the beginning of the study, HbA1c levels were 8.3% on average. Semaglutide reduced HbA1c levels by 1.5%, while canagliflozin reduced them by 1%. Patients had a 2.77 times higher chance of reducing their HbA1c levels to below 7% with semaglutide.

Patients with T2D often benefit from a reduction in their body weight, as this helps make treatment more effective. The average weight of participants was 90.2 kg before treatment. Semaglutide reduced body weight by 5.3 kg, while canagliflozin reduced it by 4.2 kg.  Patients had a 2.99 times higher chance of lowering their body weight by 10% or more after semaglutide treatment.

Overall, 76% of patients in the semaglutide group and 72% of patients in the canagliflozin group experienced side effects. Most side effects were mild. The most common ones were gut problems (25%, semaglutide) and infections (35%, canagliflozin).

The authors concluded that semaglutide more effectively lowered blood glucose levels and body weight in patients with T2D compared to canagliflozin.

The manufacturer of semaglutide, Novo Nordisk, funded this study. As participants were monitored closely during treatment, these results may not accurately reflect real-life circumstances. This study also had a short follow-up time.