In a nutshell
This study compared the effectiveness and safety of two second-line therapies for type-2 diabetes. The authors concluded that once-weekly semaglutide was more effective than once-daily sitagliptin (Januvia); and that both drugs were safe.
Some background
The first-line treatment for patients with type 2 diabetes (T2D) is generally metformin (Glucophage). However, many patients with T2D will eventually need other treatments to help control their blood glucose levels. Second-line therapies include glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dipeptidyl peptidase-4 inhibitors (DPP-4Is).
Unlike DPP-4Is (such as sitagliptin), GLP-1RAs have the added advantage of reducing bodyweight. Semaglutide is a new GLP-1RA currently under investigation.
Methods & findings
This study compared the effectiveness and safety of once-weekly semaglutide (Treatment A) with once-daily sitagliptin (Treatment B) among patients with T2D not controlled by first-line therapies.
This study examined 1,225 patients with T2D not controlled by first-line therapies. Patients were randomly assigned to either Treatment A (either 0.5 mg or 1.0 mg) or Treatment B (100 mg) for 56 weeks. Before treatment, the overall average HbA1c (average blood glucose over 3 months) was 8.1%. The average bodyweight was 89.5 kg.
All treatments reduced HbA1c levels. Compared to Treatment B, 0.5 mg of Treatment A reduced HbA1C by 0.77% and bodyweight by 2.35 kg. Compared to Treatment B, 1.0 mg of Treatment A reduced HbA1C by 1.06% and bodyweight by 4.20 kg.
Less than 10% of patients (all treatment groups) stopped therapy due to adverse effects. The number of patients reporting negative side effects were similar for both treatments. Rates of nausea were higher in Treatment A patients (18%) compared to Treatment B (7%). Rates of diarrhea were also higher with Treatment A (13%) compared to Treatment B (7%). Hypoglycemia (extremely low blood sugar) was extremely rare (1%-2% of each group).
The bottom line
This study concluded that among patients with uncontrolled T2D once-weekly semaglutide was more effective than once-daily sitagliptin at controlling blood sugar levels and bodyweight. Furthermore, semaglutide has a similar safety profile to that of other GLP-1RAs.
The fine print
Those receiving Treatment B happened to have higher initial HbA1C levels, potentially leading to a slight over-estimation of the effects of Treatment A. The concomitant loss in bodyweight may itself have led to a certain extent of the blood-sugar reductions. Longer trials are needed to assess the long-term safety of semaglutide.
Published By :
The lancet. Diabetes & endocrinology
Date :
Apr 03, 2017
