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Posted by on Apr 13, 2019 in Diabetes mellitus | 0 comments

In a nutshell

The aim of this study was to compare the effects of adding semaglutide versus sitagliptin onto metformin with or without a sulfonylurea in type 2 diabetes (T2D). The main finding was that adding 7mg or 14mg semaglutide on to metformin/sulphonylurea therapy showed greater improvements in blood sugar control compared to sitagliptin.

Some background

There are many different types of drugs used in the treatment of T2D. Combinations of different drugs are often used when blood sugars are not controlled with one drug alone. Metformin (Glucophage) is usually the first drug used. After this, other drugs can be added.

Sulfonylureas are another type of drug that can be added to the regime. Some sulfonylureas include gliclazide (Diamicron), glipizide (Glucotrol), and glimepiride (Amaryl). If blood sugar is still not controlled with metformin and a sulfonylurea, another drug can be added.

Semaglutide (Ozempic) is a GLP-1 agonist. It works by increasing the amount of insulin (the hormone that controls blood sugar levels) in the body. ?Sitagliptin (Januvia) is a DPP4 inhibitor. It also works by increasing the amount of insulin in the body.

It is not known if semaglutide or sitagliptin is better at improving blood sugar control when added to metformin with or without a sulfonylurea in patients with T2D.

Methods & findings

This study included 1,864 patients with uncontrolled T2D. They were all taking metformin. Some patients were also taking a sulfonylurea. Patients were randomly assigned to start taking either semaglutide daily (3, 7 or 14mg) or 100mg sitagliptin for 78 weeks.

After 26 weeks, patients who were taking 7mg and 14mg semaglutide had significantly lower HbA1c (blood test measuring average blood sugar level over the past 3 months) compared to patients taking sitagliptin. These patients also had significantly higher reductions in body weight compared to patients taking sitagliptin. These reductions in HbA1c and body weight were also significantly greater with 7mg and 14mg semaglutide than with sitagliptin at week 78.

The bottom line

The authors concluded that adding semaglutide 7mg or 14mg daily to metformin with or without a sulfonylurea resulted in better blood sugar control compared to sitagliptin.

The fine print

This study was funded by Novo Nordisk, the developer of semaglutide.

Published By :

Journal of the American Medical Association (JAMA)

Date :

Mar 23, 2019

Original Title :

Effect of Additional Oral Semaglutide vs Sitagliptin on Glycated Hemoglobin in Adults With Type 2 Diabetes Uncontrolled With Metformin Alone or With Sulfonylurea: The PIONEER 3 Randomized Clinical Trial.

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