Which treatment is more effective for type 2 diabetes: weekly semaglutide or daily sitagliptin?

This study compared weekly semaglutide (Ozempic) and daily sitagliptin (Januvia) for type 2 diabetes (T2D) in an Asian population. It showed that patients treated with semaglutide had a greater improvement in T2D control and increased weight loss compared to those treated with sitagliptin.

T2D is an increasingly common disease that can result in serious complications if not properly controlled. There are a wide range of medications available to treat type 2 diabetes. The most commonly recommended first treatment for T2D is metformin (Glucophage). However, many patients do not achieve adequate blood glucose control defined by a HbA1c blood level below 7% with this treatment.

Other drugs such as semaglutide and sitagliptin are needed in these patients. These drugs act in different ways but both increase the production of natural insulin in the body. Both drugs have shown good blood glucose control as add-ons to metformin treatment in people with poorly controlled T2D. However, which drug is better is still not clear.  

868 patients with poorly controlled T2D participated in this study. All patients were treated with metformin. They were divided into 3 groups. Group 1 had 287 patients receiving semaglutide 0.5 mg once a week. Group 2 had 290 patients receiving semaglutide 1 mg once a week. Group 3 had 290 patients receiving sitagliptin 100 mg once a day. Participants were followed up for 30 weeks.

After 30 weeks the HbA1c had been reduced by 1.4% in group 1, 1.7% in group 2, and 0.9% in group 3. Also, patients in groups 1 and 2 had lost significantly more weight compared to group 3. Weight had been reduced by 2.9 kg in group 1, 4.2 kg in group 2, and 0.4 kg in group 3.  

Significantly more patients in group 1 (71%) and group 2 (82%) had achieved an HbA1c below 7% compared to group 3 (45%) after 30 weeks. Also, significantly more patients in group 1 (55%) and group 2 (68%) had achieved an HbA1c level of 6.5% or lower compared to group 1 (28%).

There were similar numbers of patients in all 3 groups that experienced side effects. More patients in group 1 (5.9%) and group 2 (10.7%) stopped treatment due to side effects compared to group 3 (2.1%).

This study showed that weekly treatment with semaglutide lead to improved diabetic control and greater weight loss compared to daily treatment with sitagliptin in patients with poorly controlled T2D treated with metformin.

This study was funded by Novo Nordisk, the manufacturer of semaglutide. It was also carried out in an Asian population. More studies are needed to see if these results apply to other ethnicities.