Semaglutide improves blood sugar control and weight loss in adults with type 2 diabetes for up to three years
New research presented at this year’s EASD meeting shows that semaglutide significantly improves blood sugar control and weight loss in adults with type 2 diabetes for up to three years.
Type 2 diabetes is a chronic and progressive condition in which the body does not make or use insulin normally, leading to high levels of glucose in the blood.
The condition tends to become more severe over time and blood sugar levels become more difficult to manage.
Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, have given people more control in lowering of blood sugar.
Lead author Professor Avraham Karasik, from the Institute of Research and Innovation at Maccabi Health Services in Israel, said: “Our long-term analysis of semaglutide in a large and diverse cohort of patients with type 2 diabetes found a clinically relevant improvement in blood sugar control and weight loss after six months of treatment, comparable with that seen in randomised trials.
“Importantly, these effects were sustained for up to three years, supporting the use of once weekly semaglutide for the long-term management of type 2 diabetes.”
While the effectiveness of once weekly semaglutide to treat type 2 diabetes has been demonstrated in randomised controlled trials, long-term, large-scale real-world data have been lacking.
Israeli researchers from the Maccabi Health Services, the second largest health maintenance organisation in Israel (including 2.6 million people), retrospectively analysed data on the use of semaglutide in 200,000 individuals from the Maccabi diabetes registry.
They identified 23,442 eligible people, who had redeemed at least one prescription for weekly semaglutide subcutaneous injections (0.25, 0.5 and 1 mg) between August 2019 and December 2022, and had one blood sugar control measurement (HbA1c) 12 months before, and six months after, starting treatment.
All 23,442 people (49 per cent female, average age 62 years, average weight 94.1 kg, average BMI 33.7 kg/m2, average HbA1c 7.6 per cent) were included in the analysis and evaluated for changes in HbA1c and weight, for up for up to 3 years.
Adults with type 2 diabetes should aim for a target HbA1c of less than seven per cent. Higher HbA1c levels are associated with complications like heart disease, stroke, kidney disease (nephropathy), eye disease (retinopathy) and nerve disease (neuropathy).
Data were analysed both for the total population (23,442 people) and among individuals who started taking semaglutide at least two years before the end of study period (December 2022, 6,049 people).
The proportion of days covered (PDC; the proportion of days in which a person has access to the medication in the first 180 days and first 2 years) was used to express treatment adherence.
Before being prescribed semaglutide, 30 per cent of people were treated with insulin, and 31 per cent were treated with another GLP-1 RA.
Within the first six months, adherence to semaglutide treatment (PDC) was over 60 per cent among 75 per cent of people. Average (median) follow-up time was 17.6 months.
Six months after treatment initiation, on average people lowered their HbA1c by 0.77 per cent (from 7.6 per cent to 6.8 per cent) and reduced their body weight by 4.7 kg (from 94.1 kg to 89.7 kg).
The reduction in blood sugar levels and weight loss was more pronounced among those who had never taken a GLP-1 RA compared to those who had previously taken a GLP-1RA (HbA1c reduction -0.87% vs -0.54%; weight loss -5.5kg vs -3.0 kg, respectively).
Higher adherence to therapy resulted in greater reduction in both blood sugar levels and weight loss (PDC ≥60% compared to <60%).
Further analysis of repeated measures examining change in HbA1c and weight over time, showed that reductions were maintained over 3 years of follow-up, and this was more evident among patients with higher adherence.
Among people who initiated treatment at least two years prior to end of study period and had high adherence (PDC of at least 80 per cent), HbA1c was reduced by 0.76 per cent after 24 months and by 0.43 per cent after 36 months, and body weight was reduced by 6.0 kg after 24 months and 5.8 kg after 36 months. Side-effects were not evaluated in the study.
Professor Karasik concluded: “In this large real-world study, we were able to show durable reductions in HbA1c and body weight with emphasis on drug adherence.
“Data are in line with results in randomised controlled trials and show the long-term stable benefit of once weekly semaglutide.”