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08-04-2022 | Diabetes | News | Article

DUKPC 2022

Within-class switch to semaglutide brings benefits in real-world cohort

Author: Eleanor McDermid

medwireNews: Real-world data confirm glycated hemoglobin (HbA1c) and weight benefits, albeit attenuated, for people with type 2 diabetes switching to injectable semaglutide from other glucagon-like peptide (GLP)-1 receptor agonists.

The attenuated benefits relative to taking semaglutide as a first GLP-1 receptor agonist “makes perfectly logical sense because you would expect people having switched from dulaglutide, exenatide, lixisenatide, or liraglutide to have had some partial benefit from taking these drugs prior to switching to semaglutide,” said researcher Thomas Crabtree (Sandwell & West Birmingham Hospitals NHS Trust, UK).

Presenting the research at the 2022 Diabetes UK Professional Conference, he cautioned that the findings do not apply to switches from all GLP-1 receptor agonists because the team had little or no data on people taking oral semaglutide or those using the most recently approved higher doses of dulaglutide, which he noted “are now perhaps more commonly used in clinical practice.”

Crabtree and team analyzed data on 1623 people from the Association of British Clinical Diabetologists semaglutide audit. They were an average age of 58.9 years, with a median diabetes duration of 10.6 years, average HbA1c of 9.37% (79.5 mmol/mol), and average BMI of 37.1 kg/m2.

The presenter noted that these represented “more extreme” characteristics than those of people taking semaglutide 1 mg/week in the SUSTAIN 1 trial, and “perhaps more compatible with what we would see in a day-to-day diabetes clinic.”

Nearly a quarter (23.5%) of the real-world cohort were taking semaglutide having been switched from a different GLP-1 receptor agonist. In line with previous data, these people had significantly smaller reductions in HbA1c and bodyweight during a median follow-up of 0.7 years than those who had not already been exposed to the medication class.

There were also significantly smaller HbA1c reductions in the 29.8% of the cohort who were taking concurrent sodium-glucose cotransporter 2 inhibitors, and Crabtree observed that “the reasons for this are not 100% clear.”

People with a higher baseline BMI had significantly larger weight reductions than those with lower BMIs, consistent with them having more excess weight to lose. Also, the 68.4% of people who were taking metformin had significantly larger HbA1c reductions than those not taking it.

“Again, the reasons for this aren’t certain,” said Crabtree.

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DUKPC 2022; 28 Mar–1 Apr