Semaglutide provides more weight loss, larger HbA1c reduction than dulaglutide in diabetes
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Key takeaways:
- Adults with type 2 diabetes using liraglutide had a 0.42% reduction in HbA1c at 26 weeks after switching to semaglutide.
- Adults switching to dulaglutide had no change in body weight or HbA1c.
Adults with type 2 diabetes who switched from liraglutide to semaglutide therapy had greater reductions in HbA1c and body weight at 26 weeks than those who switched to dulaglutide, according to study data from researchers in Japan.
In findings from a randomized controlled trial published in the Journal of Diabetes Investigation, 32 adults with type 2 diabetes receiving liraglutide (Saxenda, Novo Nordisk) at baseline were randomly assigned to switch to semaglutide (Ozempic/Wegovy, Novo Nordisk) or dulaglutide (Trulicity, Eli Lilly) for 26 weeks. At the end of the study, the semaglutide group had decreases in body weight and HbA1c compared with baseline, whereas there were no changes in either metric for the dulaglutide group.
“Based on these findings, it was clinically confirmed that in Japanese patients, dulaglutide 0.75 mg does not cause any change in body weight,” Yasuo Terauchi, PhD, professor in the department of endocrinology and metabolism at Yokohama City University Graduate School of Medicine in Japan, and colleagues wrote. “In contrast, semaglutide 0.5 mg can be expected to reduce body weight by approximately 2 kg over 26 weeks. This result may be explained by the fact that the effects of GLP-1 receptor agonists on the brain differ between semaglutide and dulaglutide.”
Researchers recruited 32 adults aged 21 years and older with type 2 diabetes receiving 0.6 mg or 0.9 mg liraglutide who were treated at Yokosuka Kyosai Hospital in Japan from September 2020 to March 2022. Participants were randomly assigned to switch to semaglutide or dulaglutide therapy. The semaglutide group received 0.25 mg doses for 4 weeks, followed by 0.5 mg for the remainder of the trial. The dulaglutide group received 0.75 mg doses for all 26 weeks. Follow-up visits occurred at 8, 16 and 26 weeks. Blood glucose testing was self-performed by participants twice weekly. The Diabetes Treatment Satisfaction Questionnaire was administered at baseline and 26 weeks. Adverse events were monitored in both groups.
There were 16 adults assigned to each group, with 15 participants in each group completing the study. At 26 weeks, the semaglutide group had a 0.42% decrease in HbA1c compared with no change in the dulaglutide group (P = .012). Fasting serum glucose decreased by 10.3 mg/dL in the semaglutide group (P = .0129) vs. no change for adults receiving dulaglutide. There was no change in fasting plasma glucose for either group, the researchers reported.
Body weight decreased by 2.6 kg in the semaglutide group from baseline to 26 weeks (P = .0153), whereas no change was observed for the dulaglutide group. There were no differences between the groups in serum creatinine, estimated glomerular filtration rate, urine albumin-to-creatinine ratio, liver function, lipid levels and blood pressure.
Adverse events were reported by 75% of the semaglutide group and 18.8% of the dulaglutide group. Decreased appetite with dysgeusia was the most common adverse event reported for adults receiving semaglutide, the researchers wrote.
Diabetes Treatment Satisfaction Questionnaire score increased from baseline to 26 weeks for both groups, with no difference between the groups. The frequency of hyperglycemia and hypoglycemia decreased in both groups.
The researchers noted the study had a few limitations, including a small study population, a limited follow-up period, and the lack of a double-blind methodology. Additionally, researchers noted that baseline eGFR differed between the two groups.
“It is unclear whether this difference affected the results of this study as the hypoglycemic effects of these drugs depend on the eGFR or have not yet been reported,” the researchers wrote. “Therefore, to address these potential problems, the results of this study should be replicated in longitudinal observational studies conducted in larger populations.”
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