Semaglutide injection for the treatment of adults with type 2 diabetes

ABSTRACT

Introduction

Current estimates suggest that approximately 10% of the global adult population have type 2 diabetes. In recent years there has been a significant increase in the therapeutic options available for its treatment. This article examines the use of injectable semaglutide in the treatment of type 2 diabetes.

Areas covered

We will describe the global problem posed by type 2 diabetes followed by consideration of the glucagon-like peptide 1 receptor agonist class of glucose lowering therapies. The focus is then shifted to semaglutide and a description of the large phase 3 pre-approval trial programme known as SUSTAIN. There is consideration of glucose control, the primary end-point of the phase 3 programme, as well as secondary end-points such as weight and blood pressure. There follows a précis of the cardiovascular outcomes trial for subcutaneous semaglutide (SUSTAIN 6) and the post-approval publications. As well as the SUSTAIN trial programme we used PubMed to identify relevant publications.

Expert opinion

This section discusses the position of semaglutide and the risks and benefits versus other once weekly GLP-1RAs and finally the development of an oral version of semaglutide, which has recently been approved in the United States.

KEYWORDS:

• CVOT
• glucagon-like peptide-1
• glp-1RA
• semaglutide
• sustain
• type 2 diabetes
• T2DM

Article highlights

• Semaglutide is the most recently approved once weekly injectable GLP-1 receptor agonist for the treatment of type 2 diabetes

• Semaglutide is more efficacious in reducing HbA1c and weight than other classes of glucose lowering therapies

• Head-to-head comparisons with other GLP-1RAs, including exenatide ER and dulaglutide, show superiority of semaglutide for both HbA1c and weight reduction

• The cardiovascular outcome trial for semaglutide showed both safety and a reduction in major cardiovascular events

• Gastrointestinal side effects are commonly seen with semaglutide and may be more frequent than with other GLP-1RA therapies

• Caution is needed when initiating semaglutide in patient with pre-existing diabetic retinopathy and poor glycaemic control

Declaration of interest

R. Chudleigh has received honoraria for presentations, attended advisory boards or received travel grants from Astra Zeneca, Boehringer Ingelheim, Eli Lilly, Janssen, MSD, Novo Nordisk, Napp Pharmaceuticals and Takeda. S.C. Bain has received honoraria from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Novo Nordisk, Sanofi, provided expert advice for the All-Wales Medicines Strategy Group and National Institute for Health and Care Excellence UK, and is a shareholder of Glycosmedia. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.