Findings from Novo Nordisk's phase 3a clinical trial for semaglutide, an investigational glucagon-like peptide-1 (GLP-1) analogue, demonstrated that treatment with semaglutide, administered once-weekly, significantly improved glycemic control compared to insulin glargine U100 in adults with type 2 diabetes. Results from the SUSTAIN 4 trial were presented at the American Association of Clinical Endocrinologists 25th Annual Scientific and Clinical Congress (AACE) in Orlando, Florida.

The 30-week SUSTAIN 4 trial showed that, from a mean baseline HbA1c of 8.2 per cent, adults with type 2 diabetes receiving metformin with or without sulfonylurea, achieved statistically significant and superior improvements in HbA1c reductions of 1.2 per cent and 1.6 per cent when treated with 0.5 mg and 1.0 mg semaglutide, respectively, vs a 0.8 per cent reduction with insulin glargine U100 (p<0.0001 for both). End of trial mean dose of insulin glargine U100 was 29 IU/day.

"Type 2 diabetes is a complex disease and many patients on insulin are still uncontrolled," said Vanita Aroda, SUSTAIN 4 investigator and physician investigator at the MedStar Health Research Institute, Hyattsville, Md. "The results of SUSTAIN 4 are encouraging, as once-weekly semaglutide demonstrated superior glycemic control compared to insulin glargine U100 in people that generally had a relatively long duration of type 2 diabetes."

More adults treated with 0.5 mg and 1.0 mg semaglutide achieved HbA1c targets compared with insulin glargine U100: HbA1c <7 per cent (57.5 per cent and 73.3 per cent vs 38.1 per cent) and =6.5 per cent (37.3 per cent and 54.2 per cent vs 17.5 per cent). Additionally, from a mean baseline body weight of 93.4 kg/205.91 lb, adults treated with 0.5 mg and 1.0 mg semaglutide achieved statistically significant and superior reductions in mean body weight of 3.5 kg/7.72 lb and 5.2 kg/11.46 lb compared to an increase of 1.2 kg/2.65 lb with insulin glargine U100 (p<0.0001 for both).

The most common adverse events observed for adults treated with 0.5 mg and 1.0 mg semaglutide were gastrointestinal (nausea: 21.3 per cent and 22.2 per cent vs insulin glargine U100, 3.6 per cent; diarrhea: 16.3 per cent and 19.2 per cent vs insulin glargine U100, 4.4 per cent; vomiting: 6.6 per cent and 10.3 per cent vs insulin glargine U100, 3.1 per cent). Rates of serious adverse events were comparable across treatment groups (6.1 per cent and 4.7 per cent vs 5.0 per cent). Fewer adults reported severe or blood glucose-confirmed hypoglycemia with either semaglutide dose compared to insulin glargine U100 (4.4 per cent and 5.6 per cent vs 10.6 per cent). The proportion of adults treated with 0.5 mg and 1.0 mg semaglutide discontinuing treatment due to adverse events was 5.5 per cent and 7.5 per cent vs 1.1 per cent) for insulin glargine U100.

SUSTAIN 4 was a randomized, open-label, multicenter, multinational 30-week trial investigating the safety and efficacy of semaglutide, administered once-weekly, vs once-daily insulin glargine (U100/ml), both added on to metformin with or without sulfonylurea in 1,089 adults with an overall type 2 diabetes duration of 8.6 years and who had not previously received any insulin-based therapies. Secondary endpoints included change in body weight from baseline after 30 weeks of treatment. The trial was conducted in Argentina, Croatia, France, Germany, India, Macedonia, Mexico, the Netherlands, Puerto Rico, Romania, Slovakia, Slovenia, South Africa, UK and the US.

SUSTAIN (Semaglutide Unabated Sustainability in Treatment of Type 2 Diabetes) is a clinical program for semaglutide, administered once weekly, that comprises six phase 3a global clinical trials encompassing more than 7,000 people with type 2 diabetes as well as two Japanese trials encompassing around 1,000 people with type 2 diabetes.