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J Clin Endocrinol Metab. 2018 Jun 1;103(6):2291-2301. doi: 10.1210/jc.2018-00070.

Semaglutide Added to Basal Insulin in Type 2 Diabetes (SUSTAIN 5): A Randomized, Controlled Trial.

Author information

1
Endocrine and Metabolic Consultants, Rockville, Maryland.
2
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
3
Endocrine Research Solutions, Inc., Roswell, Georgia.
4
Four Rivers Clinical Research, Paducah, Kentucky.
5
Institute of Diabetes Research, Münster, Germany.
6
Cedar-Crosse Research Center, Chicago, Illinois.
7
Department of Metabolic Medicine, Kumamoto University, Kumamoto, Japan.
8
Novo Nordisk Inc., Plainsboro, New Jersey.
9
Novo Nordisk A/S, Søborg, Denmark.
10
University of California at San Francisco, Fresno, California.

Abstract

Context:

Combination therapy with insulin and glucagon-like peptide-1 receptor agonists (GLP-1RAs) is important for treating type 2 diabetes (T2D). This trial assesses the efficacy and safety of semaglutide, a GLP-1RA, as an add-on to basal insulin.

Objective:

To demonstrate the superiority of semaglutide vs placebo on glycemic control as an add-on to basal insulin in patients with T2D.

Design:

Phase 3a, double-blind, placebo-controlled, 30-week trial.

Setting:

This study included 90 sites in five countries.

Patients:

We studied 397 patients with uncontrolled T2D receiving stable therapy with basal insulin with or without metformin.

Interventions:

Subcutaneous semaglutide 0.5 or 1.0 mg once weekly or volume-matched placebo.

Main Outcome Measures:

Primary endpoint was change in glycated Hb (HbA1c) from baseline to week 30. Confirmatory secondary endpoint was change in body weight from baseline to week 30.

Results:

At week 30, mean HbA1c reductions [mean baseline value, 8.4% (67.9 mmol/mol)] with semaglutide 0.5 and 1.0 mg were 1.4% (15.8 mmol/mol) and 1.8% (20.2 mmol/mol) vs 0.1% (1.0 mmol/mol) with placebo [estimated treatment difference (ETD) vs placebo, -1.35 (14.8 mmol/mol); 95% CI, -1.61 to -1.10 and ETD, -1.75% (19.2 mmol/mol); 95% CI, -2.01 to -1.50; both P < 0.0001]. Severe or blood glucose-confirmed hypoglycemic episodes were reported in 11 patients (17 events) and 14 patients (25 events) with semaglutide 0.5 and 1.0 mg, respectively, vs seven patients (13 events) with placebo (estimated rate ratio vs placebo, 2.08; 95% CI, 0.67 to 6.51 and estimated rate ratio vs placebo, 2.41; 95% CI, 0.84 to 6.96 for 0.5 and 1.0 mg; both P = nonsignificant). Mean body weight decreased with semaglutide 0.5 and 1.0 mg vs placebo from baseline to end of treatment: 3.7, 6.4, and 1.4 kg (ETD, -2.31; 95% CI, -3.33 to -1.29 and ETD, -5.06; 95% CI, -6.08 to -4.04 kg; both P < 0.0001). Premature treatment discontinuation due to adverse events was higher for semaglutide 0.5 and 1.0 mg vs placebo (4.5%, 6.1%, and 0.8%), mainly due to gastrointestinal disorders.

Conclusions:

Semaglutide, added to basal insulin, significantly reduced HbA1c and body weight in patients with uncontrolled T2D vs placebo.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02305381.

PMID:
29688502
PMCID:
PMC5991220
DOI:
10.1210/jc.2018-00070
[Indexed for MEDLINE]
Free PMC Article

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