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Attacking Type 2 Diabetes: Second-Line Treatments

A recently published study assesses the use of Semaglutide, a glucagon-like peptide-1 analogue, as a treatment for patients with type 2 diabetes, in comparison with the dipeptidyl-4 inhibitor sitagliptin.


With increasing prevalence of type 2 diabetes among various populations, multiple treatments have been developed in response to the demand. Research indicates that treatment of diabetes is strongly linked with controlled blood glucose concentrations, and weight reduction in overweight patients. Despite the options, several treatments carry adverse effects while potentially causing weight gain and greater risks of hypoglycemia. The current study published by The Lancet focuses on determining the efficacy of two treatments for type 2 diabetes: glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors. The two treatments are identified as second-line therapy that is used when first-line therapy, primarily metformin, is ineffective by itself.

A trial spanning 56 weeks and taking place in 18 different countries was performed. Type 2 diabetes patients who were a minimum of 18 years old (except for Japan where the minimum age was 20) were included in the research study. All patients recruited for the study displayed inadequate glycaemic control despite receiving first-line treatment in the form of metformin, thiazolidinediones, or a combination of the two. Participants were randomly assigned to categories consisting of combinations of Semaglutide and sitagliptin doses. The change in blood glucose concentration was determined by recording levels prior to the 56 weeks of treatment, and after the treatment period. Changes in body weight were determined similarly.

A group of patients treated with 0.5 mg of Semaglutide displayed a mean blood glucose concentration of 8.1%, which was reduced by 1.3% after the 56-week treatment period. The mean blood glucose concentration was further reduced by 1.6% in the 0.1 mg Semaglutide group, 0.5% in the sitagliptin group (0.5 mg Semaglutide), and -1.06 mg in the sitagliptin group with 1.0 mg Semaglutide. The mean baseline body weight was calculated at 89.5 kg. The weight reductions after treatment were 4.3 kg in the 0.5 mg Semaglutide group, 6.1 kg in the 1.0 mg Semaglutide group, 1.9 kg in the sitagliptin group with 0.5 mg Semaglutide, and -4.20 kg in the sitagliptin group with 1.0 mg Semaglutide. Based on the once per week dosage employed by the experiment, Semaglutide was more effective than sitagliptin in improving blood glucose concentrations and body weight, thereby increasing glycaemic control.

The study appropriately determined that Semaglutide was a superior second-line treatment for type 2 diabetes patients who had already undergone some form of first-line treatment. Semaglutide was effective in controlling blood glucose concentrations and body weight while displaying few adverse effects in relation to sitagliptin. The information benefits doctors to prescribe Semaglutide as a second-line therapy for type 2 diabetes. Effective drug prescription will lead to low costs for treatment in the long run and allow for efficient use of medical resources. Researchers may also study the composition of Semaglutide to develop further treatments for type 2 diabetes and other related diseases.


Written By: Shrishti Ahuja, BSc



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