Reductions in insulin resistance are mediated primarily via weight loss in subjects with type 2 diabetes on semaglutide

• Published in: The journal of clinical endocrinology and metabolism 2019-09, Vol.104 (9), p.4078-4086
• Main Authors: Fonseca, Vivian A, Capehorn, Matthew S, Garg, Satish K, Jódar Gimeno, Esteban, Hansen, Oluf Hoejbjerg, Holst, Anders Gaarsdal, Nayak, Gurudutt, Seufert, Jochen
• Format: Article
• Language: English
• Subjects: Antidiabetics; Body weight; Body weight loss; Clinical trials; Diabetes; Diabetes mellitus (non-insulin dependent); Glucagon; Glucagon-like peptide 1; Insulin; Insulin resistance; Patients
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2018-02685

Semaglutide, a once-weekly glucagon-like peptide-1 analog approved for use in patients with type 2 diabetes (T2D), demonstrated superior body weight (BW) reductions and decreased insulin resistance (IR) vs comparators across the Semaglutide Unabated Sustainability in Treatment of Type 2 Diabetes (SUSTAIN) 1-3 clinical trials. To investigate the relationship between IR and BW across the SUSTAIN 1-3 trials. Post hoc analysis of the SUSTAIN 1-3 trials. Three hundred and eleven sites in 30 countries. 2432 subjects with T2D. Semaglutide 0.5 or 1.0 mg, placebo or active comparator (sitagliptin 100 mg, exenatide extended release 2.0 mg). To assess the extent of the effect on IR that is mediated (indirect effect) and not mediated (direct effect) by the effect on BW. Across SUSTAIN 1-3, mean BW was significantly reduced with semaglutide 0.5 mg (3.7 kg to 4.3 kg; P < 0.0001) and semaglutide 1.0 mg (4.5 kg to 6.1 kg; P < 0.0001) vs comparators (1.0 kg to 1.9 kg). There were greater reductions in IR with semaglutide 0.5 mg (27% to 36%) and semaglutide 1.0 mg (32% to 46%) vs comparators (17% to 28%). Greater reductions in BW were generally associated with greater decreases in IR. The effect on IR was primarily mediated by weight loss (70% to 80% and 34% to 94%, for semaglutide 0.5 mg and 1.0 mg, respectively, vs comparator). Semaglutide consistently reduced BW and IR in subjects with T2D in SUSTAIN 1-3. In this analysis, IR improvement was positively associated with, and primarily mediated by, the effect of semaglutide on BW.