An Indirect Comparison of Basal Insulin Plus Once-Weekly Semaglutide and Fully Optimised Basal–Bolus Insulin in Type 2 Diabetes

• Published in: Diabetes therapy 2023-01, Vol.14 (1), p.123-137
• Main Authors: Lingvay, Ildiko, Catarig, Andrei-Mircea, Lawson, Jack, Chubb, Barrie, Gorst-Rasmussen, Anders, Evans, Lyndon Marc
• Format: Article
• Language: English
• Subjects: Cardiology; Comparative analysis; Diabetes; Dosage and administration; Drug therapy; Endocrinology; Insulin; Internal Medicine; Medicine; Medicine & Public Health; Original Research; Patient outcomes; Testing; Type 2 diabetes
• ISSN: 1869-6953; 1869-6961
• DOI: 10.1007/s13300-022-01344-7

Introduction To date, there have been few head-to-head comparisons between semaglutide once-weekly (OW) and short-acting meal-time insulin in participants with type 2 diabetes (T2D) treated with basal insulin and requiring treatment intensification. This indirect comparison evaluated the effects of these regimens on glycated haemoglobin (HbA 1c ), body weight, hypoglycaemia, and other clinically relevant outcomes. Methods A post-hoc, unanchored, individual participant data meta-analysis was conducted on the basis of data from single treatment arms in the SUSTAIN 5 and DUAL 7 trials. Semaglutide 0.5 mg OW and 1.0 mg OW plus basal insulin were compared with an optimised (treat-to-target) basal–bolus regimen of insulin glargine and insulin aspart over 26 weeks, using regression adjustment to account for baseline differences between the trials. Results Over 26 weeks, semaglutide 1.0 mg OW plus basal insulin reduced mean HbA 1c by significantly more than the basal–bolus regimen (treatment difference: − 0.36%; p  = 0.003), while semaglutide 0.5 mg OW plus basal insulin was comparable with basal–bolus insulin (treatment difference: 0.08%, p  = 0.53). Both doses of semaglutide were associated with significant weight loss relative to insulin intensification (treatment differences: 6.8–9.4 kg; p