Semaglutide Initiation Associated with A1C Reduction in Type 2 Diabetes Patients

Jason Tan, MS

Following the FDA approval of glucagon-like peptide 1 receptor agonist (GLP-1 RAs) oral semaglutide (OS), controlled clinical trials have shown improved glycemic control in patients with type 2 diabetes.

Investigators, led by Jason Tan, MS, HealthCore Inc, evaluated effectiveness of oral semaglutide use in a cohort of type 2 diabetes patients with both commercial insurance and Medicare Advantage.

The results, presented at the 2021 American Diabetes Associate Virtual Meeting, found that initiation of oral semaglutide was associated with a significant reduction in HbA1c.

Study

Investigators designed a retrospective, observational cohort study.

It utilized both medical and pharmacy claims in outpatient laboratory data from the HealthCore Integrated Research Database.

Data was collected between September 2019 - October 2020. Patients with ≥1 pharmacy prescription claim for oral semaglutide made up the study population in the identification period.

In addition, investigators included a persistent population (PP) of patients with an overlap of OS fill within a delay time prior to A1C measurement data. The team defined it as 1.5 times the day’s supply of OS fill.

All patients, including GLP-1 naive, were required to have a baseline glycosylated hemoglobin A1C >9%.

Outcomes were defined as changes in A1C and A1C target attainment at A1C <7% and <8%.

Investigators performed a paired t-test and McNemar’s test to compare pre- and post-index A1C values and goal attainment.

Results

A total of 323 patients with type 2 diabetes initiating OS were included in the study, including 248 GLP-1 naive patients and 154 patients in the PP subgroup.

Data show OS initiation was associated with significant reduction in mean A1C in all patients, as well as the 2 noted subgroups, all P >.001.

Further, patients with baseline A1C of >9% were met with a significant A1C reduction after OS initiation (P >.001).

In attainment of study goals, including A1C <7% and <8%, investigators noted a respective increase of 25% and 20% from pre-index for all patients in the study.

They noted limitations considered were patients not required to have >7% or >8% A1C at baseline, as well as background antidiabetic usage not examined during the study.

In addition, 26% of patients with A1C >9% at baseline (n = 80) met the goal of post-index A1C <7%, while 43% of patients met the goal of A1C <8% (P >.001).

Furthermore, among patients who were GLP-1 naive (n = 67) and had a baseline of A1C <9% met the goal in 28% and 45% of patients in A1C <7% and <8%, respectively.

Conclusion

Following the results, investigators concluded initiation and persistence on OS in T2D patients had a significant reduction in A1C, with an increase in target attainment of A1C at <7% and <8%.

Over half of patients attained A1C <7%. while a third of patients attained a A1C of <8%.

The team noted that this study is among the first real-world evidence of data on OS, which may aid clinicians in diabetes treatment decisions and care.

“Additional real-world evidence is ongoing that will examine the full breadth of patients prescribed oral semaglutide after this initial, after-launch cohort as well as allowing for longer follow-up,” investigators wrote.

The study, “Real-World Effectiveness of Oral Semaglutide (OS) from a U.S. Commercially Insured and Medicare Advantage Population,” was published online by the ADA.