Journal Article

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

de la Rosa, Raymond, Wijayasinghe, Nelun, Norwood, Paul, Chu, Pei-Ling, Rose, Ludger, Reed, John, Sugimoto, Danny, Rodbard, Helena W, Lingvay, Ildiko, Araki, Eiichi

2018

Overview

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. The randomized, double-blind SUSTAIN 5 trial demonstrated the superiority of once-weekly semaglutide vs placebo in patients with uncontrolled T2D on basal insulin therapy.

• Publisher: Endocrine Society,Copyright Oxford University Press,Oxford University Press
• Subject: Adult / Aged / Aged, 80 and over / Antidiabetics / Blood Glucose / Body weight / Clinical s / Diabetes / Diabetes mellitus / Diabetes mellitus (non-insulin dependent) / Diabetes Mellitus, Type 2 - blood / Diabetes Mellitus, Type 2 - drug therapy / Double-Blind Method / Drug Therapy, Combination / Female / Gastrointestinal diseases / GLP-1 receptor agonists / Glucagon / Glucagon-like peptide 1 / Glucagon-Like Peptides - therapeutic use / Glycated Hemoglobin A - analysis / Humans / Hypoglycemic Agents - therapeutic use / Insulin / Insulin - therapeutic use / Male / Metformin / Middle Aged / Patients / Placebos / Treatment Outcome / Young Adult