Add on semaglutide leads to better blood sugar control compared to canagliflozin in diabetes: Lancet

The existing guidelines for management of type 2 diabetes recommend a patient-centred approach to guide the choice of pharmacological agents. Although glucagon-like peptide-1 (GLP-1) receptor agonists and sodium–glucose cotransporter-2 (SGLT2) inhibitors are increasingly used as second-line agents, direct comparisons between these treatments are insufficient.

The researchers have compared the efficacy and safety of semaglutide (a GLP-1 receptor agonist) with canagliflozin (an SGLT2 inhibitor) in patients with type 2 diabetes in the SUSTAIN 8 trial.

The new study has found that in patients with uncontrolled type 2 diabetes who are taking metformin, adding the glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide improves hemoglobin A1c levels better than the sodium–glucose cotransporter-2 (SGLT2) inhibitor canagliflozin, according to a trial findings published in the Lancet Diabetes & Endocrinology.

In the study nearly 800 adults were randomized to add-on treatment with either subcutaneous semaglutide (1 g once weekly) or oral canagliflozin (300 mg once daily). By 1 year, the mean HbA1c level had dropped significantly more with semaglutide than canagliflozin (a decrease of 1.5 vs. 1.0 percentage points). Additionally, a greater proportion of semaglutide recipients than canagliflozin recipients achieved HbA1c levels under 7% (66% vs. 45%).