Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyFebruary 2023
This drug – combined with lifestyle intervention – normalised glycaemia in most of these patients.
In three industry-sponsored, placebo-controlled, randomised trials, injected semaglutide – given weekly with a target dose of 2.4 mg – resulted in substantial weight loss in patients without diabetes who were overweight or obese (N Engl J Med 2021 384; 989-1002; JAMA 2021; 325: 1403-1413 and 1414-1425). Nearly half (about 1500) of the participants had prediabetes, and the rest had normoglycaemia.
In this post hoc analysis, researchers sought to determine the proportion of participants with prediabetes at baseline that had achieved normoglycaemia (i.e. glycated haemoglobin [HbA1c] below 39 mmol/mol (5.7%) or blood glucose below 5.55 mmol/L) by the end of the trials. Notably, both the semaglutide and placebo groups received lifestyle interventions that ranged from monthly counselling to intensive behavioural therapy. At 68 weeks, 84% to 89% of participants with prediabetes in the semaglutide groups of the three trials had converted to normoglycaemia. In the placebo groups, these proportions were lower but substantial – ranging from 48% to 70%.
Comment: Semaglutide (at the dose approved for weight loss) plus lifestyle intervention normalised blood glucose in most of these patients with prediabetes. However, improved glycaemia in the control groups indicates that the lifestyle intervention was responsible for a substantial portion of that effect. Overall, these findings are promising, but we will need more information on semaglutide’s safety and metabolic effects during longerterm treatment of people with prediabetes and obesity.
ALLAN S. BRETT, MD
Clinical Professor of Medicine, University of Colorado School of Medicine, Aurora, USA.
Perreault L, et al. Changes in glucose metabolism and glycemic status with once-weekly subcutaneous semaglutide 2.4 mg among participants with prediabetes in the STEP program. Diabetes Care 2022; 45: 2396-2405.
This summary is taken from the following Journal Watch title: General Medicine