Semaglutide was recently approved in the US as a treatment for obesity and is provisionally approved for the treatment of obesity in England. “Semaglutide appears to be the most effective drug to date for the treatment of obesity and is beginning to close the gap with the amount of weight loss after bariatric surgery.” Dr. W. Timothy Garvey, Department of Nutritional Sciences, University of Alabama at Birmingham “Its approval was based on clinical trial results showing that it reduces weight by more than 15% on average when used in conjunction with a healthy lifestyle program. “This amount of weight loss is sufficient to treat or prevent a wide range of obesity complications that impair health and quality of life and is a game changer in obesity medicine.” Obesity is known to increase the risk of T2D at least sixfold, and Dr. Garvey and colleagues were interested in whether semaglutide could reduce this risk. To learn more, they performed a new analysis of data from two semaglutide trials. In STEP 1, participants (1,961) who were overweight or obese received an injection of 2.4 mg of semaglutide or a placebo weekly for 68 weeks. STEP4 included 803 participants with overweight or obesity. All received weekly injections of 2.4 mg semaglutide for 20 weeks. They then either stayed on semaglutide or switched to placebo for the next 48 weeks. Participants in both trials received advice about diet and exercise. The researchers used the Cardiometabolic Disease Staging (CMDS) to predict the risk of developing T2D in the next 10 years. CDMS has previously been shown to be a highly accurate measure of T2D risk and is calculated using a formula that takes into account the patient’s sex, age, race, BMI and blood pressure, as well as blood glucose, HDL cholesterol and triglycerides. In STEP1 participants who received semaglutide, 10-year risk scores for T2D were reduced by 61% (from 18.2% at week 0 to 7.1% at week 68). This compared with a 13% reduction in risk score for those taking placebo (17.8% at week 0 to 15.6% at week 68). Risk scores reflect weight loss, which was 17%, on average, with semaglutide versus 3% with placebo. At the start of the trial, risk scores were higher in participants with prediabetes than in those with normal blood sugar levels. However, semaglutide reduced the risk by a similar amount in both groups. In STEP 4 participants, the largest reductions in risk scores were seen in the first 20 weeks (from 20.6% at week 0 to 11.4% at week 20). In those who continued to receive semaglutide, the risk score further decreased to 7.7%, but, in those who switched to placebo, it increased to 15.4%. This suggests that continued treatment with semaglutide is required to maintain the reduction in T2D risk Dr Garvey says: ‘Semaglutide reduces the future risk of diabetes by more than 60% in obese patients – this figure is similar whether a patient has pre-diabetes or normal blood sugar levels. “Continued treatment is required to maintain the benefit. “Given the increasing rates of obesity and diabetes, semaglutide could be used effectively to reduce the burden of these chronic diseases.”
