In Type 2 Diabetes, Semaglutide Better Than Dulaglutide for HbA1c Reduction

By Amy Orciari Herman

Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS

Semaglutide leads to greater improvements in hemoglobin A1c levels than dulaglutide, according to an international trial funded by the maker of semaglutide and published in the Lancet Diabetes & Endocrinology. Both drugs are FDA-approved, glucagon-like peptide-1 receptor agonists.

Some 1200 adults with type 2 diabetes and HbA1c levels of 7.0–10.5% despite taking metformin were randomized to receive add-on, once-weekly treatment with subcutaneous semaglutide (0.5 or 1.0 mg) or dulaglutide (0.75 or 1.5 mg). After 40 weeks' treatment, HbA1c levels dropped significantly more with semaglutide than dulaglutide — a difference of about 0.4 percentage points. Weight loss also favored semaglutide.

Serious adverse events were similar with the two drugs.

Commentators interpret the results cautiously, noting that they "apply to patients who were only on metformin and who were at relatively low cardiovascular risk since patients with renal impairment, established cardiovascular disease, and advanced diabetic retinopathy were excluded."