Add-On Diabetes Treatment: Semaglutide Improves HbA1c Better Than Canagliflozin

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

In patients with uncontrolled type 2 diabetes 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 an industry-conducted trial in the Lancet Diabetes & Endocrinology.

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%).

Patients on semaglutide also lost more weight (mean loss, 5.3 vs. 4.2 kg).

The researchers conclude, "These outcomes might guide treatment intensification choices." Commentators, however, caution that adverse events, cost, and comorbid conditions also must be considered, and they advocate for a "personalized approach" to treatment.