Semaglutide and Dapagliflozin to be Investigated for Prediabetes Reversal and Cardioprotection in High-Risk Individuals

Prediabetes affects ~7% of Danes and ~38% of US adults, serving as a precursor to Type 2 Diabetes. It's linked to microvascular complications, high cholesterol, hypertension, and hepatic steatosis, even before full diabetes onset. Crucially, prediabetes is overrepresented in individuals with coronary atherosclerosis. Current glucose-lowering medications, like semaglutide and dapagliflozin, show cardioprotective effects in diabetic patients. This study aims to assess if these drugs can normalize glucose levels and provide cardiovascular benefits in prediabetic individuals with existing coronary atherosclerosis, addressing a significant treatment gap.

Investigators will examine if glucose-lowering medications can normalize long-term average glucose levels in individuals with prediabetes and coronary atherosclerosis. Participants will receive Semaglutide via subcutaneous injection, gradually increasing weekly doses up to 2.4 mg. If this is insufficient, Dapagliflozin (10 mg daily oral) may be added. The primary aim is to reduce HbA1c to normoglycemic levels and assess potential cardioprotective benefits in this high-risk population, comparing outcomes against standard care or placebo (implied).