Real-world data confirms once-weekly semaglutide superior to dulaglutide for HbA1c and weight in UK Type 2 Diabetes.

Managing Type 2 Diabetes (T2D) effectively requires therapies that not only control glycated hemoglobin (HbA1c) but also address comorbidities like obesity. While the SUSTAIN-7 randomized controlled trial demonstrated semaglutide's superiority over dulaglutide for HbA1c and bodyweight reduction, its strict eligibility criteria, often limited to metformin monotherapy, raise questions about its external validity in diverse real-world patient populations. This gap necessitates observational studies to assess comparative effectiveness and safety in routine clinical practice, where patients often have more complex treatment regimens and comorbidities.

Researchers conducted a population-based cohort study using IQVIA Medical Research Data (IMRD) from THIN to compare semaglutide and dulaglutide. They included 6616 adults with Type 2 Diabetes in UK primary care who initiated once-weekly injectable semaglutide or dulaglutide between January 1, 2019, and December 1, 2022, with follow-up through June 30, 2023. A new-user, active-comparator cohort design was employed, utilizing marginal structural models and inverse probability of treatment weighting to estimate 1-year changes in HbA1c and bodyweight as co-primary outcomes. Safety events were assessed while patients remained on-treatment.

Among 6616 new users, 4636 (70.1%) remained on-treatment for a year, while 1980 (29.9%) discontinued early. New users of semaglutide (n = 1901) achieved significantly greater 1-year reductions compared to dulaglutide new users (n = 2735). The estimated treatment difference (ETD) for HbA1c was -0.22 percentage points (95% CI -0.30, -0.15), and for bodyweight, it was -1.92 kg (95% CI -2.91, -0.93). These benefits of semaglutide were largely preserved even among the 87.7% (n = 4064) of individuals who did not meet the strict SUSTAIN-7 trial eligibility criteria, showing an HbA1c ETD of -0.23 percentage points (95% CI -0.31, -0.15) and a bodyweight ETD of -2.01 kg (95% CI -3.07, -0.95).