Semaglutide once weekly in people with type 2 diabetes: Real-world analysis of the CanadianLMCdiabetes registry (SPAREstudy)

Aims To investigate real-world short-term clinical outcomes in adults with type 2 diabetes (T2D) who initiated semaglutide in a specialist endocrinology practice in Canada. Materials and methods This study was a retrospective observational study using data from the Canadian LMC Diabetes Registry. Adults with T2D who were naive to glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy, initiated semaglutide therapy as usual standard of care between February 2018 and February 2019, and maintained semaglutide therapy during follow-up, were eligible for analysis. The primary outcome was mean change in glycated haemoglobin (HbA1c) at 3- to 6-month follow-up. Results In the final analytical cohort (n = 937), there was a statistically significant mean +/- SD reduction in HbA1c of -1.03 +/- 1.24% (11.3 +/- 13.6 mmol/mol,P < 0.001) and weight of -3.9 +/- 4.0 kg (P < 0.001), with no significant change in self-reported incidence of hypoglycaemia. There was a significant reduction in HbA1c and weight regardless of number of co-therapies or semaglutide dose. However, adults using the 1.0-mg dose had a significantly greater reduction in HbA1c compared to adults using the 0.25- to 0.5-mg dose (between-group difference - 0.24 +/- 0.06%, 2.6 +/- 0.7 mmol/mol;P < 0.001). Adults using basal-bolus therapy required a significantly lower median total daily dose of insulin after adding semaglutide (0.82 vs. 0.93 U/kg;P < 0.001). Conclusions This retrospective observational study demonstrated that GLP-1RA-naive adults with T2D initiating semaglutide in a real-world clinical practice had a statistically and clinically significant reduction in HbA1c and body weight after 3 to 6 months, regardless of semaglutide dose or order of semaglutide therapy, with no significant change in reported incidence of hypoglycaemia.