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This article is from NEJM Journal Watch
Semaglutide's Effect on Glycemia in Patients with Prediabetes and Obesity
Effect of semeglutide on blood glucose in obese pre-diabetic patients
Reviewed by Allan S.
Brett, MD
The drug is combined with lifestyle interventions to normalize blood glucose in most patients
.
In three industry-funded placebo-controlled randomized trials, weekly injections of semeglutide (target dose 2.
4 mg) significantly reduced weight in overweight or obese patients without diabetes (NEJM JW Gen Med Mar 15 2021 and N Engl J Med 2021 384; 989; NEJM JW Gen Med Apr 1 2021 and JAMA 2021; 325:1403; JAMA 2021; 325:1414）
。 Nearly half (about 1,500 people) of the participants were pre-diabetic, and the rest had normal blood sugar
.
In a post-hoc analysis, the investigators sought to determine the proportion
of participants who were pre-diabetic at baseline with normal blood glucose (i.
e.
, glycosylated hemoglobin [HbA1c] <5.
7% or blood glucose <100 mg/dL) at the end of the trial.
Of note, participants in both the semeglutide and placebo groups received lifestyle interventions (from monthly counseling to intensive behavioral therapy).
<b21> At 68 weeks, in the three trials, 84%~89% of pre-diabetic participants in the semeglutide group turned to normal blood glucose
.
The above proportion in the placebo group was lower than that in the semeglutide group, but it also reached a fairly high level (48%~70%)
.
comments
Semeglutide (using approved weight-reducing doses) combined with lifestyle interventions normalizes blood glucose in most patients with prediabetes
.
However, improvements in blood glucose levels in the control group suggest that lifestyle interventions are the main reason
for achieving these effects.
Overall, these findings are promising, but we need to further understand the safety of semeglutide during long-term treatment in obese pre-diabetic patients, as well as its effects
on metabolism.
Articles that were commented on
Perreault L et al.
Changes in glucose metabolism and glycemic status with once-weekly subcutaneous semaglutide 2.
4 mg among participants with prediabetes in the STEP program.
Diabetes Care 2022 Oct; 45:2396.
(https://doi.
org/10.
2337/dc21-1785)
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