De‐intensification of basal‐bolus therapy by replacing prandial insulin with once‐weekly subcutaneous semaglutide in individuals with well‐controlled type 2 diabetes: A single‐centre, open‐label randomised trial (TRANSITION ‐ T2D)

🥉 Top 5% JournalNov 12, 2024Diabetes, obesity & metabolism

Reducing insulin injections by replacing mealtime insulin with once-weekly semaglutide in well-controlled type 2 diabetes

AI simplified

GLP-1 Therapies on OpenScience ↗PubMed ↗DOI ↗OA ↗

Abstract

At Week 26, 90% of participants using semaglutide maintained HbA1c ≤7.5% compared to 75% on multiple daily insulin injections.

Mean HbA1c decreased by -0.5% in the semaglutide group, while it remained unchanged in the MDI group.
Participants using semaglutide lost an average of -8.9 kg, whereas those on MDI gained 1.5 kg.
The total daily insulin dose decreased by 56.0% in the semaglutide group, while it increased by 6.7% in the MDI group.
Among those on semaglutide, 58% reduced their insulin dose by more than 50%, and 97.5% stopped using prandial insulin.
45% of participants using semaglutide lost more than 10% of their body weight, and treatment satisfaction scores trended higher in this group.

AI simplified

AIMS: The study aims to examine the outcome of replacement of prandial insulin with once-weekly subcutaneous semaglutide in people with type 2 diabetes reasonably controlled on multiple daily insulin injections (MDI).

MATERIALS AND METHODS: This single-centre, randomised, open-label trial enrolled a statistically predetermined sample of 60 adults with HbA1c ≤7.5% (58 mmol/mol) receiving MDI, with a total daily dose (TDD) ≤120 units/day. Participants were assigned 2:1 to subcutaneous semaglutide 1.0 mg plus insulin degludec, or to continue MDI. The primary outcome was percentage of subjects maintaining HbA1c ≤7.5% (58 mmol/mol) at Week 26.

RESULTS: At Week 26, 90% of semaglutide and 75% of MDI subjects maintained HbA ≤7.5% (≤58 mmol/mol) (p = 0.18). Mean changes (95% CI) in HbA, weight and percentage body weight for semaglutide versus MDI, respectively, were -0.5% (-0.7, -0.3) versus 0.0% (-0.3, 0.3; p = 0.009); -8.9 kg (-9.9, -7.8) versus 1.5 kg (-0.1, 3.1; p < 0.001); and -8.6% (-9.6, -7.6) versus 1.4% (0.0, 2.8; p < 0.001). Insulin TDD decreased 56.0% (-62.3, -49.7) with semaglutide and increased 6.7% (-2.5, 16.0) with MDI (p < 0.001). Among semaglutide subjects, 58% reduced insulin TDD > 50%, 97.5% stopped prandial insulin and 45% lost >10% body weight. Participant treatment satisfaction scores trended higher with semaglutide. Hypoglycaemia frequency was similar between groups. 1c1c

CONCLUSIONS: In people with type 2 diabetes well controlled (HbA ≤7.5% [≤58 mmol/mol]) on MDI ≤120 units/day, replacing multiple daily injections of prandial insulin with once-weekly subcutaneous semaglutide can maintain and even improve HbA, lower body weight and lessen the burden of management. 1c1c

Key numbers

36 of 40

Percentage maintaining ≤7.5%

90% of participants vs. 75% of participants.

-8.9 kg

Mean weight change

Weight loss in group vs. weight gain of 1.5 kg in group.

-56.0%

Insulin total daily dose change

Decrease in insulin TDD in group vs. increase in group.

Full Text

We can’t show the full text here under this license. Use the link below to read it at the source.

View full text ↗

Abstract

Key numbers

Full Text

Related papers