Glycaemic control efficacy of switching from dipeptidyl peptidase‐4 inhibitors to oral semaglutide in subjects with type 2 diabetes: A multicentre, prospective, randomized, open‐label, parallel‐group comparison study (SWITCH‐SEMA 2 study)

Dec 11, 2023Diabetes, obesity & metabolism

Blood sugar control after switching from DPP-4 inhibitors to oral semaglutide in people with type 2 diabetes

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Abstract

Improvement in glycated haemoglobin (HbA1c) at week 24 was -0.65 when switching to oral semaglutide compared to a change of +0.05 with DPP-4i continuation.

Switching to oral semaglutide is associated with a significant reduction in HbA1c compared to continuing DPP-4 inhibitors.
Body weight, lipid profiles, and liver enzymes show greater improvement in participants switched to semaglutide.
Factors such as higher baseline HbA1c and insulin resistance are linked to better HbA1c improvement after switching to semaglutide.
Seven participants in the semaglutide group experienced gastrointestinal symptoms leading to medication discontinuation.

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AIM: To assess whether oral semaglutide provides better glycaemic control, compared with dipeptidyl peptidase-4 inhibitor (DPP-4i) continuation, in people with type 2 diabetes.

MATERIALS AND METHODS: In this multicentre, open-label, prospective, randomized, parallel-group comparison study, participants receiving DPP-4is were either switched to oral semaglutide (3-14 mg/day) or continued on DPP-4is. The primary endpoint was the change in glycated haemoglobin (HbA1c) over 24 weeks. Secondary endpoints included changes in metabolic parameters and biomarkers, along with the occurrence of adverse events. Factors associated with HbA1c improvement were also explored.

RESULTS: In total, 174 eligible participants were enrolled; 17 dropped out of the study. Consequently, 82 participants in the DPP-4i group and 75 participants in the semaglutide group completed the study and were included in the analysis. Improvement in HbA1c at week 24 was significantly greater when switching to semaglutide compared with DPP-4i continuation [-0.65 (95% confidence interval: -0.79, -0.51) vs. +0.05 (95% confidence interval: -0.07, 0.16) (p < .001)]. Body weight, lipid profiles and liver enzymes were significantly improved in the semaglutide group than in the DPP-4i continuation group. Multiple linear regression analysis revealed that baseline HbA1c and homeostasis model assessment 2-R were independently associated with HbA1c improvement after switching to semaglutide. Seven participants in the semaglutide group discontinued medication because of gastrointestinal symptoms.

CONCLUSIONS: Although the potential for gastrointestinal symptoms should be carefully considered, switching from DPP-4is to oral semaglutide may be beneficial for glycaemic control and metabolic abnormalities in people with higher HbA1c and insulin resistance.

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Glycaemic control efficacy of switching from dipeptidyl peptidase‐4 inhibitors to oral semaglutide in subjects with type 2 diabetes: A multicentre, prospective, randomized, open‐label, parallel‐group comparison study (SWITCH‐SEMA 2 study)

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