Long-term comparative effectiveness of once-weekly semaglutide versus alternative treatments in a real-world US adult population with type 2 diabetes: a randomized pragmatic clinical trial

Oct 15, 2025BMJ open diabetes research & care

Long-term effects of once-weekly semaglutide compared to other treatments in US adults with type 2 diabetes

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Abstract

In a 2-year trial, 49.9% of participants treated with achieved (HbA)<7.0% at year 2 compared to 38.9% receiving alternative treatment.

  • Semaglutide was associated with significantly higher proportions of participants achieving HbA<7.0% at both year 1 and year 2 compared to alternative treatments.
  • Mean HbA decreases were greater in the semaglutide group at year 1 and year 2 compared to those on alternative treatment.
  • Participants treated with semaglutide experienced larger reductions in body weight at year 1, but not at year 2.
  • Treatment changes were less frequent with semaglutide than with alternative treatments.
  • Some patient-reported outcomes indicated greater improvement in the semaglutide group compared to alternative treatments.
  • No new safety concerns were identified during the trial.

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Key numbers

53.1%
Increase in <7.0%
At year 1, 53.1% of participants reached <7.0%, vs. 45.5% for alternatives.
-1.35%
Mean reduction
At year 1, mean reduction was -1.35% for vs. -1.16% for alternatives.
-3.57%
Weight loss percentage
At year 1, body weight change was -3.57% for vs. -1.91% for alternatives.

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