Once-Weekly Semaglutide Versus Sodium-Glucose Co-transporter 2 Inhibitors: Real-World Impact on Weight, HbA1c, and Healthcare Resource Utilization in Type 2 Diabetes (PAUSE)

Mar 27, 2025Diabetes therapy : research, treatment and education of diabetes and related disorders

Weekly Semaglutide Compared to SGLT2 Inhibitors: Effects on Weight, Blood Sugar, and Healthcare Use in Type 2 Diabetes

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Abstract

The observational study included 772 patients initiating either semaglutide or SGLT2 inhibitors for type 2 diabetes.

Mean weight change in the semaglutide cohort was -4.4 kg, compared to -3.4 kg in the SGLT2i cohort.
Mean BMI decreased by -1.5 kg/m in the semaglutide group versus -1.1 kg/m in the SGLT2i group.
The reduction in HbA1c was -1.6% for those on semaglutide, while it was -1.2% for those on SGLT2i.
Significant improvements in weight, BMI, and HbA1c were observed in all subgroups of the semaglutide cohort.
Healthcare resource utilization was similar between the semaglutide and SGLT2i cohorts after one year.

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INTRODUCTION: Clinical trials have demonstrated greater glycemic control and weight loss with once-weekly (OW) semaglutide versus other anti-diabetes medications, including sodium-glucose co-transporter 2 inhibitors (SGLT2is) in adults with type 2 diabetes (T2D), yet real-world evidence is limited.

METHODS: This observational study of adults with uncontrolled T2D (HbA1c ≥ 7.0%) initiating semaglutide OW or SGLT2is (January 2018-February 2022; first prescription = index) utilized linked data from IQVIA PharMetrics® Plus adjudicated claims and Ambulatory Electronic Medical Records databases. Among the all semaglutide OW cohort and subgroups (1: persistent [≤ 60-day gap in semaglutide OW supply]; 2: receiving maximum dose ≥ 1 mg; and 3: persistent and ≥ 1 mg dose), changes in weight, body mass index (BMI), and glycated hemoglobin (HbA1c) outcomes from baseline to 1 year post index were descriptively compared. For the main analysis, changes in weight, BMI, HbA1c, and all-cause healthcare resource utilization (HCRU) after 1 year were compared among adjusted semaglutide OW and comparator SGLT2i cohorts, following inverse probability of treatment weighting (IPTW).

RESULTS: The all semaglutide OW cohort included 772 patients, and IPTW adjusted cohorts included 416 semaglutide OW patients and 1093 SGLT2i patients. Significant (P < 0.0001) mean changes from baseline were observed in the all semaglutide OW cohort and all subgroups, in weight (kg [all: - 4.4; 1: - 5.0; 2: - 4.9; 3: - 5.2]), BMI (kg/m[all: - 1.5; 1: - 1.8; 2: - 1.8; 3: - 1.9]), and HbA1c (% [all: - 1.5; 1: - 1.7; 2: - 1.5; 3: - 1.6]). Post-IPTW adjustment, the semaglutide OW cohort had significantly greater mean reductions versus the SGLT2i cohort in weight (- 4.4 versus - 3.4 kg, P = 0.0061), BMI (- 1.5 versus - 1.1 kg/m, P = 0.0013), and HbA1c (- 1.6 versus - 1.2%, P < 0.0001), with similar all-cause HCRU. 2 2

CONCLUSION: Adults with T2D initiating semaglutide OW in the real-world had significant decreases in weight, BMI, and HbA1c after 1 year, with greater improvements versus SGLT2i, and similar HCRU.

Key numbers

-4.4 kg

Weight Reduction

Mean change from baseline in the cohort.

-1.6%

Reduction

Mean change from baseline in the cohort.

-1.5 kg/m

Reduction

Mean change from baseline in the cohort.

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Once-Weekly Semaglutide Versus Sodium-Glucose Co-transporter 2 Inhibitors: Real-World Impact on Weight, HbA1c, and Healthcare Resource Utilization in Type 2 Diabetes (PAUSE)

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