Oral Semaglutide Effective Real-World Treatment for Patients with T2D, Uncontrolled A1c

Oral semaglutide is an effective treatment in the real-world for patients with type 2 diabetes (T2D), including those with uncontrolled hemoglobin A1c (HbA1c), according to new late-breaking findings presented at the American Diabetes Association (ADA) 2022 Scientific Sessions.

“The initial dose of oral semaglutide appeared higher than prescribing instructions indicate for more than half of study patients,” wrote study author Caroline Swift, PhD, MPH, Novo Nordisk.

The research found patients with T2D were more often prescribed oral semaglutide by primary care physicians than endocrinologists. Investigators performed the retrospective observational analysis using medical and pharmacy claims data from the Optum Research Database between November 2018 and December 2020.

For inclusion, study participants were required to have ≥1 claims for oral semalgutide between November 2019 and June 2020 and ≥1 T2D diagnosis during the pre-index period, as well as commercial and Medicare Advantage with Part D insurance coverage.

Further, they were aged ≥18 years, had continuous enrollment for 12 months before and including index (baseline) and 6 months post-index (follow-up). Pregnant individuals were excluded from the study. The results were then stratified by the patient’s last baseline A1c (<9% or ≥9%).

From a total of 3,466 patients identified with ≥1 claim for oral semaglutide, 994 patients had ≥1 A1c value during baseline. They found 267 participants had A1c ≥9% and 727 had A1c <9%.

Investigators observed patients with baseline A1c <9% were slightly older at 59.6 years than patients with A1c ≥9% at 57.6 years (P = .018), while 50.4% were male and 63.1% had commercial coverage. They noted that there were no significant differences between A1c cohorts in the proportion of patients with atherosclerotic cardiovascular disease, heart failure, chronic kidney disease, stroke, depression or anxiety.

For those with baseline and follow-up A1c values (n = 652), the mean A1c change was -0.79%. Data show patients with A1c ≥9% had mean change of -1.99% compared to -0.35% among patients with A1c <9% (P <.001).

Within a subset of persistent patients (≥90 days of continuous semaglutide treatment and ≥1 Arc after ≥90 days of treatment; n = 200), the A1c ≥9% group had a mean A1c change of -2.7% in comparison to -0.48% among patients with A1c <9% (P <.001).

Moreover, investigators observed a higher percentage of persistent patients with baseline A1c ≥9% (86.8%) had a change of ≥1% compared to those with baseline at <9% (31.5%; P = .001). Data show 43% of patients were prescribed 3 mg on their index prescription.

Although 50.6% of index treatments were prescribed by primary care and internal medicine providers, data show a higher percentage of patients with A1c <9% had semaglutide prescribed by an endocrinologist (24.4% vs 16.1%; P = .006).

“More research is needed to understand the relationship between provider specialty, A1c values, and prescribing patterns,” Swift concluded.

The study, “Real-World A1c changes and prescribing provider types among T2DM patients initiating treatment with oral semaglutide,” was presented at ADA 2022.