Morieri Mario Luca, Candido Riccardo, Frontoni Simona, Disoteo Olga, Solini Anna, Fadini Gian Paolo
Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
Diabetes Centre, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.
Diabetes Ther. 2023 Dec;14(12):2159-2172. doi: 10.1007/s13300-023-01490-6. Epub 2023 Oct 18.
This study aimed to address therapeutic inertia in the management of type 2 diabetes (T2D) by investigating the potential of early treatment with oral semaglutide.
A cross-sectional survey was conducted between October 2021 and April 2022 among specialists treating individuals with T2D. A scientific committee designed a data collection form covering demographics, cardiovascular risk, glucose control metrics, ongoing therapies, and physician judgments on treatment appropriateness. Participants completed anonymous patient questionnaires reflecting routine clinical encounters. The preferred therapeutic regimen for each patient was also identified.
The analysis was conducted on 4449 patients initiating oral semaglutide. The population had a relatively short disease duration (42% < 5 years), and a minority (15.6%) had a history of cardiovascular events. Importantly, oral semaglutide was started in subjects with various disease durations and background therapies. Notably, its initiation was accompanied by de-prescription of sulfonylureas, pioglitazone, DPP-4 inhibitors, and insulin. Choice of oral semaglutide was influenced by patient profiles and ongoing glucose-lowering regimens. Factors such as younger age, higher HbA1c, and ongoing SGLT-2 inhibitor therapy drove the choice of oral semaglutide with the aim of improving glycemic control. Projected glycemic effectiveness analysis revealed that oral semaglutide could potentially lead HbA1c to target in > 60% of patients, and more often than sitagliptin or empagliflozin.
The study supports the potential of early implementation of oral semaglutide as a strategy to overcome therapeutic inertia and enhance T2D management.
本研究旨在通过调查口服司美格鲁肽早期治疗的潜力，解决2型糖尿病（T2D）管理中的治疗惰性问题。
2021年10月至2022年4月期间，对治疗T2D患者的专科医生进行了一项横断面调查。一个科学委员会设计了一份数据收集表，涵盖人口统计学、心血管风险、血糖控制指标、正在进行的治疗以及医生对治疗适宜性的判断。参与者完成了反映常规临床诊疗情况的匿名患者问卷。还确定了每位患者的首选治疗方案。
对4449例开始使用口服司美格鲁肽的患者进行了分析。该人群的病程相对较短（42%<5年），少数患者（15.6%）有心血管事件史。重要的是，不同病程和背景治疗的患者都开始使用口服司美格鲁肽。值得注意的是，在开始使用口服司美格鲁肽的同时，停用了磺脲类药物、吡格列酮、二肽基肽酶4（DPP-4）抑制剂和胰岛素。口服司美格鲁肽的选择受患者特征和正在进行的降糖方案影响。年龄较轻、糖化血红蛋白（HbA1c）较高以及正在使用钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂治疗等因素促使选择口服司美格鲁肽以改善血糖控制。预测的血糖有效性分析显示，口服司美格鲁肽可能使超过60%的患者HbA1c达标，且比西格列汀或恩格列净更常达标。
该研究支持早期应用口服司美格鲁肽作为克服治疗惰性和加强T2D管理策略的潜力。
