Bonora Benedetta Maria, Giaccari Andrea, Consoli Agostino, Broglio Fabio, Avogaro Angelo, Fadini Gian Paolo
Department of Medicine, University of Padova, Padua, Italy.
Veneto Institute of Molecular Medicine, Padua, Italy.
Diabetes Metab Res Rev. 2025 May;41(4):e70045. doi: 10.1002/dmrr.70045.
The introduction of glucagon-like peptide 1 receptor agonists (GLP-1RAs) has provided new avenues for managing type 2 diabetes (T2D), aiming to achieve optimal glycaemic control while minimising treatment burden. We conducted a multicentre retrospective real-world study to assess the effectiveness of semaglutide once-weekly (OW) in patients previously treated with insulin.
We included individuals with T2D who were on insulin (basal and/or bolus) and initiated OW semaglutide at 18 specialist care centres. We collected retrospective data on baseline clinical characteristics and updated values of HbA1c and body weight. The primary outcome was the change in HbA1c analysed using the mixed model for repeated measures. Secondary outcomes included the changes in body weight, insulin discontinuation and the change in insulin doses.
The study included 674 individuals. At baseline, participants were 61.7 years old, with a mean diabetes duration of 11.5 years and an HbA1c of 8.2%. During a median follow-up of 18 months, OW semaglutide initiation led to a significant reduction in HbA1c (-0.9%) and body weight (-4.3 kg), with 60% of patients achieving HbA1c < 7%. 32.8% of patients discontinued insulin therapy, 72.5% of whom achieved an HbA1c < 7%. Among patients on basal-bolus insulin, 75% completely discontinued bolus, 62% of whom achieved an HbA1c < 7%. Predictors of insulin discontinuation included shorter diabetes duration, lower baseline HbA1c, and lower insulin doses. Among patients who remained on insulin, initiation of OW semaglutide was associated with a decrease in total daily insulin requirement.
Our study highlights OW semaglutide as a valuable addition to a T2D regimen based on insulin, offering effective glycaemic and weight control with the potential for insulin deintensification or discontinuation.
胰高血糖素样肽1受体激动剂（GLP-1RAs）的引入为2型糖尿病（T2D）的管理提供了新途径，旨在实现最佳血糖控制，同时最小化治疗负担。我们开展了一项多中心回顾性真实世界研究，以评估每周一次（OW）司美格鲁肽在既往接受胰岛素治疗的患者中的有效性。
我们纳入了正在接受胰岛素（基础胰岛素和/或餐时胰岛素）治疗且在18个专科护理中心开始使用OW司美格鲁肽的T2D患者。我们收集了关于基线临床特征以及糖化血红蛋白（HbA1c）和体重的更新值的回顾性数据。主要结局是使用重复测量混合模型分析的HbA1c变化。次要结局包括体重变化、胰岛素停用情况以及胰岛素剂量变化。
该研究纳入了674名个体。基线时，参与者年龄为61.7岁，糖尿病平均病程为11.5年，HbA1c为8.2%。在中位随访18个月期间，开始使用OW司美格鲁肽导致HbA1c显著降低（-0.9%）和体重显著减轻（-4.3千克），60%的患者HbA1c < 7%。32.8%的患者停止胰岛素治疗，其中72.5%的患者HbA1c < 7%。在接受基础-餐时胰岛素治疗的患者中，75%完全停用了餐时胰岛素，其中62%的患者HbA1c < 7%。胰岛素停用的预测因素包括较短的糖尿病病程、较低的基线HbA1c和较低的胰岛素剂量。在继续使用胰岛素的患者中，开始使用OW司美格鲁肽与每日总胰岛素需求量减少有关。
我们的研究强调OW司美格鲁肽是基于胰岛素的T2D治疗方案中有价值的补充药物，可有效控制血糖和体重，并有可能减少胰岛素用量或停用胰岛素。
