Ishiguro Mizuki, Nishimura Rimei
Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Front Endocrinol (Lausanne). 2025 Aug 26;16:1615516. doi: 10.3389/fendo.2025.1615516. eCollection 2025.
GLP-1 receptor agonists (GLP-1 RAs) reduce cardiovascular events in type 2 diabetes (T2D), and oral formulations improve accessibility. However, their real-world effectiveness and predictors of response remain unclear. This study assessed the proportions of individuals achieving HbA1c < 7.0% and experiencing ≥3.0% weight reduction after 180 days of maintenance-dose therapy (no dose modification for ≥180 days).
We retrospectively analyzed 169 participants with T2D (3 mg: n=45; 7 mg: n=92; 14 mg: n=32) treated at a single medical care center in Japan. The cohort included participants with HbA1c ≥ 7.0% at baseline. We evaluated semaglutide changes in HbA1c and weight, and predictors of glycemic response after 180 days of maintenance therapy using logistic regression.
Baseline characteristics included median age 63.0 years, body mass index (BMI) 27.2 kg/m², diabetes duration 10.0 years, and HbA1c 7.7%. Oral semaglutide was initiated as the first or second choice in 45.0% of participants. HbA1c < 7.0% was achieved in 60.0%, 53.3%, and 46.9% of the 3 mg, 7 mg, and 14 mg groups, respectively. Weight reduction ≥ 3.0% occurred in approximately half of participants across all groups. Lower baseline HbA1c (B = -1.330, p < 0.001) and earlier semaglutide use (first/second choice; B = 1.070, p = 0.013) were significant predictors of HbA1c < 7.0%.
Approximately 50% of participants across all dosing groups achieved HbA1c < 7.0% after 180 days of maintenance therapy. Weight reduction (≥ 3.0%) occurred frequently in parallel with HbA1c reduction. Early semaglutide use (first/second choice) and lower baseline HbA1c predicted HbA1c < 7.0% on maintenance therapy.
胰高血糖素样肽-1受体激动剂（GLP-1 RAs）可降低2型糖尿病（T2D）患者的心血管事件风险，口服制剂则提高了药物可及性。然而，其在现实世界中的有效性及反应预测因素仍不明确。本研究评估了维持剂量治疗180天（≥180天未调整剂量）后糖化血红蛋白（HbA1c）<7.0%以及体重减轻≥3.0%的个体比例。
我们回顾性分析了在日本一家医疗中心接受治疗的169例T2D患者（3 mg组：n = 45；7 mg组：n = 92；14 mg组：n = 32）。该队列包括基线时HbA1c≥7.0%的患者。我们使用逻辑回归评估了司美格鲁肽治疗180天后HbA1c和体重的变化以及血糖反应的预测因素。
基线特征包括年龄中位数63.0岁、体重指数（BMI）27.2 kg/m²、糖尿病病程10.0年以及HbA1c 7.7%。45.0%的患者将口服司美格鲁肽作为首选或次选起始治疗。3 mg、7 mg和14 mg组分别有60.0%、53.3%和46.9%的患者HbA1c<7.0%。所有组中约一半的患者体重减轻≥3.0%。较低的基线HbA1c（B = -1.330，p < 0.001）和更早使用司美格鲁肽（首选/次选；B = 1.070，p = 0.013）是HbA1c<7.0%的显著预测因素。
所有给药组中约50%的患者在维持治疗180天后HbA1c<7.0%。体重减轻（≥3.0%）常与HbA1c降低同时出现。早期使用司美格鲁肽（首选/次选）和较低的基线HbA1c可预测维持治疗时HbA1c<7.0%。
