Pill for Glycemic Control for Type 2 Diabetes Shows Promise

Among patients with type 2 diabetes, the drug semaglutide taken by pill resulted in better glycemic control than placebo over 26 weeks, findings that support phase 3 studies to assess longer-term and clinical outcomes, as well as safety, according to a study published by JAMA.
 
Although several type 2 diabetes treatments are available, therapy selection involves consideration of the risks of adverse effects such as hypoglycemia (low blood sugar) or weight gain and complexity of treatment. The oral formulation of semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonists (a class of drugs used for the treatment of type 2 diabetes) may improve acceptance and adherence for some patients compared with the injectable formulation of GLP-1 receptor agonists. In a phase 2 trial, Melanie Davies, M.D., of the University of Leicester, United Kingdom, and colleagues randomly assigned 632 patients with type 2 diabetes and insufficient glycemic control to different doses and dose escalation of once-daily oral semaglutide; oral placebo; or once-weekly semaglutide by injection (subcutaneous) for 26 weeks.
 
The researchers found that average change in hemoglobin Alc (HbA1c) level from baseline to week 26 decreased with oral semaglutide (dosage-dependent range, -0.7 percent to -1.9 percent) and subcutaneous semaglutide (-1.9 percent) and placebo (-0.3 percent); oral semaglutide reductions were significant vs placebo. From an average baseline HbA1c level of 7.9 percent, between 44 percent (2.5-mg group) and 90 percent (40-mg standard escalation group) of patients receiving oral semaglutide achieved the target HbA1c level of less than 7 percent. Clinically relevant (5 percent or more) weight loss was achieved in up to 71 percent of patients receiving oral semaglutide. The adverse event profile of oral semaglutide was comparable with subcutaneous semaglutide.
 
Several limitations of the study are noted in the article, including duration.
 
(doi:10.1001/jama.2017.14752)