GLP-1 receptor agonist is effective and safe in elderly type 2 diabetic patients
Semaglutide as a therapeutic option for elderly patients with type 2 diabetes: pooled analysis of the SUSTAIN 1–5 trialsLiterature - Warren M, Chaykin L, Trachtenbarg D, et al. - Diabetes Obes Metab 2018; published online ahead of print
Introduction and methods
Elderly patients with type 2 diabetes (T2DM) are at increased risk of hypoglycemia . Semaglutide, a human GLP-1 analogue, reduces HbA1c and body weight (BW), either as monotherapy once weekly, or combined with other antidiabetic treatments, and is well tolerated in general [2-6].
In this pooled analysis of the SUSTAIN studies, the efficacy and safety of semaglutide was evaluated in elderly (≥65 years) vs non-elderly (<65 years) T2DM patients. In SUSTAIN 1-5, 3045 patients with T2DM were randomized to once-weekly subcutaneous semaglutide (0.5 mg or 1.0 mg) or comparators (placebo, sitagliptin, exenatide or insulin).
- With semaglutide 0.5 mg, HbA1c reductions ranged from 1.2 to 1.5% (non-elderly) and 1.3 to 1.5% (elderly) and from 1.5 to 1.9% (non-elderly) and 1.2 to 1.8% (elderly) with semaglutide 1.0 mg. For comparators, the range of reduction was 0.0 to 0.9% (non-elderly) and 0.2 to 1.0% (elderly).
- In non-elderly, the estimated treatment difference (ETD) vs comparator ranged from –0.37 to –1.50% for semaglutide 0.5 mg and –0.62 to –1.87% for semaglutide 1.0 mg. In elderly, ETDs ranged from –0.43 to –1.35% and –0.50 to –1.55%, respectively.
- In non-elderly, HbA1c <7.0% was achieved by a larger proportion of patients treated with semaglutide 0.5 mg (54–70%) and 1.0 mg (65–78%) vs comparators (11–36%). In the elderly group, the corresponding proportions were 69–92%, 67–86% vs 11–51%, respectively.
- With semaglutide 0.5 mg, BW reductions ranged from 3.3 to 4.3 kg (non-elderly) and 3.6 to 4.6 kg (elderly), and from 4.6 to 6.4 kg (non-elderly) and 4.1 to 6.7 kg (elderly) with semaglutide 1.0 mg. With comparators, BW ranged from +1.1 to –2.1 kg (non-elderly) and +1.5 to –1.7 kg (elderly).
- The proportion of patients experiencing AEs was comparable between the age groups. The proportion of patients prematurely discontinuing treatment due to AEs was higher in the elderly than the non-elderly group, and in the semaglutide vs comparator arms for both groups.
- The rate (events per 100 exposure years) of severe hypoglycemia events was similar between age groups in the semaglutide arms, except for in SUSTAIN-5 where patients were on a background of basal insulin therapy.
Semaglutide consistently improved HbA1c and BW vs comparators, in elderly (≥65 years) and non-elderly patients with T2DM, and was well tolerated, suggesting that semaglutide may be an effective treatment option for elderly T2DM patients.