Great news from the diabetes world: semaglutide, a medication in development for the treatment of type 2 diabetes and obesity, has been shown to reduce the risk of cardiovascular events.

The SUSTAIN-6 study (a study in which I was an investigator) was a global study of about 3,300 people with type 2 diabetes, who were randomized to receive semaglutide subcutaneously (injected under the skin) once weekly vs placebo for treatment of their diabetes. They found that after 2 years of treatment, semaglutide reduced cardiovascular events (defined as a sum of non fatal heart attack, non fatal stroke, and cardiovascular death).  Exactly how much the risk is reduced is not yet public knowledge – the information is currently available in a press release only, with the exact data to be released at a later date.

Semaglutide is a GLP-1 receptor agonist, which helps the pancreas control the release of hormones involved in blood sugar control (insulin and glucagon), and also stimulates the fullness centre in the brain to tell a person that they feel full.  Thus, not only does it help with blood sugar control, it is also effective for weight loss.  Semaglutide is currently in development as both a type 2 diabetes treatment and as a treatment for obesity in people with or without diabetes (it is not yet available as a prescription).   Interestingly, while all GLP-1 receptor agonists currently available are administered by injection under the skin (similar to how insulin is administered), semaglutide is also currently under development as an oral medication. (ie as a pill)

This marks the third time in the last eight months that we have been so thrilled to hear that a medication designed for the treat type 2 diabetes decreases the risk of cardiovascular events: empagliflozin (trade name Jardiance) (read here) and liraglutide (trade name Victoza) (read here) reduce cardiovascular events as well.  These are landmark times for the world of type 2 diabetes, as prior to these studies, we had not definitively proven that a medication for treatment of type 2 diabetes could decrease the risk of cardiovascular events.  In fact, we have had great difficulty proving that improving blood sugar control by any means reduces cardiovascular events (though it is clear that improving blood sugar control reduces the eye and kidney complications of diabetes).

Amongst the class of GLP-1 receptor agonists, both liraglutide and semaglutide have shown that they reduce cardiovascular events (though the numbers on this are not yet available on either one), whereas lixisenatide (not available in Canada) did not decrease cardiovascular events.  It remains to be seen what effect the other GLP-1 receptor agonists available in Canada have on cardiovascular events (exenatide (trade names Bydureon and Byetta) and dulaglutide (trade name Trulicity)) – these studies are still underway.

Disclaimer: I am involved in research trials of semaglutide for type 2 diabetes and obesity.  I receive honoraria as a continuing medical education speaker and consultant from the makers of liraglutide (Novo Nordisk). 

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