Efficacy of Subcutaneous Semaglutide Dose Escalation in Reducing Insulin in Patients With Type 2 Diabetes.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic disease that affects nearly 25% of patients in the US Department of Veterans Affairs (VA) health care system. Semaglutide 2 mg has been found to significantly improve hemoglobin A1c (HbA1c) when compared with semaglutide 1 mg in patients who are not taking insulin. The purpose of this study was to investigate the effect subcutaneous semaglutide dose escalation has on total daily insulin dose in patients with T2DM. METHODS: This retrospective, single-center chart review study was conducted at the VA Sioux Falls Health Care System. The primary endpoint was change in daily insulin dose from baseline to semaglutide dose increase after receiving semaglutide 2 mg for ≥ 3 months. Baseline was defined as initiation of semaglutide 0.5 mg. Secondary endpoints included changes in daily bolus or basal insulin doses, HbA1c level, and number of hypoglycemic events reported. RESULTS: Sixty-two patients were included. Daily insulin dose changed -5.6% (95% CI, 2.2-14.0; P = .008) from baseline to 1-mg dose initiation, -22.2% (95% CI, 22.0-35.1; P < .001) at 2-mg dose initiation, and -36.9% (95% CI, 37.4-56.5; P < .001) after ≥ 3 months at the 2-mg dose. Mean HbA1c level decreased from 7.7% at baseline to 7.1% at 2-mg dose initiation (95% CI, 0.3-0.8; P < .001). CONCLUSIONS: There were statistically significant reductions in total daily insulin dose when subcutaneous semaglutide was initiated and further reduction with each semaglutide dose increase. These results support the current practice of prescribing semaglutide to treat T2DM and suggest that when the dose is increased to 2 mg, patients may experience reductions in total daily insulin dose and HbA1c levels.