Seniors with T2D fare well with oral semaglutide in real world

Oral semaglutide, when used in routine clinical practice, appears effective in managing type 2 diabetes (T2D) even in “very elderly” populations.

In a real-world study of oral semaglutide use in T2D patients, those who were at least 76 years of age achieved significant reductions in HbA1c at 6 months (–0.53 percent; p<0.0001) and 12 months (–0.54 percent; p=0.0002) of follow up. They also lost a significant amount of body weight at both time points (6 months: −1.57 kg; p=0.0003 and 12 months: −2.74 kg; p<0.0001). [Diabetes Res Clin Pract 2024;doi:10.1016/j.diabres.2024.111928]

At the 6- and 12-month follow-up, substantial improvements were additionally seen in systolic blood pressure (–4.23 and –6.4 mm Hg), total cholesterol (–15.61 and –9.63 mg/dl), and low-density lipoprotein cholesterol (–13.2 and –8.6 mg/dl).

“These results were accomplished by simplifying therapy, mainly reducing the prescription of drugs linked to increased risk of hypoglycaemia,” the investigators noted. 

The introduction of oral semaglutide in the treatment regimen enabled a reduction in the use of sulphonylureas (from 6.1 percent to 2.1 percent), basal insulin (from 31.6 percent to 23.6 percent), and rapid insulin (from 17.2 percent to 8.8 percent) in the overall population.

“For patients already on injectable GLP1-RA, switching to oral semaglutide, led to an improvement in HbA1c and an additional weight loss,” they said.

Despite the presence of limitations such as the observational design and the lack of information on dose escalation, among others, the study suggests that oral semaglutide is equally effective in very elderly TD2M patients as it is their younger counterparts, according to the investigators. This makes the drug a viable treatment option for patients at least 76 years of age, they added.

Study details

For the study, the investigators used data from seven diabetes centres in Tuscany, Italy. The total population comprised 1,824 T2D patients (mean age 65.4 years, 59.2 percent male), of which 18.7 percent were in the >75-years age group. The average duration of T2D was 11.1 years.

At baseline, mean HbA1c was 8.0 percent, while mean BMI was 31.2 kg/m². One-third of the patients had an eGFR of <60 ml/min/1.73 m² (35.5 percent), 36.1 percent had albuminuria, and 13.9 percent had established cardiovascular disease. 

Oral semaglutide was initiated at a dose of 3 mg in 45.1 percent of the patients, at 7 mg in 40.0 percent, and at 14 mg in the remaining 14.9 percent. Upon initiation, 25.2 percent of the patients were already on treatment with an injectable GLP1-RA.

Overall, oral semaglutide use resulted in 0.87-percent reduction in HbA1c at 6 months (p<0.0001) and at 12 months (p<0.0001). Body weight dropped by 2.78 kg (p<0.0001) and by 3.89 kg (p<0.0001) at the respective time points. Notably, 28.4 percent of patients achieved the composite outcome of a decrease of ≥1.0 percent in HbA1c and a weight loss of at least 3 percent.