Semaglutide Initiation Associated with A1C Reduction in Type 2 Diabetes Patients

June 26, 2021
Connor Iapoce

Connor Iapoce is an associate editor for HCPLive and joined the MJH Life Sciences team in April 2021. He graduated from The College of New Jersey with a degree in Journalism and Professional Writing. He enjoys listening to records, going to concerts, and playing with his cat Squish. You can reach him at

Over half of patients attained target A1C <7%. while a third of patients attained target A1C of <8%.

Following the FDA approval of glucagon-like peptide 1 receptor agonist (GLP-1 RAs) oral semaglutide (OS), controlled clinical trials have shown improved glycemic control in patients with type 2 diabetes.

Investigators, led by Jason Tan, MS, HealthCore Inc, evaluated effectiveness of oral semaglutide use in a cohort of type 2 diabetes patients with both commercial insurance and Medicare Advantage.

The results, presented at the 2021 American Diabetes Associate Virtual Meeting, found that initiation of oral semaglutide was associated with a significant reduction in HbA1c.


Investigators designed a retrospective, observational cohort study.

It utilized both medical and pharmacy claims in outpatient laboratory data from the HealthCore Integrated Research Database.

Data was collected between September 2019 - October 2020. Patients with ≥1 pharmacy prescription claim for oral semaglutide made up the study population in the identification period.

In addition, investigators included a persistent population (PP) of patients with an overlap of OS fill within a delay time prior to A1C measurement data. The team defined it as 1.5 times the day’s supply of OS fill.

All patients, including GLP-1 naive, were required to have a baseline glycosylated hemoglobin A1C >9%.

Outcomes were defined as changes in A1C and A1C target attainment at A1C <7% and <8%.

Investigators performed a paired t-test and McNemar’s test to compare pre- and post-index A1C values and goal attainment.


A total of 323 patients with type 2 diabetes initiating OS were included in the study, including 248 GLP-1 naive patients and 154 patients in the PP subgroup.

Data show OS initiation was associated with significant reduction in mean A1C in all patients, as well as the 2 noted subgroups, all P >.001.

Further, patients with baseline A1C of >9% were met with a significant A1C reduction after OS initiation (P >.001).

In attainment of study goals, including A1C <7% and <8%, investigators noted a respective increase of 25% and 20% from pre-index for all patients in the study.

They noted limitations considered were patients not required to have >7% or >8% A1C at baseline, as well as background antidiabetic usage not examined during the study.

In addition, 26% of patients with A1C >9% at baseline (n = 80) met the goal of post-index A1C <7%, while 43% of patients met the goal of A1C <8% (P >.001).

Furthermore, among patients who were GLP-1 naive (n = 67) and had a baseline of A1C <9% met the goal in 28% and 45% of patients in A1C <7% and <8%, respectively.


Following the results, investigators concluded initiation and persistence on OS in T2D patients had a significant reduction in A1C, with an increase in target attainment of A1C at <7% and <8%.

Over half of patients attained A1C <7%. while a third of patients attained a A1C of <8%.

The team noted that this study is among the first real-world evidence of data on OS, which may aid clinicians in diabetes treatment decisions and care.

“Additional real-world evidence is ongoing that will examine the full breadth of patients prescribed oral semaglutide after this initial, after-launch cohort as well as allowing for longer follow-up,” investigators wrote.

The study, “Real-World Effectiveness of Oral Semaglutide (OS) from a U.S. Commercially Insured and Medicare Advantage Population,” was published online by the ADA.