Semaglutide improves chronic kidney disease in people with type 2 diabetes
Finding from the landmark FLOW trial, the first dedicated kidney outcomes trial with a GLP-1 receptor agonist, were reported at the conference.
FLOW set out to assess the efficacy and safety of semaglutide for the prevention of kidney failure, substantial loss of kidney function and death from kidney-related or cardiovascular causes in people with type 2 diabetes and CKD. The 3533 adult participants with type 2 diabetes and CKD were randomly assigned to receive subcutaneous semaglutide at a dose of 1.0 mg weekly (n=1767) or matching placebo (n=1766). An 8-week dose-escalation regimen was used. Follow-up was for a median of 3.4 years, after the monitoring committee recommended early completion of the trial for efficacy.
The primary outcome was major kidney disease events, a composite of the onset of kidney failure, a sustained ≥50% reduction in eGFR from baseline, or death from kidney-related or cardiovascular causes. The risk of such an event was 24% lower in the semaglutide group than in the placebo group (331 vs 410 first events; HR, 0.76 [95% CI, 0.67–0.88; P=0.0003]).
Lower risk with semaglutide was also observed for a composite of the kidney-specific components of the primary outcome (HR, 0.79; 95% CI, 0.66–0.94) and for death from cardiovascular causes (HR, 0.71; 95% CI, 0.56–0.89).
The benefits of semaglutide were also observed for the three confirmatory secondary outcomes. The mean annual eGFR slope was significantly less steep (indicating a slower decrease) in the semaglutide group than the placebo group (−2.19 vs −3.36 mL/min/1.73 m2; between-group difference, 1.16; 95% CI, 0.86–1.47; P<0.001).
There was an 18% lower risk of major cardiovascular events with semaglutide compared to placebo (212 vs 254; HR, 0.82; 95% CI, 0.68–0.98; P=0.029), and the risk of death from any cause was 20% lower (HR, 0.80; 95% CI, 0.67–0.95; P=0.01).
There were fewer serious adverse events in the semaglutide group than the placebo group (877 [49.6%] vs 950 [53.8%]). This was primarily owing to fewer reported serious infections or serious cardiovascular disorders with semaglutide.
The study’s findings that semaglutide reduced the risk of clinically important kidney outcomes and death from cardiovascular causes offers the potential to develop new treatment strategies for people with type 2 diabetes and CKD.
The full findings can be read in the NEJM.
Fenofibrate reduces diabetic retinopathy progression
A study has demonstrated that a common cholesterol-lowering drug may reduce the progression of diabetic retinopathy. Results from the LENS (Lowering Events in Non-proliferative Retinopathy in Scotland) trial, were presented at the conference and published in NEJM Evidence.
Diabetic retinopathy is the second most common cause of vision loss in working-age adults in the UK. Apart from the effective management of glucose levels, there have been no treatment options available for early retinopathy. Cardiovascular outcome trials with people with type 2 diabetes have, however, suggested the fenofibrate might reduce risk for worsening of the condition. LENS set out to assess this relationship.
The trial was conducted within Scotland’s Diabetic Eye Screening (DES) programme, which provides regular retinal imaging nationally to all people with diabetes aged 12 years or over. It included 1151 adults with type 1 or type 2 diabetes with early diabetic retinopathy or maculopathy, who were randomised to receive either 145 mg fenofibrate tablets or placebo. The primary outcome was a composite of developing referable diabetic retinopathy or maculopathy (based on DES grading) or requiring treatment with laser, intravitreal injection or vitrectomy.
Over a median of 4.0 years, progression to the primary outcome occurred in 22.7% of the fenofibrate group and 29.2% of the placebo group (HR, 0.73; 95% CI, 0.58–0.91; P=0.006). Any progression of retinopathy or maculopathy occurred in 32.1% of the treatment group and 40.2% of the placebo group (HR, 0.74; 95% CI, 0.61–0.90). Development of macular oedema occurred in 3.8% of those treated with fenofibrate compared with 7.5% of the placebo group (HR, 0.50; 95% CI, 0.30–0.84). Serious adverse event rates were similar between the groups.
Dr David Preiss, one of the investigators, hopes that fenofibrate may provide a valuable addition to treat people with early-to-moderate diabetic retinopathy.
Consensus advice on monitoring for early-stage type 1 diabetes
An international consensus group has produced the first guidance for clinicians on the care and monitoring of people who are at high risk of developing type 1 diabetes. The document addresses the care of children and adults who have undergone screening and have tested positive for one or more islet autoantibodies associated with type 1 diabetes.
Such screening has usually been undertaken as part of programmes to detect people who are at higher risk of developing type 1 diabetes as they have a first-degree relative with the condition or are known to have a high-risk genotype. Most people who develop type 1 diabetes, however, are not part of at-risk groups, so screening programmes within the general population are being initiated.
These initiatives will identify significant numbers who are at risk of, or are living with, early-stage type 1 diabetes. Monitoring offers the opportunity to:
- Identify those eligible to receive therapeutic interventions to delay the progression of type 1 diabetes.
- Provide advice on the timely initiation of insulin.
- Avoid misdiagnosis and a consequent delay in insulin therapy.
- Refer to research studies.
Guidance for healthcare professionals, including in primary care, who will be responsible for much of the monitoring of this population was previously limited. Convened by Breakthrough T1D (formerly JDRF), the consensus group aimed, therefore, to provide expert advice specifying the required monitoring and management approach for people identified as being at risk, but who do not yet meet the diagnostic criteria for clinical type 1 diabetes.
The guidance includes the following broad advice:
- Primary care and endocrinologists should partner to care for people who are type 1 diabetes autoantibody-positive.
- When people screen positive for one or more autoantibody, a second sample should be tested for confirmation.
- Single autoantibody positivity confers a lower risk for progression than multiple autoantibodies.
- Those with early-stage type 1 diabetes should have periodic monitoring, including regular assessments of glucose levels, regular diabetes education and psychosocial support.
- Interested people with early-stage type 1 diabetes should be offered trial participation or approved therapies.
- Healthcare professionals involved in the care of people with type 1 diabetes have a duty to provide education.
The document was presented at the Scientific Sessions and published in Diabetes Care and Diabetologia.
SELECT trial: Preventative effects of semaglutide on type 2 diabetes development
The SELECT (Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity) trial previously showed that the GLP-1 receptor agonist semaglutide was effective in reducing the risk of major adverse cardiovascular events in people with cardiovascular disease (CVD) and overweight or obesity, but without type 2 diabetes.
Further pre-specified analyses of SELECT data demonstrated that semaglutide also had beneficial effects on glycaemia, reducing the risk of developing type 2 diabetes and increasing the likelihood of reverting to normoglycaemia in those with prediabetes.
Among the large study population of 17,604 participants, average BMI was 33.3 kg/m2, HbA1c 5.8% (40 mmol/mol) and age 61.6 years. Overall, 66% of participants had prediabetes at baseline. Results showed that the semaglutide group had a significant reduction in HbA1c of 0.31% (3.4 mmol/mol) at 20 weeks and, thereafter, HbA1c gradually increased, in parallel, in both the semaglutide and placebo arms. Notably, the effect on HbA1c was greatest in the group with the most severe dysglycaemia (HbA1c 6.0% to <6.5%) at baseline.
At the 3-year follow-up, 306 people in the semaglutide group had progressed to type 2 diabetes, compared with 1059 in the placebo group (HR, 0.27; 95% CI, 0.24–0.31). This effect was independent of body weight and BMI at baseline; however, it was significantly affected by HbA1c at baseline, with the greatest efficacy in those with prediabetes at study initiation (although the effect was still significant in those with normoglycaemia).
Semaglutide also increased the likelihood of reversion from prediabetes to normoglycaemia, with the proportion of participants with prediabetes falling from 66% at baseline to 24% at 20 weeks and 31% at 3 years. In contrast, prediabetes rates in the placebo group were more or less stable throughout. Those with lower HbA1c at baseline were more likely to achieve normoglycaemia; nonetheless, 47% of those with the most severe dysglycaemia at baseline were still able to achieve normoglycaemia at 3 years (compared with around 7% in the placebo group).
Unsurprisingly, progression to type 2 diabetes was inversely associated with the amount of weight lost in both groups; however, mediation analysis suggested that weight loss explained only about 30% of the beneficial effects of semaglutide on glycaemia. The authors proposed that this might be due to benefits of semaglutide in terms of beta-cell preservation, in addition to the improved insulin sensitivity resulting from weight loss.
It should be noted that these results were in people with established CVD, and it remains uncertain whether they would extend to people without CVD. Furthermore, 70% of participants were male and 80% were of White ethnicity, so the results should be interpreted cautiously in other groups.
The results were also published in Diabetes Care.
Benefits of tirzepatide in obstructive sleep apnoea
The dual GIP/GLP-1 receptor agonist tirzepatide shows promise as a treatment for obstructive sleep apnoea (OSA), both alone and in combination with continuous positive airway pressure (CPAP), according to findings presented at the Scientific Sessions and published in the NEJM.
SURMOUNT-OSA comprised two phase 3 trials of tirzepatide in people with moderate to severe OSA (apnoea–hypopnoea index [AHI] ≥15 events/hour) and obesity, but without diabetes. One trial enrolled people who were unable or unwilling to use CPAP, while the other included people on CPAP.
After 1 year of treatment with tirzepatide or placebo, both in addition to regular diet and lifestyle counselling sessions, AHI reduced from 53 to 28 events/hour in tirzepatide recipients who were not using CPAP, and from 46 to 17 events/hour in the CPAP group. In comparison, placebo recipients had significantly lesser reductions of around 5 events/hour.
Mean body weight was reduced by 18–20% in the tirzepatide groups, and there were significant reductions in systolic blood pressure and C-reactive protein levels. Patient-reported outcome measures showed significant improvements in sleep quality and daytime sleepiness; however, in an accompanying NEJM editorial, Sanjay Patel cautions that the measurements used have not yet been validated for use in treatment studies and that the improvements were not necessarily clinically significant in their extent.
Adverse events were mostly gastrointestinal in nature and mostly occurred during tirzepatide dose escalation. Serious adverse events occurred in 7.5% of participants overall, with similar rates between the tirzepatide and placebo groups. Two confirmed cases of acute pancreatitis occurred in the tirzepatide group, and there were no cases of medullary thyroid cancer.
This study was limited by its short duration, and longer studies will be required to determine whether the observed improvements in AHI translate to improved clinical outcomes, including cardiovascular disease, over time. The ongoing SURMOUNT-Morbidity and Mortality in Obesity trial should shed further light on this.
Semaglutide effective treatment for HFpEF in people with type 2 diabetes
Results from the STEP-HFpEF-DM trial suggest that the GLP-1 receptor agonist semaglutide is effective for treatment of obesity-related heart failure with preserved ejection fraction (HFpEF) in people with type 2 diabetes.
Previous research had suggested semaglutide was effective in people without diabetes who had obesity and HFpEF; however, there had been concerns that efficacy might be lower in people with type 2 diabetes, given that the weight-lowering effects of semaglutide are reduced in people with diabetes versus those without the condition.
A total of 616 adults with type 2 diabetes, obesity and HFpEF (left ventricular ejection fraction of at least 45%) were randomised to semaglutide 2.4 mg or placebo for 52 weeks. Median age was 69 years, BMI 36.9 kg/m2 and HbA1c 51 mmol/mol (6.8%). Most participants were receiving diuretics, RAAS blockers and beta-blockers, and around a third were receiving an MRA and/or an SGLT2 inhibitor.
The dual primary endpoints were the percentage change in body weight and the change in Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS) – an indicator of HF symptoms, physical function, social function and quality of life, with scores ranging from 0 (worst) to 100 (best).
At 52 weeks, for the treatment policy estimand (similar to an intention-to-treat analysis), KCCQ-CSS improved, from a baseline of around 60 points, by 13.7 points and 6.4 points in the semaglutide and placebo groups, respectively (estimated difference, 7.3 points; P<0.001). Notably, the treatment difference was 8.3 points in people not taking SGLT2 inhibitors at baseline and 5.3 points in those who were, suggesting some benefit of combining the two drug classes in this patient group.
Mean weight loss at 52 weeks was 9.8% in the semaglutide group versus 3.4% in the placebo group (estimated treatment difference, 6.4%), which was about 40% less than in the STEP-HFpEF trial conducted in people without type 2 diabetes (Kosiborod et al, 2023).
Among the prespecified secondary endpoints, 6-minute walk distance improved in the semaglutide group compared with placebo, as did C-reactive protein levels. Serious adverse event rates were significantly lower in the semaglutide group (17.7% vs 28.8%). One limitation of the study was that it was not powered to assess clinical outcomes (e.g. hospitalisation for heart failure); however, these favoured semaglutide.
The authors concluded that the previously demonstrated benefits of semaglutide for HFpEF extend to people with type 2 diabetes, resulting in significant reductions in HF-related symptoms and physical limitations, weight loss, and improvements in exercise function.
The findings were published in the NEJM.
Journal of
Diabetes Nursing
Issue:
Vol:28 | No:04
Conference news: Highlights from the 84th Scientific Sessions of the American Diabetes Association
Semaglutide improves chronic kidney disease in people with type 2 diabetes
Finding from the landmark FLOW trial, the first dedicated kidney outcomes trial with a GLP-1 receptor agonist, were reported at the conference.
FLOW set out to assess the efficacy and safety of semaglutide for the prevention of kidney failure, substantial loss of kidney function and death from kidney-related or cardiovascular causes in people with type 2 diabetes and CKD. The 3533 adult participants with type 2 diabetes and CKD were randomly assigned to receive subcutaneous semaglutide at a dose of 1.0 mg weekly (n=1767) or matching placebo (n=1766). An 8-week dose-escalation regimen was used. Follow-up was for a median of 3.4 years, after the monitoring committee recommended early completion of the trial for efficacy.
The primary outcome was major kidney disease events, a composite of the onset of kidney failure, a sustained ≥50% reduction in eGFR from baseline, or death from kidney-related or cardiovascular causes. The risk of such an event was 24% lower in the semaglutide group than in the placebo group (331 vs 410 first events; HR, 0.76 [95% CI, 0.67–0.88; P=0.0003]).
Lower risk with semaglutide was also observed for a composite of the kidney-specific components of the primary outcome (HR, 0.79; 95% CI, 0.66–0.94) and for death from cardiovascular causes (HR, 0.71; 95% CI, 0.56–0.89).
The benefits of semaglutide were also observed for the three confirmatory secondary outcomes. The mean annual eGFR slope was significantly less steep (indicating a slower decrease) in the semaglutide group than the placebo group (−2.19 vs −3.36 mL/min/1.73 m2; between-group difference, 1.16; 95% CI, 0.86–1.47; P<0.001).
There was an 18% lower risk of major cardiovascular events with semaglutide compared to placebo (212 vs 254; HR, 0.82; 95% CI, 0.68–0.98; P=0.029), and the risk of death from any cause was 20% lower (HR, 0.80; 95% CI, 0.67–0.95; P=0.01).
There were fewer serious adverse events in the semaglutide group than the placebo group (877 [49.6%] vs 950 [53.8%]). This was primarily owing to fewer reported serious infections or serious cardiovascular disorders with semaglutide.
The study’s findings that semaglutide reduced the risk of clinically important kidney outcomes and death from cardiovascular causes offers the potential to develop new treatment strategies for people with type 2 diabetes and CKD.
The full findings can be read in the NEJM.
Fenofibrate reduces diabetic retinopathy progression
A study has demonstrated that a common cholesterol-lowering drug may reduce the progression of diabetic retinopathy. Results from the LENS (Lowering Events in Non-proliferative Retinopathy in Scotland) trial, were presented at the conference and published in NEJM Evidence.
Diabetic retinopathy is the second most common cause of vision loss in working-age adults in the UK. Apart from the effective management of glucose levels, there have been no treatment options available for early retinopathy. Cardiovascular outcome trials with people with type 2 diabetes have, however, suggested the fenofibrate might reduce risk for worsening of the condition. LENS set out to assess this relationship.
The trial was conducted within Scotland’s Diabetic Eye Screening (DES) programme, which provides regular retinal imaging nationally to all people with diabetes aged 12 years or over. It included 1151 adults with type 1 or type 2 diabetes with early diabetic retinopathy or maculopathy, who were randomised to receive either 145 mg fenofibrate tablets or placebo. The primary outcome was a composite of developing referable diabetic retinopathy or maculopathy (based on DES grading) or requiring treatment with laser, intravitreal injection or vitrectomy.
Over a median of 4.0 years, progression to the primary outcome occurred in 22.7% of the fenofibrate group and 29.2% of the placebo group (HR, 0.73; 95% CI, 0.58–0.91; P=0.006). Any progression of retinopathy or maculopathy occurred in 32.1% of the treatment group and 40.2% of the placebo group (HR, 0.74; 95% CI, 0.61–0.90). Development of macular oedema occurred in 3.8% of those treated with fenofibrate compared with 7.5% of the placebo group (HR, 0.50; 95% CI, 0.30–0.84). Serious adverse event rates were similar between the groups.
Dr David Preiss, one of the investigators, hopes that fenofibrate may provide a valuable addition to treat people with early-to-moderate diabetic retinopathy.
Consensus advice on monitoring for early-stage type 1 diabetes
An international consensus group has produced the first guidance for clinicians on the care and monitoring of people who are at high risk of developing type 1 diabetes. The document addresses the care of children and adults who have undergone screening and have tested positive for one or more islet autoantibodies associated with type 1 diabetes.
Such screening has usually been undertaken as part of programmes to detect people who are at higher risk of developing type 1 diabetes as they have a first-degree relative with the condition or are known to have a high-risk genotype. Most people who develop type 1 diabetes, however, are not part of at-risk groups, so screening programmes within the general population are being initiated.
These initiatives will identify significant numbers who are at risk of, or are living with, early-stage type 1 diabetes. Monitoring offers the opportunity to:
Guidance for healthcare professionals, including in primary care, who will be responsible for much of the monitoring of this population was previously limited. Convened by Breakthrough T1D (formerly JDRF), the consensus group aimed, therefore, to provide expert advice specifying the required monitoring and management approach for people identified as being at risk, but who do not yet meet the diagnostic criteria for clinical type 1 diabetes.
The guidance includes the following broad advice:
The document was presented at the Scientific Sessions and published in Diabetes Care and Diabetologia.
SELECT trial: Preventative effects of semaglutide on type 2 diabetes development
The SELECT (Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity) trial previously showed that the GLP-1 receptor agonist semaglutide was effective in reducing the risk of major adverse cardiovascular events in people with cardiovascular disease (CVD) and overweight or obesity, but without type 2 diabetes.
Further pre-specified analyses of SELECT data demonstrated that semaglutide also had beneficial effects on glycaemia, reducing the risk of developing type 2 diabetes and increasing the likelihood of reverting to normoglycaemia in those with prediabetes.
Among the large study population of 17,604 participants, average BMI was 33.3 kg/m2, HbA1c 5.8% (40 mmol/mol) and age 61.6 years. Overall, 66% of participants had prediabetes at baseline. Results showed that the semaglutide group had a significant reduction in HbA1c of 0.31% (3.4 mmol/mol) at 20 weeks and, thereafter, HbA1c gradually increased, in parallel, in both the semaglutide and placebo arms. Notably, the effect on HbA1c was greatest in the group with the most severe dysglycaemia (HbA1c 6.0% to <6.5%) at baseline.
At the 3-year follow-up, 306 people in the semaglutide group had progressed to type 2 diabetes, compared with 1059 in the placebo group (HR, 0.27; 95% CI, 0.24–0.31). This effect was independent of body weight and BMI at baseline; however, it was significantly affected by HbA1c at baseline, with the greatest efficacy in those with prediabetes at study initiation (although the effect was still significant in those with normoglycaemia).
Semaglutide also increased the likelihood of reversion from prediabetes to normoglycaemia, with the proportion of participants with prediabetes falling from 66% at baseline to 24% at 20 weeks and 31% at 3 years. In contrast, prediabetes rates in the placebo group were more or less stable throughout. Those with lower HbA1c at baseline were more likely to achieve normoglycaemia; nonetheless, 47% of those with the most severe dysglycaemia at baseline were still able to achieve normoglycaemia at 3 years (compared with around 7% in the placebo group).
Unsurprisingly, progression to type 2 diabetes was inversely associated with the amount of weight lost in both groups; however, mediation analysis suggested that weight loss explained only about 30% of the beneficial effects of semaglutide on glycaemia. The authors proposed that this might be due to benefits of semaglutide in terms of beta-cell preservation, in addition to the improved insulin sensitivity resulting from weight loss.
It should be noted that these results were in people with established CVD, and it remains uncertain whether they would extend to people without CVD. Furthermore, 70% of participants were male and 80% were of White ethnicity, so the results should be interpreted cautiously in other groups.
The results were also published in Diabetes Care.
Benefits of tirzepatide in obstructive sleep apnoea
The dual GIP/GLP-1 receptor agonist tirzepatide shows promise as a treatment for obstructive sleep apnoea (OSA), both alone and in combination with continuous positive airway pressure (CPAP), according to findings presented at the Scientific Sessions and published in the NEJM.
SURMOUNT-OSA comprised two phase 3 trials of tirzepatide in people with moderate to severe OSA (apnoea–hypopnoea index [AHI] ≥15 events/hour) and obesity, but without diabetes. One trial enrolled people who were unable or unwilling to use CPAP, while the other included people on CPAP.
After 1 year of treatment with tirzepatide or placebo, both in addition to regular diet and lifestyle counselling sessions, AHI reduced from 53 to 28 events/hour in tirzepatide recipients who were not using CPAP, and from 46 to 17 events/hour in the CPAP group. In comparison, placebo recipients had significantly lesser reductions of around 5 events/hour.
Mean body weight was reduced by 18–20% in the tirzepatide groups, and there were significant reductions in systolic blood pressure and C-reactive protein levels. Patient-reported outcome measures showed significant improvements in sleep quality and daytime sleepiness; however, in an accompanying NEJM editorial, Sanjay Patel cautions that the measurements used have not yet been validated for use in treatment studies and that the improvements were not necessarily clinically significant in their extent.
Adverse events were mostly gastrointestinal in nature and mostly occurred during tirzepatide dose escalation. Serious adverse events occurred in 7.5% of participants overall, with similar rates between the tirzepatide and placebo groups. Two confirmed cases of acute pancreatitis occurred in the tirzepatide group, and there were no cases of medullary thyroid cancer.
This study was limited by its short duration, and longer studies will be required to determine whether the observed improvements in AHI translate to improved clinical outcomes, including cardiovascular disease, over time. The ongoing SURMOUNT-Morbidity and Mortality in Obesity trial should shed further light on this.
Semaglutide effective treatment for HFpEF in people with type 2 diabetes
Results from the STEP-HFpEF-DM trial suggest that the GLP-1 receptor agonist semaglutide is effective for treatment of obesity-related heart failure with preserved ejection fraction (HFpEF) in people with type 2 diabetes.
Previous research had suggested semaglutide was effective in people without diabetes who had obesity and HFpEF; however, there had been concerns that efficacy might be lower in people with type 2 diabetes, given that the weight-lowering effects of semaglutide are reduced in people with diabetes versus those without the condition.
A total of 616 adults with type 2 diabetes, obesity and HFpEF (left ventricular ejection fraction of at least 45%) were randomised to semaglutide 2.4 mg or placebo for 52 weeks. Median age was 69 years, BMI 36.9 kg/m2 and HbA1c 51 mmol/mol (6.8%). Most participants were receiving diuretics, RAAS blockers and beta-blockers, and around a third were receiving an MRA and/or an SGLT2 inhibitor.
The dual primary endpoints were the percentage change in body weight and the change in Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS) – an indicator of HF symptoms, physical function, social function and quality of life, with scores ranging from 0 (worst) to 100 (best).
At 52 weeks, for the treatment policy estimand (similar to an intention-to-treat analysis), KCCQ-CSS improved, from a baseline of around 60 points, by 13.7 points and 6.4 points in the semaglutide and placebo groups, respectively (estimated difference, 7.3 points; P<0.001). Notably, the treatment difference was 8.3 points in people not taking SGLT2 inhibitors at baseline and 5.3 points in those who were, suggesting some benefit of combining the two drug classes in this patient group.
Mean weight loss at 52 weeks was 9.8% in the semaglutide group versus 3.4% in the placebo group (estimated treatment difference, 6.4%), which was about 40% less than in the STEP-HFpEF trial conducted in people without type 2 diabetes (Kosiborod et al, 2023).
Among the prespecified secondary endpoints, 6-minute walk distance improved in the semaglutide group compared with placebo, as did C-reactive protein levels. Serious adverse event rates were significantly lower in the semaglutide group (17.7% vs 28.8%). One limitation of the study was that it was not powered to assess clinical outcomes (e.g. hospitalisation for heart failure); however, these favoured semaglutide.
The authors concluded that the previously demonstrated benefits of semaglutide for HFpEF extend to people with type 2 diabetes, resulting in significant reductions in HF-related symptoms and physical limitations, weight loss, and improvements in exercise function.
The findings were published in the NEJM.
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