All SUSTAIN trials were performed at 0.5mg or 1.0mg, where glycemic control was largely achieved with 0.5mg dose, except for severe patients where lower dosage was inadequate to reach the HbA1c target.
STEP trials for weight loss were done with 2.4mg per week, which is 5 times the dosage normally prescribed for Type 2 diabetes patients.
Yeah they did another trial (SUSTAIN FORTE) for diabetes after those
Semaglutide is an effective treatment for type 2 diabetes; however, 20–30% of patients given semaglutide 1·0 mg do not reach glycaemic treatment goals. We aimed to investigate the efficacy and safety of once-weekly semaglutide 2·0 mg versus 1·0 mg in adults with inadequately controlled type 2 diabetes
Yes, one trial in the last 5 years. Which is why I said we’re nowhere close to knowing the long term effect of these dosage. The first SUSTAIN goes back to 2014 and we have about a decade of data. All the STEP trials are within 5 years.
You should also note that going from 1.0mg to 2.0mg (doubling the dosage) improved the HbA1c measure from 1.9% reduction to 2.1%. It’s statistically significant but the effect is also small (an improvement for treating severe patients but not so much for the rest of the disease population). Most of the reduction is in the body weight when increasing the dosage.
Right, but the weight loss increase was also very small
Mean change in bodyweight from baseline at week 40 was −6·9 kg with semaglutide 2·0 mg and −6·0 kg with semaglutide 1·0 mg
So glycated haemoglobin improves by 10 percent and weight loss increase by 15 percent.
This would suggest to me that whatever long term problems are associated with semaglutide at 2mg are probably going to be associated with semaglutide at 1mg at broadly similar rates.
All SUSTAIN trials were performed at 0.5mg or 1.0mg, where glycemic control was largely achieved with 0.5mg dose, except for severe patients where lower dosage was inadequate to reach the HbA1c target.
STEP trials for weight loss were done with 2.4mg per week, which is 5 times the dosage normally prescribed for Type 2 diabetes patients.
Yeah they did another trial (SUSTAIN FORTE) for diabetes after those
10.1016/S2213-8587(21)00174-1
Yes, one trial in the last 5 years. Which is why I said we’re nowhere close to knowing the long term effect of these dosage. The first SUSTAIN goes back to 2014 and we have about a decade of data. All the STEP trials are within 5 years.
You should also note that going from 1.0mg to 2.0mg (doubling the dosage) improved the HbA1c measure from 1.9% reduction to 2.1%. It’s statistically significant but the effect is also small (an improvement for treating severe patients but not so much for the rest of the disease population). Most of the reduction is in the body weight when increasing the dosage.
Right, but the weight loss increase was also very small
So glycated haemoglobin improves by 10 percent and weight loss increase by 15 percent.
This would suggest to me that whatever long term problems are associated with semaglutide at 2mg are probably going to be associated with semaglutide at 1mg at broadly similar rates.
Time will tell though!