Drug adherence, glycemic control, and weight reduction with subcutaneous semaglutide in real-world management of type 2 diabetes

Background: We describe changes in HbA1c and body-weight and the relationship between drug adherence and clinical response in a large real-world cohort of patients with type 2 diabetes (T2D) treated with subcutaneous semaglutide for up to three years. Methods: We included adults with T2D registered at Maccabi Healthcare Services, Israel, who initiated subcutaneous semaglutide (August 2019 - June 2022). Adherence, assessed as Proportion of Days Covered (PDC), was based on drug's dispensation. We assessed the absolute change in HbA1c and the relative change in body-weight from baseline. Results: The 23,442 participants (11,513 women) had a mean age of 62.2 years, HbA1c of 7.6 %, and BMI of 33.7 kg/m2. Compared to baseline, the mean reductions in HbA1c were 0.77 [95 %CI 0.75-0.78], 0.57 [0.53-0.61], and 0.35 [0.27-0.44] %-points at 6 months, 2 years, and 3 years, respectively. The respective body-weight reductions were 4.9 % [4.8-5.0], 5.3% [5.1-5.5], and 4.5 % [3.7-5.2]. Among 6049 patients with >= 2 years of potential follow-up, median PDC between 0-6 months was 83.9 %, and remained relatively stable thereafter, reaching 74.6 % between 18-24 months. Higher PDC was associated with more pronounced HbA1c and bodyweight reductions. Conclusions: Long-term real-world adherence with semaglutide was relatively stable. Semaglutide use was associated with sustained glycemic control and weight reduction in patients with T2D and relatively good baseline glycemic control, especially among those with high adherence, supporting its use for long-term management of T2D.