Efficacy of oral semaglutide after switching from DPP-4 inhibitors in Japanese type 2 diabetes patients with obesity

Abstract Background Although these findings suggest that oral semaglutide may be a suitable treatment option for obese patients with type 2 diabetes mellitus inadequately responsive to dipeptidyl peptidase (DPP)-4 inhibitor–based therapy, evidence from actual clinical settings remains limited. Objective The objective of this study was to investigate the effect of oral semaglutide in obese patients with type 2 diabetes mellitus who had an inadequate response to DPP-4 inhibitor–based therapy. Methods This study was a retrospective, single-center study in which outpatients with type 2 diabetes were (1) aged 20 years or older at the time of oral semaglutide administration, (2) treated with an existing DPP-4 inhibitor for 3 months and/or longer at the time of oral semaglutide administration, and (3) had a hemoglobin A1c (HbA1c) level of ≥ 6.5% and/or a body mass index (BMI) ≥ 25.0 kg/m2. The primary endpoints were changes in HbA1c and body weight from baseline to 6 months after oral semaglutide treatment switching from DPP-4 inhibitor. Results In the 48 patients studied, HbA1c was 7.01 ± 0.54%, and BMI was 26.7 ± 3.6 kg/m2 at baseline. HbA1c significantly decreased by 0.68 ± 0.36%, and body weight significantly decreased by 3.4 ± 2.3 kg (p < 0.001 for each). Improvements in indices of lipid metabolism and liver function were observed. Non-serious nausea and loss of appetite were observed in many patients, but these symptoms resolved in approximately 3 months. Mild constipation was also observed. Conclusion Oral semaglutide appears to be a promising alternative to DPP-4 inhibitors as a means of glycemic and weight control in obese type 2 diabetes.