Semaglutide delivers greater real-world weight loss and HbA1c reduction than dulaglutide in type 2 diabetes.
Background
For individuals with type 2 diabetes (T2D), managing both glycemic control and body weight is crucial, yet often challenging with conventional therapies. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) like semaglutide and dulaglutide offer effective options, but real-world comparative data, especially in diverse populations, remains valuable. This study addresses the gap by comparing the effectiveness of these two widely used weekly injectable GLP-1 RAs in an urban, predominantly African American patient cohort, providing insights beyond controlled clinical trials.
Study Design
This retrospective cohort study analyzed adult patients with type 2 diabetes from an academic internal medicine clinic who initiated treatment with either semaglutide or dulaglutide. The study included n=60 patients in each treatment arm. The primary outcome measured was the percentage change in actual body weight (ABW) from baseline at 52 weeks. Secondary outcomes included absolute weight loss in kg, the proportion of patients achieving at least 5% and 10% weight loss, and changes in hemoglobin A1c (HbA1c) levels at 52 weeks.
Results
At 52 weeks, patients treated with semaglutide demonstrated significantly greater weight loss compared to those on dulaglutide. The percentage change in ABW was -6.51% for semaglutide versus -1.14% for dulaglutide (P = .001). This translated to an absolute ABW reduction of -15.98 kg with semaglutide compared to -4.93 kg with dulaglutide (P = .001).
Key Findings
- Semaglutide led to -6.51% mean body weight reduction at 52 weeks vs. -1.14% for dulaglutide (P = .001).
- Absolute weight loss was -15.98 kg with semaglutide vs. -4.93 kg with dulaglutide (P = .001).
- More semaglutide patients achieved ≥5% weight loss (51.7% vs. 25.0%; P = .003).
- More semaglutide patients achieved ≥10% weight loss (31.7% vs. 8.3%; P = .001).
- Semaglutide reduced HbA1c by -2.15% vs. -1.36% for dulaglutide (P = .033).
Why It Matters
This real-world data provides strong evidence that semaglutide offers superior weight loss and glycemic control compared to dulaglutide in patients with type 2 diabetes, particularly within an urban, predominantly African American population. For clinicians, this reinforces semaglutide as a preferred GLP-1 RA when significant weight reduction is a primary treatment goal alongside glycemic management. For individuals using or considering GLP-1 RAs, this study highlights the potential for greater efficacy with semaglutide, which could inform discussions about treatment selection and expectations. While this is a retrospective study, the findings align with and extend previous clinical trial data, offering practical insights into real-world outcomes.
semaglutide
dulaglutide
type 2 diabetes
weight loss
hba1c
glp-1 agonist