Combined Semaglutide and Sodium–Glucose Cotransporter-2 Inhibitor Use and Metabolic Outcomes in Chinese Adults With Diabetes: Post Hoc Analysis

Real-world use of once-weekly semaglutide in adults with type 2 diabetes in China has been shown in SCHOLAR. This post hoc analysis investigated the use of combination semaglutide–sodium–glucose cotransporter-2 inhibitor (SGLT2i) treatment, glycated hemoglobin (HbA1c) changes, and safety in a subset of SCHOLAR participants. Participants from SCHOLAR were included in this post hoc, single-arm analysis if they were prescribed once-weekly subcutaneous semaglutide and had ≥ 1 SGLT2i prescription within 6 months of initiating semaglutide. Participants were grouped according to whether semaglutide use was continuous or not and by baseline HbA1c (≥ 7%). We evaluated the proportion of SCHOLAR participants prescribed combined semaglutide–SGLT2i. Key endpoints were: change in HbA1c from baseline to month 6; proportion of participants achieving a HbA1c level < 7% at month 6; change in lipid profile from baseline to month 6; and safety profile of combined semaglutide–SGLT2i. A total of 11,361 (42.3%) SCHOLAR participants were treated with combined semaglutide–SGLT2i. Mean change in HbA1c (95% confidence interval [CI]) from baseline to month 6 was − 0.64%-points (− 0.71, − 0.56) ( p < 0.0001) for the overall combined semaglutide–SGLT2i group. The greatest change was seen in the continuous semaglutide group with baseline HbA1c ≥ 7% (− 1.20%-points [95% CI − 1.36, − 1.04]). The proportion of participants with HbA1c levels < 7% increased from 37.8% at baseline to 55.1% at month 6 for the overall combined treatment group. There were significant reductions in mean total cholesterol ( p < 0.0001), low-density lipoprotein cholesterol ( p < 0.0001), and triglycerides ( p = 0.0043) as well as a significant increase in high-density lipoprotein cholesterol ( p < 0.0001). Gastrointestinal adverse events were most frequent. Combined semaglutide–SGLT2i treatment was prevalent in this subset of the SCHOLAR population and associated with significant reduction in HbA1c and changes in lipid profile. The safety profile of combined semaglutide–SGLT2i was similar to the overall SCHOLAR population. NCT06351748.