Cited by 113Diabetes Treatment and ManagementDiabetes Management and ResearchPharmacology and Obesity Treatment

Efficacy and safety of once‐weekly semaglutide versus once‐daily sitagliptin as add‐on to metformin in patients with type 2 diabetes in SUSTAIN China : A 30‐week, double‐blind, phase 3a, randomized trial

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Ji, Linong, Dong, Xiaolin, Li, Yiming, Li, Yufeng, Lim, Soo, Liu, Ming, Ning, Zu, Rasmussen, Søren +3 more·2021·Diabetes, Obesity and Metabolism

Abstract

Aim: To evaluate the efficacy and safety of once‐weekly subcutaneous semaglutide, a glucagon‐like peptide‐1 (GLP‐1) analogue, versus once‐daily sitagliptin as add‐on to metformin in patients with type 2 diabetes (T2D) in a multiregional clinical trial. Materials and Methods: In the 30‐week, randomized, double‐blind, double‐dummy, active comparator SUSTAIN China trial, 868 adults with T2D inadequately controlled on metformin (HbA1c 7.0%‐10.5%) were randomized to receive once‐weekly semaglutide 0.5 mg (n = 288), semaglutide 1.0 mg (n = 290) or once‐daily sitagliptin 100 mg (n = 290). The primary and confirmatory secondary endpoints were change from baseline to week 30 in HbA 1c and body weight, respectively. Results: The trial enrolled ~70% (605/868) of the patients in China, and the remaining patients from four other countries, including the Republic of Korea. Both doses of semaglutide were superior to sitagliptin in reducing HbA 1c and body weight after 30 weeks of treatment. The odds of achieving target HbA 1c of less than 7.0% (53 mmol/mol), weight loss of 5% or higher, or 10% or higher, and the composite endpoint of HbA 1c less than 7.0% (53 mmol/mol) without severe or blood glucose‐confirmed symptomatic hypoglycaemia no weight gain, were all significantly higher with both semaglutide doses compared with sitagliptin. The safety profile for semaglutide was consistent with the known class effects of GLP‐1 receptor agonists (RAs). Consistent efficacy and safety findings were seen in the Chinese subpopulation. Conclusions: Once‐weekly semaglutide was superior to sitagliptin in improving glycaemic control and reducing body weight in patients with T2D inadequately controlled on metformin. The safety and tolerability profiles were consistent with those of semaglutide and other GLP‐1 RAs. Semaglutide is an effective once‐weekly treatment option for the Chinese population.

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  • A randomized trial conducted in China for 30 weeks showed that semaglutide caused a significant reduction in the likelihood of major adverse cardiovascular events by 26% and decreased the occurrence of stroke by 39% in comparison to placebo.

    “a randomized trial conducted in China for 30 weeks, with a double-blind and phase 3a design, showed that semaglutide caused a significant reduction in the likelihood of major adverse cardiovascular events by 26% and decreased the occurrence of stroke by 39% in comparison to placebo.”

    From Efficacy and safety of semaglutide 2.4 mg for weight loss in overweight or obese adults without diabetes: An updated systematic review and meta‐analysis including the 2‐year <scp>STEP</scp> 5 trial (2024) · cites this paper as [40]

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  • In the sitagliptin comparison group of 1518 patients, severe hypoglycemia occurred in 62 cases, approximately 4.08%.

    “The sitagliptin group comprised 1518 patients, within which there were 62 reported cases of severe hypoglycemia, resulting in a proportion of approximately 4.08%.”

    From Assessment of Thyroid Carcinogenic Risk and Safety Profile of GLP1-RA Semaglutide (Ozempic) Therapy for Diabetes Mellitus and Obesity: A Systematic Literature Review (2024) · cites this paper as [48]

    The Results (Participant disposition and baseline characteristics) report 290 patients in the sitagliptin group, not 1,518. The Results (Safety and tolerability) explicitly state that no severe hypoglycaemia episodes were reported; Table 3 lists four sitagliptin patients (1.4%) with severe or blood-glucose-confirmed hypoglycaemia, a broader category than severe hypoglycaemia alone. (LLM, conf=0.95)

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  • In the sitagliptin comparison group, acute kidney injury occurred in 3 cases (0.20%).

    “this group experienced a lower incidence of acute kidney injury (AKI) and pancreatitis, with only three cases (0.20%) and one case (0.07%), respectively.”

    From Assessment of Thyroid Carcinogenic Risk and Safety Profile of GLP1-RA Semaglutide (Ozempic) Therapy for Diabetes Mellitus and Obesity: A Systematic Literature Review (2024) · cites this paper as [48]

    The Results (Participant disposition and baseline characteristics) state that the sitagliptin group had 290 patients. Three cases among 290 patients would be about 1.03%, not 0.20%, so the claimed percentage is incompatible with this trial's group size. The passages found do not report an acute kidney injury count. (LLM, conf=0.78)

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  • In the sitagliptin comparison group, pancreatitis occurred in 1 case (0.07%).

    “this group experienced a lower incidence of acute kidney injury (AKI) and pancreatitis, with only three cases (0.20%) and one case (0.07%), respectively.”

    From Assessment of Thyroid Carcinogenic Risk and Safety Profile of GLP1-RA Semaglutide (Ozempic) Therapy for Diabetes Mellitus and Obesity: A Systematic Literature Review (2024) · cites this paper as [48]

    The Results (Safety and tolerability, Table 3) report zero EAC-confirmed mild acute pancreatitis cases in the sitagliptin group. The single case occurred in the semaglutide 1.0 mg group, where it represented 0.3%, not 0.07%. (LLM, conf=0.95)

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  • Semaglutide is effective for weight loss in the general population.

    “Across these trials, semaglutide demonstrated significant body weight reductions from baseline to end of treatment versus all comparators.”

    From Semaglutide for the treatment of antipsychotic-associated weight gain in patients not responding to metformin – a case series (2023) · cites this paper as [24]

    The Introduction reports greater body-weight reductions with semaglutide than with placebo and a range of active comparators across the SUSTAIN trials. The Discussion reports greater weight reduction than with sitagliptin in this trial. These findings concern patients with type 2 diabetes, not the general population, so they do not support that broader population claim. (LLM, conf=0.88)

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Cites

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1 of the 39 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. International Diabetes Federation, 2019, IDF Diabetes Atlas
  2. 10.1016/S0140-6736(98)07037-8 · DOI · Paper page
  3. Rodbard H, 2016, Efficacy and safety of semaglutide once‐weekly vs placebo as add‐on to basal insulin alone or in combination with metformin in subjects with type 2 diabetes (SUSTAIN 5) [abstract], Diabetologia., 59, 364
  4. International Conference on Harmonisation, 1996, ICH Harmonised Tripartite Guideline for Good Cinical Practice
  5. Novo Nordisk A/S, 2020, Ozempic® (semaglutide), US prescribing information (PI)

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Authors
Ji, L., Dong, X., Li, Y., Li, Y., Lim, S., Liu, M., Ning, Z., Rasmussen, S., Skjøth, T. V., Yuan, G., & Eliaschewitz, F. G.
Affiliations
  • Peking University People's Hospital (CN)
  • Jinan Central Hospital (CN)
  • Fudan University (CN)
  • Seoul National University (KR)
  • Tianjin Medical University (CN)
  • Novo Nordisk (China) Pharmaceuticals Co., Ltd Beijing China
  • Novo Nordisk (Denmark) (DK)
  • Affiliated Hospital of Jiangsu University (CN)
  • CPClin/DASA Centro de Pesquisas Clínicas São Paulo Brazil
Corresponding author
Ji, Linong
Venue
Diabetes, Obesity and Metabolism
Publisher
Wiley
Published
2021-01-03
Volume
23
Issue
2
Pages
404-414
ISSN
  • 1462-8902 (ISSN-L)
  • 1463-1326
OpenAlex
W3093123473
Cited by
113
References
39
Citations by year
2026: 23 · 2025: 23 · 2024: 28 · 2023: 20 · 2022: 11 · 2021: 7 · 2020: 1
FWCI
7.35
Type
journal article
Language
en
Open access
Locations
  • Diabetes Obesity and Metabolism (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
Keywords
semaglutide, sitagliptin, type 2 diabetes, GLP-1 receptor agonists, metformin add-on therapy, glycemic control, HbA1c, weight loss, hypoglycemia, adverse events, Chinese patients, DPP-4 inhibitors
MeSH terms
Sitagliptin Phosphate, Semaglutide, Adult, China, Diabetes Mellitus, Type 2, Double-Blind Method, Drug Therapy, Combination, Glucagon-Like Peptides, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Metformin, Treatment Outcome, Republic of Korea

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