You have options when it comes to prescribing the first injectable for your adult patients with type 2 diabetes. Hear from 2 health care professionals on why they choose a GLP-1 RA therapy as the first injectable for some of their patients.
Consider why
a GLP-1 RA therapy once-weekly Ozempic® should be the
first injectable
for most patients
a GLP-1 RA therapy once-weekly Ozempic® should be the
first injectable
for most patients
See why it’s time to think of prescribing a GLP-1 RA therapy prior to basal insulin for your appropriate adult patients with type 2 diabetes.
This program is sponsored by Novo Nordisk. Dr Craig Wierum and Lisa Coco, NP, received a fee from Novo Nordisk Inc. for their participation in this video.
PEER INSIGHTS
Is it time to reconsider your options?
CRAIG WIERUM | MD, FACE
Endocrinologist
Heritage Medical Associates
Nashville, TN
LISA COCO | NP
Certified Diabetes Educator
Jefferson University Physicians
Philadelphia, PA
GLP-1 RA therapy before basal insulin
When additional glycemic control is needed, many health care professionals prescribe a basal insulin as their adult patients’ first injectable after metformin. While there are patients who benefit from the use of a basal insulin, there are other options that may help patients reach their A1C goals.
The ADA guidelines recommend GLP-1 RA therapies prior to basal insulin for most adult patients with type 2 diabetes who need the greater efficacy of an injectable medication. This recommendation is based on efficacy, side effects, cost, and patient preferences.1
How do you treat your adult patients with type 2 diabetes?
“In my experience, my peers are more familiar with basal insulin and understand the benefits and side effects. There would be a huge impact if they knew about the once-weekly dosing options available with GLP-1 RA therapies.2
When I talk with my patients, I take my time explaining the guidelines and treatment, as well as what causes hypoglycemic events. I stress that every treatment plan is different for each patient and patients like that GLP-1 RA therapy offers once-weekly dosing.”
Lisa Coco NP
How does the ADA change the way you prescribe?
“The ADA guidelines recommend GLP-1 RA therapies for most patients with type 2 diabetes who need the greater glucose-lowering effect of an injectable medication.1 I take into consideration the once-weekly dosing options, efficacy, cost, and tolerability issues when prescribing a treatment.1”
Craig Wierum MD, FACE
MECHANISM OF ACTION
The different ways GLP-1 RA therapy and basal insulin
work after entering the bloodstream
GLP-1 RA therapy:
Signals the pancreas
- To release the body’s own insulin, if blood sugar is high3,4
- To lower glucagon secretion, which signals the liver to stop releasing glucose into the blood3,4
Works in the gut by slowing gastric emptying3
Basal insulin:
Signals muscle and fat cells to absorb sugar and turn it into energy5
Signals the liver to store sugar instead of releasing it into the blood5
“When I am deciding on a first injection for my patients, I consider A1C results, rates of hypoglycemia, and dosing schedule.”
CRAIG WIERUM | MD, FACE
“When I am deciding on a first injection for my patients, I consider A1C results, rates of hypoglycemia, and dosing schedule.”
CRAIG WIERUM | MD, FACE
SUSTAIN 4
See how once-weekly Ozempic® compared to Lantus®
in a head-to-head trial3,6
When patients are no longer reaching their A1C goals with oral medications and you are thinking about their first injectable, it’s important to consider the efficacy of the treatments you prescribe. The SUSTAIN 4 clinical trial was designed to compare the efficacy and safety of Ozempic® versus study-titrated Lantus® in adult patients with type 2 diabetes.2,6
PATIENTS: 1089
KEY INCLUSION CRITERIA: Insulin-naïve, T2D, inadequately controlled on metformin alone or in combination with sulfonylurea
STUDY DESIGN: 30-week, randomized, open-label, active-controlled, parallel-group, multinational, multicenter trial. Insulin glargine dose adjustments occurred throughout the trial period based on self-measured fasting plasma glucose before breakfast, targeting 71 to <100 mg/dL. In addition, investigators could titrate insulin glargine at their discretion between study visits.
PRIMARY ENDPOINT
Based on study protocol insulin titration, in insulin-naïve patients on metformin with or without sulfonylurea
Ozempic® demonstrated statistically significant A1C reductions vs Lantus®2,6
Primary endpoint: Mean change in A1C from baseline at Week 30
26% of insulin patients titrated to goal by Week 30. Mean daily insulin dose: 29 U/day.2
Results are from a 30-week, randomized, open-label, active-controlled trial in 1089 adult patients with type 2 diabetes comparing Ozempic® 0.5 mg and Ozempic® 1 mg to Lantus®.2,6
“My peers and I were quite surprised by the A1C results in SUSTAIN 4. There were greater A1C reductions with Ozempic® vs study-titrated Lantus®.”2
CRAIG WIERUM | MD, FACE
SECONDARY ENDPOINT
Based on study protocol insulin titration, in insulin-naïve patients on metformin with or without sulfonylurea
Ozempic® demonstrated statistically significant reduction in body weight vs Lantus®2,6
Ozempic® is not indicated for weight loss.
Secondary endpoint: Mean change in body weight from baseline at Week 30
Results are from a 30-week, randomized, open-label, active-controlled trial in 1089 adult patients with type 2 diabetes comparing Ozempic® 0.5 mg and Ozempic® 1 mg to Lantus®.2,6
CI=confidence interval; ETD=estimated treatment difference.
“Even though Ozempic® is not indicated for weight loss, I was impressed by the approximate 12-lb mean weight difference with Ozempic® 1 mg vs study-titrated Lantus®.”2
Lisa Coco | NP
ADVERSE EVENTS
Adverse events (AEs) occurring in ≥5% of participants in SUSTAIN 46
SUSTAIN 4 was not designed to evaluate relative safety between Ozempic® and Lantus®
The AEs occurring in ≥5% of participants in SUSTAIN 4 taking Lantus® (n=360), Ozempic® 0.5 mg (n=362), and Ozempic® 1 mg (n=360), respectively, were:
Nausea (4%, 21%, 22%)
Diarrhea (4%, 16%, 19%)
Nasopharyngitis (12%, 12%, 8%)
Lipase increased (4%, 10%, 8%)
Decreased appetite (<1%, 7%, 6%)
Vomiting (3%, 7%, 10%)
Headache (6%, 5%, 6%)
Dyspepsia (1%, 3%, 7%)
Back pain (2%, 3%, 5%)
Gastro-esophageal reflux disease (1%, 1%, 5%)
GI AEs leading to treatment discontinuation (0%, 3%, 5%)6
AE=adverse events; GI=gastrointestinal.
aDefined as an event requiring assistance of another person to actively administer carbohydrates or glucagon, or take other corrective actions or blood glucose-confirmed symptomatic hypoglycemia (plasma glucose ≤3.1 mmol/L [56 mg/dL]).6
Results from a 30-week, randomized, open-label, active-controlled trial in 1089 adult, insulin-naïve patients with type 2 diabetes.2,6
- In placebo-controlled trials, the most common adverse reactions reported in ≥5% of patients treated with Ozempic® are nausea, vomiting, diarrhea, abdominal pain, and constipation2
- Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice2
- Comparator adverse event rates are not an adequate basis for comparison of safety between products
- Incidence of severe hypoglycemia was ≤1.5% across all placebo-controlled trials2
- Incidence of severe hypoglycemia or blood glucose-confirmed hypoglycemia (% of patients) was 4% with Ozempic® 0.5 mg, 6% with Ozempic® 1 mg, and 11% with Lantus®6,a
AE=adverse events; GI=gastrointestinal.
aDefined as an event requiring assistance of another person to actively administer carbohydrates or glucagon, or take other corrective actions or blood glucose-confirmed symptomatic hypoglycemia (plasma glucose ≤3.1 mmol/L [56 mg/dL]).6
Results from a 30-week, randomized, open-label, active-controlled trial in 1089 adult, insulin-naïve patients with type 2 diabetes.2,6
Consider once-weekly Ozempic® for your appropriate T2D patients
"When patients are not reaching their A1C goals on oral therapy, you may need to consider reaching for a different type of injectable option other than insulin.”
CRAIG WIERUM | MD, FACE
"When I explain that they only need to inject Ozempic® once a week, it usually helps alleviate patient concerns about taking injections.”
LISA COCO | NP
Consider once-weekly Ozempic® for your appropriate T2D patients
“When patients are not reaching their A1C goals on oral therapy, you may need to consider reaching for a different type of injectable option other than insulin.”
CRAIG WIERUM | MD, FACE
“When I explain that they only need to inject Ozempic® once a week, it usually helps alleviate patient concerns about taking injections.”
LISA COCO | NP
STUDY DESIGN
SUSTAIN 4: Head-to-head vs Lantus® (insulin glargine U-100)2,6
Study design: 30-week, randomized, open-label, active-controlled, parallel-group, multinational, multicenter trial to compare the efficacy and safety of Ozempic® vs insulin glargine U-100.
Patients: A total of 1089 insulin-naïve adult patients with type 2 diabetes inadequately controlled on metformin alone (48%) or in combination with a sulfonylurea (51%) were randomized to receive once-weekly Ozempic® 0.5 mg (n=362), once-weekly Ozempic® 1 mg (n=360), or once-daily insulin glargine U-100 (n=360). Patients assigned to insulin glargine had a baseline mean A1C of 8.1% and were started on a dose of 10 units once daily. Insulin glargine dose adjustments occurred throughout the trial period based on self-measured fasting plasma glucose before breakfast, targeting 71 to <100 mg/dL. In addition, investigators could titrate insulin glargine based on their discretion between study visits. Twenty-six percent of patients had been titrated to goal by the primary endpoint at Week 30, at which time the mean daily insulin dose was 29 units per day.
Primary endpoint: Mean change in A1C from baseline at Week 30.
Secondary endpoint: Mean change in body weight from baseline at Week 30.
See the insulin response of patients taking Ozempic® vs healthy people
Help patients realize the potential with Ozempic®
Help patients realize the potential with Ozempic®
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