Background: Once-weekly treatment with the subcutaneous glucagon-like receptor-1 receptor agonist (GLP-1RA) semaglutide has been reported to have potent beneficial effects on metabolic abnormalities. However, little is known about the usefulness of switching from other GLP-1RAs to semaglutide, especially in older people with type 2 diabetes.

Methods: This study is a subgroup analysis of the SWITCH-SEMA1 study, a multicenter, prospective, open-label, parallel-group, randomized controlled study in which people with type 2 diabetes continued liraglutide or dulaglutide therapy or switched to semaglutide for 24 weeks (jRCTs1011200008). One hundred people enrolled in this study were divided into two groups: an aged group consisting of people 65 years or older (n = 49; 72.8 ± 4.4 years old) and a non-aged group (n = 51; 51.2 ± 6.8 years old). The changes of metabolic parameters between the two treatment arms (continuation vs switching to semaglutide) were compared between an aged and a non-aged group.

Results: At baseline, BMI, fatty liver index (FLI), C-peptide index (CPI), HOMA2-β, HOMA2-R, eGFR, and triglyceride levels were significantly lower in the aged group (all P < 0.05). After 24 weeks, switching to semaglutide significantly ameliorated HbA1c in both groups (aged: −0.7%, P<0.001; non-aged: −0.7%, P < 0.01). In the aged group, FLI; CPI; HOMA2-β; AST, γ-GTP, and uric acid (UA) levels; and the Diabetes Treatment Satisfaction Questionnaire (DTSQ) score significantly improved after switching to semaglutide (all P < 0.05). The magnitude of changes in BMI and UA levels after switching to semaglutide was greater in the aged group than in the non-aged group (BMI: −1.1 vs. −0.5 kg/m2, P < 0.01; UA: −0.4 vs. −0.1 mg/dL, P <0.05).

Conclusions: The effects on metabolic parameters of switching from other GLP-1RAs to once-weekly semaglutide might be greater in aged people than in non-aged people.


Y.Takahashi: None. H.Nomoto: Speaker's Bureau; Novo Nordisk, Sumitomo Pharma, Co., Ltd. H.Yokoyama: None. A.Miya: None. A.Miyazaki: None. H.Kameda: None. T.Atsumi: Speaker's Bureau; Eli Lilly Japan K.K., Kowa Company, Ltd. A.Nakamura: Research Support; Abbott Japan Co., Ltd., Boehringer Ingelheim Japan, Inc., Daiichi Sankyo, Taisho Pharmaceutical Holdings Co., Ltd., Teijin Pharma Limited, Kowa Company, Ltd., Mitsubishi Tanabe Pharma Corporation. H.Miyoshi: Research Support; Abbott, LifeScan Diabetes Institute, Taisho Pharmaceutical Holdings Co., Ltd., Speaker's Bureau; AstraZeneca, Boehringer Ingelheim Japan, Inc., Eli Lilly Japan K.K., Kowa Company, Ltd., MSD Life Science Foundation, Novo Nordisk, Ono Pharmaceutical Co., Ltd., Sanofi K.K., Mitsubishi Tanabe Pharma Corporation.

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