- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02648204
Efficacy and Safety of Semaglutide Versus Dulaglutide as add-on to Metformin in Subjects With Type 2 Diabetes. (SUSTAIN 7)
October 2, 2019 updated by: Novo Nordisk A/S
Efficacy and Safety of Semaglutide Versus Dulaglutide as add-on to Metformin in Subjects With Type 2 Diabetes
This trial is conducted in Asia, Europe and the United States of America (USA).
The aim of the trial is to investigate efficacy and safety of semaglutide versus dulaglutide as add-on to metformin in subjects with type 2 diabetes.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
1201
Phase
- Phase 3
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Blagoevgrad, Bulgaria, 2700
- Novo Nordisk Investigational Site
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Burgas, Bulgaria, 8000
- Novo Nordisk Investigational Site
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Montana, Bulgaria, 3400
- Novo Nordisk Investigational Site
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Sofia, Bulgaria, 1233
- Novo Nordisk Investigational Site
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Stara Zagora, Bulgaria, 6000
- Novo Nordisk Investigational Site
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Karlovac, Croatia, 47000
- Novo Nordisk Investigational Site
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Krapinske Toplice, Croatia, 49217
- Novo Nordisk Investigational Site
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Rijeka, Croatia, 51 000
- Novo Nordisk Investigational Site
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Varazdin, Croatia, 42 000
- Novo Nordisk Investigational Site
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Virovitica, Croatia, 33000
- Novo Nordisk Investigational Site
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Zagreb, Croatia, 10 000
- Novo Nordisk Investigational Site
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Jyväskylä, Finland, 40100
- Novo Nordisk Investigational Site
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Kerava, Finland, FI-04200
- Novo Nordisk Investigational Site
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Kuusamo, Finland, 93600
- Novo Nordisk Investigational Site
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Raisio, Finland, 21200
- Novo Nordisk Investigational Site
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Tampere, Finland, 33210
- Novo Nordisk Investigational Site
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Turku, Finland, 20520
- Novo Nordisk Investigational Site
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Dresden, Germany, 01219
- Novo Nordisk Investigational Site
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Falkensee, Germany, 14612
- Novo Nordisk Investigational Site
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Friedrichsthal, Germany, 66299
- Novo Nordisk Investigational Site
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Hamburg, Germany, 22607
- Novo Nordisk Investigational Site
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Münster, Germany, 48145
- Novo Nordisk Investigational Site
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Rehlingen-Siersburg, Germany, 66780
- Novo Nordisk Investigational Site
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Saint Ingbert-Oberwürzbach, Germany, 66386
- Novo Nordisk Investigational Site
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Athens, Greece, GR-17562
- Novo Nordisk Investigational Site
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Athens, Greece, 115 25
- Novo Nordisk Investigational Site
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Chalkida, Evia, Greece, GR-34100
- Novo Nordisk Investigational Site
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Ioannina, Greece, 45500
- Novo Nordisk Investigational Site
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Piraeus, Greece, GR-18536
- Novo Nordisk Investigational Site
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Thessaloniki, Greece, GR-54636
- Novo Nordisk Investigational Site
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Thessaloniki, Greece, GR-57010
- Novo Nordisk Investigational Site
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Thessaloniki, Greece, GR-57001
- Novo Nordisk Investigational Site
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Shatin, New Territories, Hong Kong
- Novo Nordisk Investigational Site
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Hyderabad, India, 500 012
- Novo Nordisk Investigational Site
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Ludhiana, India, 141001
- Novo Nordisk Investigational Site
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New Delhi, India, 110001
- Novo Nordisk Investigational Site
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Andhra Pradesh
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Guntur, Andhra Pradesh, India, 522001
- Novo Nordisk Investigational Site
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Hyderabad, Andhra Pradesh, India, 500004
- Novo Nordisk Investigational Site
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Visakhapatnam, Andhra Pradesh, India, 530002
- Novo Nordisk Investigational Site
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Assam
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Guwahati, Assam, India, 781008
- Novo Nordisk Investigational Site
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Gujarat
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Ahmedabad, Gujarat, India, 380007
- Novo Nordisk Investigational Site
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Karnataka
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Bangalore, Karnataka, India, 560002
- Novo Nordisk Investigational Site
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Bangalore, Karnataka, India, 560054
- Novo Nordisk Investigational Site
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Kerala
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Kochi, Kerala, India, 682041
- Novo Nordisk Investigational Site
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Kozhikode, Kerala, India, 673017
- Novo Nordisk Investigational Site
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Madhya Pradesh
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Indore, Madhya Pradesh, India, 452008
- Novo Nordisk Investigational Site
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Maharashtra
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Goa, Maharashtra, India, 403 202
- Novo Nordisk Investigational Site
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Mumbai, Maharashtra, India, 400008
- Novo Nordisk Investigational Site
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Mumbai, Maharashtra, India, 400022
- Novo Nordisk Investigational Site
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Pune, Maharashtra, India, 411004
- Novo Nordisk Investigational Site
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Pune, Maharashtra, India, 411040
- Novo Nordisk Investigational Site
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New Delhi
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Delhi, New Delhi, India, 110002
- Novo Nordisk Investigational Site
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New Dehli, New Delhi, India, 110029
- Novo Nordisk Investigational Site
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Orissa
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Bhubaneswar, Orissa, India, 751005
- Novo Nordisk Investigational Site
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Punjab
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Mohali, Punjab, India, 160062
- Novo Nordisk Investigational Site
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Tamil Nadu
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Chennai, Tamil Nadu, India, 600086
- Novo Nordisk Investigational Site
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Vellore, Tamil Nadu, India, 632004
- Novo Nordisk Investigational Site
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West Bengal
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Kolkata, West Bengal, India, 700020
- Novo Nordisk Investigational Site
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Kolkata, West Bengal, India, 700017
- Novo Nordisk Investigational Site
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Dublin, Ireland, DUBLIN 15
- Novo Nordisk Investigational Site
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Dublin, Ireland, DUBLIN 4
- Novo Nordisk Investigational Site
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Dublin, Ireland, DUBLIN 7
- Novo Nordisk Investigational Site
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Galway, Ireland, H91 YR71
- Novo Nordisk Investigational Site
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Gorey, Ireland
- Novo Nordisk Investigational Site
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Riga, Latvia, LV-1002
- Novo Nordisk Investigational Site
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Riga, Latvia, LV-1024
- Novo Nordisk Investigational Site
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Riga, Latvia, LV-1038
- Novo Nordisk Investigational Site
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Kaunas, Lithuania, 48259
- Novo Nordisk Investigational Site
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Kaunas, Lithuania, 50009
- Novo Nordisk Investigational Site
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Panevezys, Lithuania, 37355
- Novo Nordisk Investigational Site
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Vilnius, Lithuania, 04318
- Novo Nordisk Investigational Site
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Vilnius, Lithuania, 08661
- Novo Nordisk Investigational Site
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Almada, Portugal, 2805-267
- Novo Nordisk Investigational Site
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Aveiro, Portugal, 3814-501
- Novo Nordisk Investigational Site
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Lisboa, Portugal, 1250-230
- Novo Nordisk Investigational Site
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Tomar, Portugal, 2304-909
- Novo Nordisk Investigational Site
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Viana do Castelo, Portugal, 4901-858
- Novo Nordisk Investigational Site
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Vila Nova de Gaia, Portugal, 4434-502
- Novo Nordisk Investigational Site
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Ponce, Puerto Rico, 00716
- Novo Nordisk Investigational Site
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Brasov, Romania, 500101
- Novo Nordisk Investigational Site
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Bucharest, Romania, 010507
- Novo Nordisk Investigational Site
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Bucharest, Romania, 13682
- Novo Nordisk Investigational Site
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Buzau, Romania, 120203
- Novo Nordisk Investigational Site
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Galati, Romania, 800578
- Novo Nordisk Investigational Site
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Bihor
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Oradea, Bihor, Romania, 410469
- Novo Nordisk Investigational Site
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Mures
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Tirgu Mures, Mures, Romania, 540142
- Novo Nordisk Investigational Site
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Bratislava, Slovakia, 851 01
- Novo Nordisk Investigational Site
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Bratislava, Slovakia, 81108
- Novo Nordisk Investigational Site
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Levice, Slovakia, 93401
- Novo Nordisk Investigational Site
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Piestany, Slovakia, 92101
- Novo Nordisk Investigational Site
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Poprad, Slovakia, 05801
- Novo Nordisk Investigational Site
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Prievidza, Slovakia, 97101
- Novo Nordisk Investigational Site
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Alicante, Spain, 03010
- Novo Nordisk Investigational Site
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La Roca del Vallés, Spain, 08430
- Novo Nordisk Investigational Site
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Madrid, Spain, 28009
- Novo Nordisk Investigational Site
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Málaga, Spain, 29006
- Novo Nordisk Investigational Site
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Palma de Mallorca, Spain, 07010
- Novo Nordisk Investigational Site
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Palma de Mallorca, Spain, 07014
- Novo Nordisk Investigational Site
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Segovia, Spain, 40002
- Novo Nordisk Investigational Site
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Sevilla, Spain, 41010
- Novo Nordisk Investigational Site
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Vic (Barcelona), Spain, 08500
- Novo Nordisk Investigational Site
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Bradford-on-Avon, United Kingdom, BA15 1DQ
- Novo Nordisk Investigational Site
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Northwood, United Kingdom, HA6 2RN
- Novo Nordisk Investigational Site
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Romford, United Kingdom, RM1 3PJ
- Novo Nordisk Investigational Site
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Soham, United Kingdom, CB7 5JD
- Novo Nordisk Investigational Site
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Southampton, United Kingdom, SO16 6YD
- Novo Nordisk Investigational Site
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Southampton, United Kingdom, SO30 3JB
- Novo Nordisk Investigational Site
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Stevenage, United Kingdom, SG1 4AB
- Novo Nordisk Investigational Site
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Watford, United Kingdom, WD25 7NL
- Novo Nordisk Investigational Site
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Alabama
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Tuscumbia, Alabama, United States, 35674
- Novo Nordisk Investigational Site
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Arizona
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Chandler, Arizona, United States, 85224
- Novo Nordisk Investigational Site
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Phoenix, Arizona, United States, 85032
- Novo Nordisk Investigational Site
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Phoenix, Arizona, United States, 85050
- Novo Nordisk Investigational Site
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California
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Anaheim, California, United States, 92801
- Novo Nordisk Investigational Site
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Buena Park, California, United States, 90620
- Novo Nordisk Investigational Site
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Carlsbad, California, United States, 92008
- Novo Nordisk Investigational Site
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Concord, California, United States, 94520
- Novo Nordisk Investigational Site
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Huntington Park, California, United States, 90255
- Novo Nordisk Investigational Site
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Lincoln, California, United States, 95648
- Novo Nordisk Investigational Site
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Los Angeles, California, United States, 90057
- Novo Nordisk Investigational Site
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Montclair, California, United States, 91763
- Novo Nordisk Investigational Site
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Poway, California, United States, 92064
- Novo Nordisk Investigational Site
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Riverside, California, United States, 92506
- Novo Nordisk Investigational Site
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San Diego, California, United States, 92103
- Novo Nordisk Investigational Site
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Tustin, California, United States, 92780
- Novo Nordisk Investigational Site
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Van Nuys, California, United States, 91405
- Novo Nordisk Investigational Site
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Colorado
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Denver, Colorado, United States, 80220
- Novo Nordisk Investigational Site
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Connecticut
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Norwalk, Connecticut, United States, 06851
- Novo Nordisk Investigational Site
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Florida
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Clearwater, Florida, United States, 33756
- Novo Nordisk Investigational Site
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Clearwater, Florida, United States, 33761
- Novo Nordisk Investigational Site
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Coral Gables, Florida, United States, 33134
- Novo Nordisk Investigational Site
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Edgewater, Florida, United States, 32132
- Novo Nordisk Investigational Site
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Fort Lauderdale, Florida, United States, 33316
- Novo Nordisk Investigational Site
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Kissimmee, Florida, United States, 34741
- Novo Nordisk Investigational Site
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Miami, Florida, United States, 33173
- Novo Nordisk Investigational Site
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Orlando, Florida, United States, 32804
- Novo Nordisk Investigational Site
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Orlando, Florida, United States, 32806
- Novo Nordisk Investigational Site
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Pembroke Pines, Florida, United States, 33027
- Novo Nordisk Investigational Site
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Port Orange, Florida, United States, 32127
- Novo Nordisk Investigational Site
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Tampa, Florida, United States, 33614
- Novo Nordisk Investigational Site
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Tampa, Florida, United States, 33634
- Novo Nordisk Investigational Site
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Georgia
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Adairsville, Georgia, United States, 30103
- Novo Nordisk Investigational Site
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Atlanta, Georgia, United States, 30342
- Novo Nordisk Investigational Site
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Bainbridge, Georgia, United States, 39819
- Novo Nordisk Investigational Site
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Conyers, Georgia, United States, 30094-5965
- Novo Nordisk Investigational Site
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Marietta, Georgia, United States, 30060
- Novo Nordisk Investigational Site
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Marietta, Georgia, United States, 30067
- Novo Nordisk Investigational Site
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Suwanee, Georgia, United States, 30024
- Novo Nordisk Investigational Site
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Idaho
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Meridian, Idaho, United States, 83646
- Novo Nordisk Investigational Site
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Illinois
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Addison, Illinois, United States, 60101
- Novo Nordisk Investigational Site
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Chicago, Illinois, United States, 60607
- Novo Nordisk Investigational Site
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Gillespie, Illinois, United States, 62033
- Novo Nordisk Investigational Site
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Gurnee, Illinois, United States, 60031
- Novo Nordisk Investigational Site
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Peoria, Illinois, United States, 61602
- Novo Nordisk Investigational Site
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Indiana
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Avon, Indiana, United States, 46123
- Novo Nordisk Investigational Site
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Evansville, Indiana, United States, 47714
- Novo Nordisk Investigational Site
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Greenfield, Indiana, United States, 46140
- Novo Nordisk Investigational Site
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Indianapolis, Indiana, United States, 46254
- Novo Nordisk Investigational Site
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Muncie, Indiana, United States, 47304
- Novo Nordisk Investigational Site
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Kansas
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Newton, Kansas, United States, 67114
- Novo Nordisk Investigational Site
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Park City, Kansas, United States, 67219
- Novo Nordisk Investigational Site
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Kentucky
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Covington, Kentucky, United States, 41011
- Novo Nordisk Investigational Site
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Louisville, Kentucky, United States, 40213
- Novo Nordisk Investigational Site
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Owensboro, Kentucky, United States, 42303
- Novo Nordisk Investigational Site
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Maryland
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Hyattsville, Maryland, United States, 20782
- Novo Nordisk Investigational Site
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Oxon Hill, Maryland, United States, 20745
- Novo Nordisk Investigational Site
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Massachusetts
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Methuen, Massachusetts, United States, 01844
- Novo Nordisk Investigational Site
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Michigan
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Rochester, Michigan, United States, 48307
- Novo Nordisk Investigational Site
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Mississippi
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Port Gibson, Mississippi, United States, 39150
- Novo Nordisk Investigational Site
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Montana
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Missoula, Montana, United States, 59808
- Novo Nordisk Investigational Site
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New Jersey
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Trenton, New Jersey, United States, 08611
- Novo Nordisk Investigational Site
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New York
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New York, New York, United States, 10016
- Novo Nordisk Investigational Site
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North Carolina
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Garner, North Carolina, United States, 27529
- Novo Nordisk Investigational Site
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Whiteville, North Carolina, United States, 28472
- Novo Nordisk Investigational Site
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Winston-Salem, North Carolina, United States, 27103
- Novo Nordisk Investigational Site
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Ohio
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Cincinnati, Ohio, United States, 45242
- Novo Nordisk Investigational Site
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Dayton, Ohio, United States, 45439
- Novo Nordisk Investigational Site
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Mason, Ohio, United States, 45040-6815
- Novo Nordisk Investigational Site
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Wadsworth, Ohio, United States, 44281-9236
- Novo Nordisk Investigational Site
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Oklahoma
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Tulsa, Oklahoma, United States, 74136
- Novo Nordisk Investigational Site
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Oregon
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Corvallis, Oregon, United States, 97330-3737
- Novo Nordisk Investigational Site
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Pennsylvania
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Fleetwood, Pennsylvania, United States, 19522
- Novo Nordisk Investigational Site
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Harleysville, Pennsylvania, United States, 19438
- Novo Nordisk Investigational Site
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Philadelphia, Pennsylvania, United States, 19114
- Novo Nordisk Investigational Site
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Pittsburgh, Pennsylvania, United States, 15224-2215
- Novo Nordisk Investigational Site
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Pittsburgh, Pennsylvania, United States, 15236
- Novo Nordisk Investigational Site
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South Carolina
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Greer, South Carolina, United States, 29651
- Novo Nordisk Investigational Site
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Moncks Corner, South Carolina, United States, 29461
- Novo Nordisk Investigational Site
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Spartanburg, South Carolina, United States, 29303
- Novo Nordisk Investigational Site
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South Dakota
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Rapid City, South Dakota, United States, 57702
- Novo Nordisk Investigational Site
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Tennessee
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Humboldt, Tennessee, United States, 38343
- Novo Nordisk Investigational Site
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Texas
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Arlington, Texas, United States, 76015
- Novo Nordisk Investigational Site
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Corpus Christi, Texas, United States, 78404
- Novo Nordisk Investigational Site
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Dallas, Texas, United States, 75230
- Novo Nordisk Investigational Site
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Dallas, Texas, United States, 75390-9302
- Novo Nordisk Investigational Site
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Houston, Texas, United States, 77074
- Novo Nordisk Investigational Site
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Houston, Texas, United States, 77081
- Novo Nordisk Investigational Site
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Houston, Texas, United States, 77040
- Novo Nordisk Investigational Site
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Houston, Texas, United States, 77025
- Novo Nordisk Investigational Site
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Houston, Texas, United States, 77079
- Novo Nordisk Investigational Site
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Houston, Texas, United States, 77090
- Novo Nordisk Investigational Site
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Katy, Texas, United States, 77450
- Novo Nordisk Investigational Site
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San Antonio, Texas, United States, 78231
- Novo Nordisk Investigational Site
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Sugar Land, Texas, United States, 77479
- Novo Nordisk Investigational Site
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Utah
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Riverton, Utah, United States, 84065
- Novo Nordisk Investigational Site
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Saint George, Utah, United States, 84790
- Novo Nordisk Investigational Site
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Washington
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Spokane, Washington, United States, 99216-1557
- Novo Nordisk Investigational Site
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Walla Walla, Washington, United States, 99362-4445
- Novo Nordisk Investigational Site
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Wenatchee, Washington, United States, 98801-2028
- Novo Nordisk Investigational Site
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria: - Male or female, age at least 18 years at the time of signing informed consent.
- HbA1c (glycosylated haemoglobin) 7.0 - 10.5% (53 - 91 mmol/mol) (both inclusive) - Subjects on stable diabetes treatment with metformin (minimum of 1500 mg/day or maximal tolerated dose documented in the patient medical record) for 90 days prior to screening Exclusion Criteria: - Female who is pregnant, breast-feeding or intends to become pregnant or is of child-bearing potential and not using an adequate contraceptive method (adequate contraceptive measures as required by local regulation or practice) - Any condition, which in the investigator's opinion might jeopardise subject's safety or compliance with the protocol - Treatment with any medication for the indication of diabetes or obesity other than stated in the inclusion criteria in a period of 90 days before screening.
An exception is short-term insulin treatment for acute illness for a total of equal to or below 14 days - History of pancreatitis (acute or chronic) - Screening calcitonin equal to or above 50 ng/L - Family or personal history of Multiple Endocrine Neoplasia Type 2 or Medullary Thyroid Carcinoma - Renal impairment defined as eGFR (electronic case report form) below 60 mL/min/1.73
m^2 as per CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) - Subjects presently classified as being in New York Heart Association Class IV - Planned coronary, carotid or peripheral artery revascularisation on the day of screening - Proliferative retinopathy or maculopathy requiring acute treatment - History or presence of malignant neoplasms within the last 5 years (except basal and squamous cell skin cancer and in-situ carcinomas) - Anticipated initiation or change in concomitant medications (for more than 14 consecutive days or on a frequent basis) known to affect weight or glucose metabolism (e.g.
orlistat, thyroid hormones, corticosteroids)
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Experimental: Semaglutide 0.5 mg/Week
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Administered subcutaneously (s.c., under the skin) once-weekly.
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Experimental: Semaglutide 1.0 mg/Week
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Administered subcutaneously (s.c., under the skin) once-weekly.
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Active Comparator: Dulaglutide 0.75 mg/Week
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Administered subcutaneously (s.c., under the skin) once-weekly.
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Active Comparator: Dulaglutide 1.5 mg/Week
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Administered subcutaneously (s.c., under the skin) once-weekly.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Change in HbA1c
Time Frame: Week 0, week 40
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Results are based on HbA1c data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on-treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
The post-baseline responses are analysed using a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
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Week 0, week 40
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Change in Body Weight (kg)
Time Frame: Week 0, week 40
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Results are based on body weight data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
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Week 0, week 40
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Change in Fasting Plasma Glucose
Time Frame: Week 0, week 40
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Results are based on fasting plasma glucose data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
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Week 0, week 40
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Change in Systolic and Diastolic Blood Pressure
Time Frame: Week 0, week 40
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Results are based on systolic and diastolic blood pressure data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
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Week 0, week 40
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Change in Overall Scores for Patient Reported Outcomes: Diabetes Treatment Satisfaction Questionnaire
Time Frame: Week 0, week 40
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The questionnaire contains 8 items and evaluates subjects' diabetes treatment in terms of convenience, flexibility and general feelings towards treatment.
The result presented is 'Treatment Satisfaction' summary score (sum of 6 of the 8 items).
Response options: 6 (best case) to 0 (worst case).
Total scores range: 0-36.
Higher scores=higher satisfaction.
Results are based on data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was period where subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This includes observations recorded at, or after the date of first dose of trial product and not after first occurrence of following: the end-date of the 'on-treatment' observation period or initiation of rescue medication
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Week 0, week 40
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HbA1c Below or Equal to 6.5% (48 mmol/Mol) American Association of Clinical Endocrinologists Target
Time Frame: After 40 weeks treatment
|
Percentage of subjects who achieved HbA1c target below or equal to 6.5% (48 mmol/mol) after 40 weeks of treatment.
Results are based on data from on-treatment without rescue medication period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
Missing data imputed from a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
|
After 40 weeks treatment
|
|
Change From Baseline in 7-point Self-measured Plasma Glucose (SMPG) Mean Profile
Time Frame: Week 0, week 40
|
SMPG values were recorded at 7 time-points: before and 90 minutes after start of breakfast, lunch, and dinner, and at bedtime.
Reported results are mean profile from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
The post-baseline responses are analysed using a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
|
Week 0, week 40
|
|
Change From Baseline 7-point Self-measured Plasma Glucose Increment
Time Frame: Week 0, week 40
|
SMPG values were recorded at 7 time-points: before and 90 minutes after start of breakfast, lunch, and dinner, and at bedtime.
Reported results are plasma glucose incremental profile from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was period where subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes observations recorded at, or after date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
The post-baseline responses are analysed using a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit
|
Week 0, week 40
|
|
Change in Fasting Blood Lipids (Total Cholesterol)
Time Frame: Week 0, week 40
|
Results are based on the data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
The post-baseline responses are analysed using a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
Change from baseline is presented in terms of ratio to baseline value.
|
Week 0, week 40
|
|
Change in Fasting Blood Lipids (Low Density Lipoprotein [LDL] Cholesterol)
Time Frame: Week 0, week 40
|
Results are based on the data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
The post-baseline responses are analysed using a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
Change from baseline is presented in terms of ratio to baseline value.
|
Week 0, week 40
|
|
Change in Fasting Blood Lipids (High Density Lipoprotein [HDL] Cholesterol)
Time Frame: Week 0, week 40
|
Results are based on the data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
The post-baseline responses are analysed using a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
Change from baseline is presented in terms of ratio to baseline value.
|
Week 0, week 40
|
|
Change in Fasting Blood Lipids (Triglycerides)
Time Frame: Week 0, week 40
|
Results are based on the data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
The post-baseline responses are analysed using a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
Change from baseline is presented in terms of ratio to baseline value.
|
Week 0, week 40
|
|
Change in Body Mass Index (BMI)
Time Frame: Week 0, week 40
|
Results are based on the data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
The post-baseline responses are analysed using a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
|
Week 0, week 40
|
|
Change in Waist Circumference
Time Frame: Week 0, week 40
|
Results are based on the data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
The post-baseline responses are analysed using a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
|
Week 0, week 40
|
|
Change in Short Form Health Survey (SF-36v2™)
Time Frame: Week 0, week 40
|
The questionnaire contains 36 items across 8 domains and 2 summary scores.
Score range: 0 (worst score) to 100 (best score).
Results are based on the data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was period where subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
The post-baseline responses are analysed using a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
|
Week 0, week 40
|
|
Subjects Who After 40 Weeks Treatment Achieve (Yes/no) HbA1c <7.0% (53 mmol/Mol) American Diabetes Association (ADA) Target
Time Frame: After 40 weeks of treatment
|
Percentage of subjects who achieved HbA1c target below or equal to <7.0% (53 mmol/mol) after 40 weeks of treatment.
Results are based on data from on-treatment without rescue medication period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
Missing data imputed from a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
|
After 40 weeks of treatment
|
|
Subjects Who After 40 Weeks Treatment Achieve (Yes/no) Weight Loss ≥5%
Time Frame: After 40 weeks treatment
|
Percentage of subjects who achieved weight loss ≥5% after 40 weeks of treatment.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
Missing data imputed from a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
|
After 40 weeks treatment
|
|
Subjects Who After 40 Weeks Treatment Achieve (Yes/no) Weight Loss ≥10%
Time Frame: After 40 weeks treatment
|
Percentage of subjects who achieved weight loss ≥10% after 40 weeks of treatment.
Results are based on the data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
Missing data imputed from a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
|
After 40 weeks treatment
|
|
Subjects Who After 40 Weeks Treatment Achieve (Yes/no) HbA1c <7.0% (53 mmol/Mol) Without Severe or Blood Glucose (BG) Confirmed Symptomatic Hypoglycaemia Episodes and no Weight Gain
Time Frame: After 40 weeks of treatment
|
Percentage of subjects achieved (yes/no) HbA1c <7.0% (53 mmol/mol) without severe or BG confirmed symptomatic hypoglycaemia episodes and no weight gain after 40 weeks of treatment.
Results are based on data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was period where subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was subset of 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
Missing data imputed from mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit
|
After 40 weeks of treatment
|
|
Subjects Who After 40 Weeks Treatment Achieve (Yes/no) HbA1c Reduction ≥1%
Time Frame: After 40 weeks of treatment
|
Percentage of subjects who achieved (yes/no) HbA1c reduction of ≥1% after 40 weeks of treatment.
Results are based on the data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
Missing data imputed from a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
|
After 40 weeks of treatment
|
|
Subjects Who After 40 Weeks Treatment Achieve (Yes/no) Weight Loss ≥3%
Time Frame: After 40 weeks treatment
|
Percentage of subjects who achieved (yes/no) weight loss of ≥3% after 40 weeks of treatment.
Results are based on the data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
Missing data imputed from a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
|
After 40 weeks treatment
|
|
Subjects Who After 40 Weeks Treatment Achieve (Yes/no) HbA1c Reduction ≥1% and Weight Loss ≥3%
Time Frame: After 40 weeks treatment
|
Percentage of subjects who achieved (yes/no) HbA1c reduction ≥1% and weight loss ≥3% 40 weeks of treatment.
Results are based on the data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
Missing data imputed from a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
|
After 40 weeks treatment
|
|
Number of Treatment Emergent Adverse Events (TEAEs)
Time Frame: 40 weeks + follow-up of 5 weeks
|
A TEAE was defined as an AE with onset in the 'on-treatment' period (information collected while subjects were considered as exposed to trial product).
This corresponded to information collected until the follow-up (5 weeks after the last treatment including a visit window of +7 days).
|
40 weeks + follow-up of 5 weeks
|
|
Number of Treatment Emergent Severe or BG Confirmed Symptomatic Hypoglycaemia Episodes
Time Frame: 40 weeks + follow-up of 5 weeks
|
A treatment emergent hypoglycaemic episode was defined as an episode with onset in the 'on-treatment' period (information collected while subjects were considered as exposed to trial product).
This corresponded to information collected until the follow-up (5 weeks after the last treatment including a visit window of +7 days).
Severe or BG-confirmed symptomatic hypoglycaemia was defined as an episode that was severe according to the American Diabetes Association classification or BG-confirmed by a plasma glucose value <3.1 mmol/L (56 mg/dL) with symptoms consistent with hypoglycaemia.
|
40 weeks + follow-up of 5 weeks
|
|
Treatment Emergent Severe or BG Confirmed Symptomatic Hypoglycaemic Episodes
Time Frame: 40 weeks + follow-up of 5 weeks
|
Percentage of subjects with treatment emergent severe or BG confirmed symptomatic hypoglycaemic episodes.
A treatment emergent hypoglycaemic episode was defined as an episode with onset in the 'on-treatment' period (information collected while subjects were considered as exposed to trial product).
This corresponded to information collected until the follow-up (5 weeks after the last treatment including a visit window of +7 days).
Severe or BG-confirmed symptomatic hypoglycaemia was defined as an episode that was severe according to the American Diabetes Association classification or BG-confirmed by a plasma glucose value <3.1 mmol/L (56 mg/dL) with symptoms consistent with hypoglycaemia.
|
40 weeks + follow-up of 5 weeks
|
|
Change in Amylase
Time Frame: Week 0, week 40
|
Results are based on the data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
The post-baseline responses are analysed using a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
Change from baseline is presented in terms of ratio to baseline value.
|
Week 0, week 40
|
|
Change in Lipase
Time Frame: Week 0, week 40
|
Results are based on the data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
The post-baseline responses are analysed using a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
Change from baseline is presented in terms of ratio to baseline value.
|
Week 0, week 40
|
|
Change in Pulse Rate
Time Frame: Week 0, week 40
|
Results are based on the data from on-treatment without rescue medication observation period.
The 'on-treatment' observation period was the period where the subject was considered to be exposed to trial product.
The 'on-treatment without rescue medication' observation period was a subset of the 'on -treatment' observation period, where subjects did not receive any non-investigational antidiabetic medication (rescue medication).
This period includes the observations recorded at, or after the date of first dose of trial product and not after the first occurrence of the following: the end-date of the 'on-treatment' observation period or initiation of rescue medication.
The post-baseline responses are analysed using a mixed model for repeated measurements with treatment and country as fixed factors and baseline value as covariate, all nested within visit.
|
Week 0, week 40
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Rodbard HW, Bellary S, Hramiak I, Seino Y, Silver R, Damgaard LH, Nayak G, Zacho J, Aroda VR. GREATER COMBINED REDUCTIONS IN HbA1C >/=1.0% AND WEIGHT >/=5.0% WITH SEMAGLUTIDE VERSUS COMPARATORS IN TYPE 2 DIABETES. Endocr Pract. 2019 Jun;25(6):589-597. doi: 10.4158/EP-2018-0444. Epub 2019 Mar 13.
- Ahmann AJ, Capehorn M, Charpentier G, Dotta F, Henkel E, Lingvay I, Holst AG, Annett MP, Aroda VR. Efficacy and Safety of Once-Weekly Semaglutide Versus Exenatide ER in Subjects With Type 2 Diabetes (SUSTAIN 3): A 56-Week, Open-Label, Randomized Clinical Trial. Diabetes Care. 2018 Feb;41(2):258-266. doi: 10.2337/dc17-0417. Epub 2017 Dec 15.
- Aroda VR, Ahmann A, Cariou B, Chow F, Davies MJ, Jodar E, Mehta R, Woo V, Lingvay I. Comparative efficacy, safety, and cardiovascular outcomes with once-weekly subcutaneous semaglutide in the treatment of type 2 diabetes: Insights from the SUSTAIN 1-7 trials. Diabetes Metab. 2019 Oct;45(5):409-418. doi: 10.1016/j.diabet.2018.12.001. Epub 2019 Jan 4.
- DeSouza C, Cariou B, Garg S, Lausvig N, Navarria A, Fonseca V. Efficacy and Safety of Semaglutide for Type 2 Diabetes by Race and Ethnicity: A Post Hoc Analysis of the SUSTAIN Trials. J Clin Endocrinol Metab. 2020 Feb 1;105(2):dgz072. doi: 10.1210/clinem/dgz072.
- Jendle J, Birkenfeld AL, Polonsky WH, Silver R, Uusinarkaus K, Hansen T, Hakan-Bloch J, Tadayon S, Davies MJ. Improved treatment satisfaction in patients with type 2 diabetes treated with once-weekly semaglutide in the SUSTAIN trials. Diabetes Obes Metab. 2019 Oct;21(10):2315-2326. doi: 10.1111/dom.13816. Epub 2019 Jul 12.
- Johansen P, Hakan-Bloch J, Liu AR, Bech PG, Persson S, Leiter LA. Cost Effectiveness of Once-Weekly Semaglutide Versus Once-Weekly Dulaglutide in the Treatment of Type 2 Diabetes in Canada. Pharmacoecon Open. 2019 Dec;3(4):537-550. doi: 10.1007/s41669-019-0131-6.
- Malkin SJP, Russel-Szymczyk M, Psota M, Hlavinkova L, Hunt B. The Management of Type 2 Diabetes with Once-Weekly Semaglutide Versus Dulaglutide: A Long-Term Cost-Effectiveness Analysis in Slovakia. Adv Ther. 2019 Aug;36(8):2034-2051. doi: 10.1007/s12325-019-00965-y. Epub 2019 Jun 5.
- Pratley RE, Aroda VR, Lingvay I, Ludemann J, Andreassen C, Navarria A, Viljoen A; SUSTAIN 7 investigators. Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7): a randomised, open-label, phase 3b trial. Lancet Diabetes Endocrinol. 2018 Apr;6(4):275-286. doi: 10.1016/S2213-8587(18)30024-X. Epub 2018 Feb 1.
- Sharma R, Wilkinson L, Vrazic H, Popoff E, Lopes S, Kanters S, Druyts E. Comparative efficacy of once-weekly semaglutide and SGLT-2 inhibitors in type 2 diabetic patients inadequately controlled with metformin monotherapy: a systematic literature review and network meta-analysis. Curr Med Res Opin. 2018 Sep;34(9):1595-1603. doi: 10.1080/03007995.2018.1476332. Epub 2018 May 29.
- Wilkinson L, Hunt B, Johansen P, Iyer NN, Dang-Tan T, Pollock RF. Cost of Achieving HbA1c Treatment Targets and Weight Loss Responses with Once-Weekly Semaglutide Versus Dulaglutide in the United States. Diabetes Ther. 2018 Jun;9(3):951-961. doi: 10.1007/s13300-018-0402-8. Epub 2018 Mar 19.
- Viljoen A, Hoxer CS, Johansen P, Malkin S, Hunt B, Bain SC. Evaluation of the long-term cost-effectiveness of once-weekly semaglutide versus dulaglutide for treatment of type 2 diabetes mellitus in the UK. Diabetes Obes Metab. 2019 Mar;21(3):611-621. doi: 10.1111/dom.13564. Epub 2018 Nov 28.
- Pratley RE, Aroda VR, Catarig AM, Lingvay I, Lüdemann J, Yildirim E, Viljoen A. Impact of patient characteristics on efficacy and safety of once-weekly semaglutide versus dulaglutide: SUSTAIN 7 post hoc analyses. BMJ Open. 2020 Nov 16;10(11):e037883. doi: 10.1136/bmjopen-2020-037883.
Helpful Links
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
January 6, 2016
Primary Completion (Actual)
April 10, 2017
Study Completion (Actual)
May 19, 2017
Study Registration Dates
First Submitted
January 5, 2016
First Submitted That Met QC Criteria
January 5, 2016
First Posted (Estimate)
January 6, 2016
Study Record Updates
Last Update Posted (Actual)
October 15, 2019
Last Update Submitted That Met QC Criteria
October 2, 2019
Last Verified
October 1, 2019
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- NN9535-4216
- 2014-005375-91 (EudraCT Number)
- U1111-1164-8495 (Other Identifier: WHO)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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