Efficacy and Safety of Semaglutide Versus Canagliflozin as add-on to Metformin in Subjects With Type 2 Diabetes (SUSTAIN 8)

This trial is conducted in Africa, Asia, Europe, North and South America. The aim of the trial is to compare the effect of once-weekly (OW) dosing of subcutaneous semaglutide (1.0 mg) versus once-daily dosing of oral canagliflozin (300 mg) on glycaemic control in subjects with type 2 diabetes (T2D) on a background treatment of metformin

Study Overview

• Status: Completed
• Conditions: Diabetes Mellitus, Type 2; Diabetes
• Intervention / Treatment: Drug: Semaglutide; Drug: Placebo (canagliflozin); Drug: Canagliflozin; Drug: Placebo (semaglutide)

• Study Type: Interventional
• Enrollment (Actual): 788
• Phase: Phase 3

Contacts and Locations

Study Locations

• Argentina
  • Buenos Aires, Argentina, C1250AAN
    • Novo Nordisk Investigational Site
  • Caba, Argentina, C1093AAS
    • Novo Nordisk Investigational Site
  • Caba, Argentina, C1430CKE
    • Novo Nordisk Investigational Site
  • Rosario, Argentina, S2000CUD
    • Novo Nordisk Investigational Site
  • Salta, Argentina, 4400
    • Novo Nordisk Investigational Site
• Brazil
  • Porto Alegre, Brazil, 90035-170
    • Novo Nordisk Investigational Site
  • Rio de Janeiro, Brazil, 22271-100
    • Novo Nordisk Investigational Site
• Canada
  • British Columbia
    • Surrey, British Columbia, Canada, V3S 2N6
      • Novo Nordisk Investigational Site
  • Ontario
    • Brampton, Ontario, Canada, L6T 0G1
      • Novo Nordisk Investigational Site
    • Burlington, Ontario, Canada, L7M 4Y1
      • Novo Nordisk Investigational Site
    • London, Ontario, Canada, N5W 6A2
      • Novo Nordisk Investigational Site
    • Sarnia, Ontario, Canada, N7T 4X3
      • Novo Nordisk Investigational Site
    • Toronto, Ontario, Canada, M9V 4B4
      • Novo Nordisk Investigational Site
  • Quebec
    • Pointe Claire, Quebec, Canada, H9R 4S3
      • Novo Nordisk Investigational Site
    • Pointe-Claire, Quebec, Canada, H9R 3J1
      • Novo Nordisk Investigational Site
• India
  • Andhra Pradesh
    • Hyderabad, Andhra Pradesh, India, 500034
      • Novo Nordisk Investigational Site
  • Haryana
    • Rohtak, Haryana, India, 124001
      • Novo Nordisk Investigational Site
  • Karnataka
    • Bangalore, Karnataka, India, 560054
      • Novo Nordisk Investigational Site
  • Kerala
    • Kochi, Kerala, India, 682041
      • Novo Nordisk Investigational Site
  • Maharashtra
    • Mumbai, Maharashtra, India, 400008
      • Novo Nordisk Investigational Site
    • Nagpur, Maharashtra, India, 440008
      • Novo Nordisk Investigational Site
  • Rajasthan
    • Jaipur, Rajasthan, India, 302006
      • Novo Nordisk Investigational Site
  • Tamil Nadu
    • Chennai, Tamil Nadu, India, 600 013
      • Novo Nordisk Investigational Site
    • Chennai, Tamil Nadu, India, 600001
      • Novo Nordisk Investigational Site
  • West Bengal
    • Kolkata, West Bengal, India, 700020
      • Novo Nordisk Investigational Site
    • Kolkata, West Bengal, India, 700054
      • Novo Nordisk Investigational Site
• Ireland
  • Dublin, Ireland, DUBLIN 15
    • Novo Nordisk Investigational Site
  • Dublin, Ireland, DUBLIN 4
    • Novo Nordisk Investigational Site
  • Dublin, Ireland, DUBLIN 7
    • Novo Nordisk Investigational Site
  • Galway, Ireland, H91 YR71
    • Novo Nordisk Investigational Site
  • Mallow, Ireland, P51Y8EC
    • Novo Nordisk Investigational Site
• Italy
  • Milano, Italy, 20100
    • Novo Nordisk Investigational Site
• Lebanon
  • Achrafieh, Lebanon
    • Novo Nordisk Investigational Site
  • Hazmieh, Lebanon
    • Novo Nordisk Investigational Site
  • Lebanon - Beirut, Lebanon, 9611
    • Novo Nordisk Investigational Site
  • Mansourieh, Lebanon
    • Novo Nordisk Investigational Site
  • Zgharta, Lebanon, 9616
    • Novo Nordisk Investigational Site
• Malaysia
  • Alor Gajah, Malaysia, 78300
    • Novo Nordisk Investigational Site
  • Ipoh, Malaysia, 30450
    • Novo Nordisk Investigational Site
  • Melaka, Malaysia, 75400
    • Novo Nordisk Investigational Site
  • Penang, Malaysia, 10450
    • Novo Nordisk Investigational Site
  • Sandakan, Malaysia, 90000
    • Novo Nordisk Investigational Site
  • Seremban, Malaysia, 70300
    • Novo Nordisk Investigational Site
• Mexico
  • Morelos
    • Cuernavaca, Morelos, Mexico, 62250
      • Novo Nordisk Investigational Site
  • México, D.F.
    • Mexico City, México, D.F., Mexico, 02230
      • Novo Nordisk Investigational Site
  • Nuevo León
    • Monterrey, Nuevo León, Mexico, 64620
      • Novo Nordisk Investigational Site
• Sweden
  • Eksjö, Sweden, 575 35
    • Novo Nordisk Investigational Site
  • Kristianstad, Sweden, 291 85
    • Novo Nordisk Investigational Site
  • Lund, Sweden, 221 85
    • Novo Nordisk Investigational Site
  • Malmö, Sweden, 205 02
    • Novo Nordisk Investigational Site
  • Örebro, Sweden, 701 85
    • Novo Nordisk Investigational Site
• United Kingdom
  • Basingstoke, United Kingdom, RG24 9GT
    • Novo Nordisk Investigational Site
  • Bradford-on-Avon, United Kingdom, BA15 1DQ
    • Novo Nordisk Investigational Site
  • Dundee, United Kingdom, DD1 9SY
    • Novo Nordisk Investigational Site
  • Haxey, United Kingdom, DN9 2HY
    • Novo Nordisk Investigational Site
  • Nottingham, United Kingdom, NG7 2UH
    • Novo Nordisk Investigational Site
  • Plymouth, United Kingdom, PL8 8DQ
    • Novo Nordisk Investigational Site
  • Soham, United Kingdom, CB7 5JD
    • Novo Nordisk Investigational Site
  • Southampton, United Kingdom, SO30 3JB
    • Novo Nordisk Investigational Site
  • Stevenage, United Kingdom, SG1 4AB
    • Novo Nordisk Investigational Site
  • Torquay, United Kingdom, TQ2 7AA
    • Novo Nordisk Investigational Site
  • Wellingborough, United Kingdom, NN8 4RW
    • Novo Nordisk Investigational Site
• United States
  • California
    • Anaheim, California, United States, 92801
      • Novo Nordisk Investigational Site
    • La Mesa, California, United States, 91942
      • Novo Nordisk Investigational Site
    • Los Angeles, California, United States, 90057
      • Novo Nordisk Investigational Site
    • Montclair, California, United States, 91763
      • Novo Nordisk Investigational Site
    • San Diego, California, United States, 92111
      • Novo Nordisk Investigational Site
    • Spring Valley, California, United States, 91978
      • Novo Nordisk Investigational Site
    • Tustin, California, United States, 92780
      • Novo Nordisk Investigational Site
    • Walnut Creek, California, United States, 94598
      • Novo Nordisk Investigational Site
  • Florida
    • Fleming Island, Florida, United States, 32003
      • Novo Nordisk Investigational Site
    • Hallandale Beach, Florida, United States, 33009
      • Novo Nordisk Investigational Site
    • Hialeah, Florida, United States, 33012
      • Novo Nordisk Investigational Site
    • Miami, Florida, United States, 33135
      • Novo Nordisk Investigational Site
    • Miami, Florida, United States, 33174
      • Novo Nordisk Investigational Site
    • Miami, Florida, United States, 33175
      • Novo Nordisk Investigational Site
    • Miami, Florida, United States, 33155
      • Novo Nordisk Investigational Site
    • Miami, Florida, United States, 33186
      • Novo Nordisk Investigational Site
    • Spring Hill, Florida, United States, 34609
      • Novo Nordisk Investigational Site
  • Georgia
    • Conyers, Georgia, United States, 30094-5965
      • Novo Nordisk Investigational Site
    • Marietta, Georgia, United States, 30060
      • Novo Nordisk Investigational Site
  • Idaho
    • Meridian, Idaho, United States, 83646
      • Novo Nordisk Investigational Site
  • Iowa
    • Council Bluffs, Iowa, United States, 51501
      • Novo Nordisk Investigational Site
  • Kentucky
    • Lexington, Kentucky, United States, 40503
      • Novo Nordisk Investigational Site
  • Louisiana
    • Lake Charles, Louisiana, United States, 70601
      • Novo Nordisk Investigational Site
    • Metairie, Louisiana, United States, 70002
      • Novo Nordisk Investigational Site
  • Maryland
    • Baltimore, Maryland, United States, 21239
      • Novo Nordisk Investigational Site
    • Hyattsville, Maryland, United States, 20782
      • Novo Nordisk Investigational Site
  • Michigan
    • Detroit, Michigan, United States, 48202
      • Novo Nordisk Investigational Site
    • Flint, Michigan, United States, 48504
      • Novo Nordisk Investigational Site
    • Flint, Michigan, United States, 48532
      • Novo Nordisk Investigational Site
    • Sterling Heights, Michigan, United States, 48310-3503
      • Novo Nordisk Investigational Site
    • Troy, Michigan, United States, 48098
      • Novo Nordisk Investigational Site
  • New Jersey
    • Trenton, New Jersey, United States, 08611
      • Novo Nordisk Investigational Site
  • New York
    • Brooklyn, New York, United States, 11229
      • Novo Nordisk Investigational Site
    • New Windsor, New York, United States, 12553
      • Novo Nordisk Investigational Site
  • North Carolina
    • Greensboro, North Carolina, United States, 27408
      • Novo Nordisk Investigational Site
  • Ohio
    • Cincinnati, Ohio, United States, 45212
      • Novo Nordisk Investigational Site
    • Maumee, Ohio, United States, 43537
      • Novo Nordisk Investigational Site
    • Toledo, Ohio, United States, 43614
      • Novo Nordisk Investigational Site
    • Toledo, Ohio, United States, 43623
      • Novo Nordisk Investigational Site
  • Oregon
    • Corvallis, Oregon, United States, 97330-3737
      • Novo Nordisk Investigational Site
  • South Carolina
    • Anderson, South Carolina, United States, 29621
      • Novo Nordisk Investigational Site
  • Texas
    • Amarillo, Texas, United States, 79106
      • Novo Nordisk Investigational Site
    • Corpus Christi, Texas, United States, 78404
      • Novo Nordisk Investigational Site
    • Corpus Christi, Texas, United States, 78413
      • Novo Nordisk Investigational Site
    • Dallas, Texas, United States, 75230
      • Novo Nordisk Investigational Site
    • Dallas, Texas, United States, 75390-9302
      • Novo Nordisk Investigational Site
    • Dallas, Texas, United States, 75251
      • Novo Nordisk Investigational Site
    • Houston, Texas, United States, 77074
      • Novo Nordisk Investigational Site
    • Houston, Texas, United States, 77058
      • Novo Nordisk Investigational Site
    • Houston, Texas, United States, 77081
      • Novo Nordisk Investigational Site
    • Katy, Texas, United States, 77450
      • Novo Nordisk Investigational Site
    • San Antonio, Texas, United States, 78230
      • Novo Nordisk Investigational Site
    • Splendora, Texas, United States, 77372
      • Novo Nordisk Investigational Site
  • Utah
    • Saint George, Utah, United States, 84790
      • Novo Nordisk Investigational Site
  • Virginia
    • Herndon, Virginia, United States, 20171
      • Novo Nordisk Investigational Site
  • Washington
    • Olympia, Washington, United States, 98502
      • Novo Nordisk Investigational Site
    • Wenatchee, Washington, United States, 98801-2028
      • Novo Nordisk Investigational Site

Participation Criteria

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: - Informed consent obtained before any trial-related activities. Trial-related activities are any procedures that are carried out as part of the trial, including activities to determine suitability for the trial - Male or female, age equal to or above18 years at the time of signing informed consent - Diagnosed with type 2 diabetes mellitus (T2D) - HbA1c of 7.0-10.5% (53-91 mmol/mol, both inclusive) - Stable daily dose of metformin (equal to or above1500 mg or maximum tolerated dose as documented in the subject medical record and in compliance with current local label) for at least 90 days prior to the day of screening Exclusion Criteria: - Known or suspected hypersensitivity to trial product(s) or related products - Previous participation in this trial. Participation is defined as signed informed consent - 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 measure as required by local regulation or practice) - Participation in any clinical trial of an approved or non-approved investigational medicinal product within 90 days prior to the day of screening - Any disorder which in the investigator's opinion might jeopardise subject's safety or compliance with the protocol - Subject with alanine aminotransferase (ALT) above 2.5 x upper normal limit (UNL) - Family or personal history of multiple endocrine neoplasia type 2 or medullary thyroid carcinoma. Family is defined as a first degree relative - History or presence of pancreatitis (acute or chronic) - History of diabetic ketoacidosis (DKA) - Any of the following: myocardial infarction (MI), stroke, hospitalization for unstable angina or transient ischaemic attack within the past 180 days prior to the day of screening - Subjects presently classified as being in New York Heart Association (NYHA) Class IV - Planned coronary, carotid or peripheral artery revascularisation known on the day of screening - Renal impairment measured as eGFR below 60 ml/min/1.73 m^2 as defined by Kidney Disease Improving global outcomes (KDIGO 2012) classification using isotope dilution mass spectrometry (IDMS) for serum creatinine measured at screening - Treatment with any medication for the indication of diabetes or obesity other than stated in the inclusion criteria within the past 90 days prior to the day of screening. However, short term insulin treatment for a maximum of 14 days prior to the day of screening is allowed - Proliferative retinopathy or maculopathy requiring acute treatment. Verified by fundus photography or dilated fundoscopy performed within the past 90 days prior to randomisation - Presence or history of malignant neoplasms within the past 5 years prior to the day of screening. Basal and squamous cell skin cancer and any carcinoma in-situ is allowed - Medical history of diabetes-related lower limb amputations or signs of critical lower limb ischemia, (e.g. skin ulcer, osteomyelitis, or gangrene) within the last 26 weeks prior to screening

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Semaglutide + canagliflozin placebo	Drug: Semaglutide; Following a dose escalation phase of 8 weeks, semaglutide 1.0 mg once-weekly(administered subcutaneously, s.c., under the skin) and canagliflozin placebo once-daily (administered orally, as a tablet). Subjects will continue on their pre-trial daily dose of metformin.; Drug: Placebo (canagliflozin); Following a dose escalation phase of 8 weeks, semaglutide 1.0 mg once-weekly(administered subcutaneously, s.c., under the skin) and canagliflozin placebo once-daily (administered orally, as a tablet). Subjects will continue on their pre-trial daily dose of metformin.
Active Comparator: Canagliflozin + semaglutide placebo	Drug: Canagliflozin; Following a dose escalation phase of 8 weeks, canagliflozin 300 mg once-daily (administered orally, as a tablet) and semaglutide placebo (administered subcutaneously, s.c., under the skin). Subjects will continue on their pre-trial daily dose of metformin.; Drug: Placebo (semaglutide); Following a dose escalation phase of 8 weeks, canagliflozin 300 mg once-daily (administered orally, as a tablet) and semaglutide placebo (administered subcutaneously, s.c., under the skin). Subjects will continue on their pre-trial daily dose of metformin.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in HbA1c	Change from baseline (week 0) to week 52 in HbA1c (glycosylated haemoglobin) was evaluated. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first; and 'In-trial' observation period which started at the date of randomisation and include the period after initiation of rescue medication and/or premature trial product discontinuation, if any and ended at the last contact, withdrawal of consent or death, whichever came first.	Week 0, week 52

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Body Weight (kg)	Change from baseline (week 0) to week 52 in body weight was evaluated. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Change in Total Fat Mass (kg)	Change from baseline (week 0) to week 52 in total fat mass was evaluated. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Change in FPG (Fasting Plasma Glucose)	Change from baseline (week 0) to week 52 in FPG was evaluated. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Change in SMPG (Self-measured Plasma Glucose)- Mean 7-point Profile	Change from baseline (week 0) to week 52 in SMPG- mean 7-point profile was evaluated. SMPG was recorded at the following 7 time points: before breakfast, 90 minutes after start of breakfast, before lunch, 90 minutes after start of lunch, before dinner, 90 minutes after dinner and at bedtime. Mean 7-point profile was defined as the area under the profile, calculated using the trapezoidal method, divided by the measurement time. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Change in SMPG- Mean Postprandial Increment Over All Meals	Change from baseline (week 0) to week 52 in SMPG- mean postprandial increment over all meals was evaluated. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Change in Fasting Total Cholesterol	Change from baseline (week 0) to week 52 in fasting total cholesterol (mmol/L) is presented as ratio to baseline. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Change in Fasting LDL-cholesterol	Change from baseline (week 0) to week 52 in fasting low-density lipoprotein (LDL) cholesterol (mmol/L) is presented as ratio to baseline. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Change in Fasting HDL-cholesterol	Change from baseline (week 0) to week 52 in fasting high-density lipoprotein (HDL) cholesterol (mmol/L) is presented as ratio to baseline. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Change in Fasting Triglycerides	Change from baseline (week 0) to week 52 in fasting triglycerides (mmol/L) is presented as ratio to baseline. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Change in Vital Signs (Systolic Blood Pressure and Diastolic Blood Pressure)	Change from baseline (week 0) to week 52 in systolic blood pressure and diastolic blood pressure. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Percentage Change in Body Weight (%)	Change from baseline (week 0) to week 52 in body weight was evaluated. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Change in Body Mass Index (BMI)	Change from baseline (week 0) to week 52 in BMI was evaluated. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Change in Waist Circumference	Change from baseline (week 0) to week 52 in waist circumference was evaluated. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Percentage Change in Total Fat Mass (%)	Change from baseline (week 0) to week 52 in total fat mass was evaluated. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Change in Total Lean Mass (kg)	Change from baseline (week 0) to week 52 in total lean mass was evaluated. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Percentage Change in Total Lean Mass (%)	Change from baseline (week 0) to week 52 in total lean mass was evaluated. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Change in Visceral Fat Mass (kg)	Change from baseline (week 0) to week 52 in visceral fat mass was evaluated. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Percentage Change in Visceral Fat Mass (%)	Change from baseline (week 0) to week 52 in visceral fat mass was evaluated. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Change in Ratio Between Total Fat Mass and Total Lean Mass	Change from baseline (week 0) to week 52 in ratio between total fat mass and total lean mass was evaluated. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Participants Who Achieved HbA1c < 7.0% (53 mmol/Mol), American Diabetes Association (ADA) Target (Yes/no)	Percentage of participants who achieved HbA1c < 7.0% (53 millimoles per mole [mmol/mol]), ADA target (yes/no) is presented. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 52
Participants Who Achieved HbA1c ≤ 6.5% (48 mmol/Mol), American Association of Clinical Endocrinologists (AACE) Target (Yes/no)	Percentage of participants who achieved HbA1c ≤ 6.5% (48 mmol/mol), AACE target (yes/no) is presented. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 52
Participants Who Achieved HbA1c Reduction ≥1% (Yes/no)	Percentage of participants who achieved ≥1% reduction of baseline HbA1c (yes/no) is presented. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Participants Who Achieved Weight Loss ≥3% (Yes/no)	Percentage of participants losing ≥3% of baseline body weight (yes/no) is presented. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Participants Who Achieved Weight Loss ≥5% (Yes/no)	Percentage of participants losing ≥5% of baseline body weight (yes/no) is presented. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Participants Who Achieved Weight Loss ≥10% (Yes/no)	Percentage of participants losing ≥10% of baseline body weight is presented. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Participants Who Achieved HbA1c Below 7.0% (53 mmol/Mol) Without Severe or Blood Glucose (BG)-Confirmed Symptomatic Hypoglycaemia Episodes and no Weight Gain (Yes/no)	Severe or BG-confirmed symptomatic hypoglycaemia is an episode that is severe according to the American Diabetes Association classification or blood glucose-confirmed by a plasma glucose value <3.1 mmol/L (56 milligrams per deciliter [mg/dL]) with symptoms consistent with hypoglycaemia. Percentage of participants who achieved HbA1c below 7.0% (53 mmol/mol) without severe or blood glucose confirmed symptomatic hypoglycaemia episodes and no weight gain (yes/no) is presented. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Participants Who Achieved HbA1c Reduction ≥1% and Weight Loss ≥3% (Yes/no)	Percentage of participants who achieved ≥1% reduction of baseline HbA1c and losing ≥3% of baseline body weight (yes/no) is presented. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Participants Who Achieved HbA1c Reduction ≥1% and Weight Loss ≥5% (Yes/no)	Percentage of participants who achieved ≥1% reduction of baseline HbA1c and losing ≥5% of baseline body weight (yes/no) is presented. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Participants Who Achieved HbA1c Reduction ≥1% and Weight Loss ≥10% (Yes/no)	Percentage of participants who achieved ≥1% reduction of baseline HbA1c and losing ≥10% of baseline body weight (yes/no) is presented. Results are based on the 'on-treatment without rescue medication' observation period, which started at the date of first dose to either the day of last dose plus 7 days or first initiation of rescue medication, whichever came first.	Week 0, week 52
Total Number of Treatment Emergent Adverse Events (TEAEs)	A TEAE is defined as an adverse event with onset in the on-treatment observation period (which started at the date of first dose of trial product and included the period after initiation of rescue medication, if any and excluded the period after premature trial product discontinuation, if any. TEAEs assessed up to approximately 57 weeks is presented.	Weeks 0-57
Change in Haematological Parameter- Haemoglobin	Change from baseline (week 0) to week 52 in haemoglobin (mmol/L) is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Haematological Parameter- Haematocrit	Change from baseline (week 0) to week 52 in haematocrit (%) is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Haematological Parameter- Erythrocytes	Change from baseline (week 0) to week 52 in erythrocytes (10^12 cells/L) is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Haematological Parameter- Leukocytes	Change from baseline (week 0) to week 52 in leukocytes (10^9 cells/L) is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Haematological Parameter- Thrombocytes	Change from baseline (week 0) to week 52 in thrombocytes (10^9 cells/L) is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Biochemistry Parameter- Amylase	Change from baseline (week 0) to week 52 in amylase (units per liter [U/L]) is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Biochemistry Parameter- Lipase	Change from baseline (week 0) to week 52 in lipase (U/L) is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Biochemistry Parameter- ALT	Change from baseline (week 0) to week 52 in alanine aminotransferase (ALT) (U/L) is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Biochemistry Parameter- AST	Change from baseline (week 0) to week 52 in aspartate aminotransferase (AST) (U/L) is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Biochemistry Parameter- ALP	Change from baseline (week 0) to week 52 in alkaline phosphatase (ALP) (U/L) is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Biochemistry Parameter- Total Bilirubin	Change from baseline (week 0) to week 52 in total bilirubin (U/L) is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Biochemistry Parameter- Creatinine	Change from baseline (week 0) to week 52 in creatinine (micromoles per liter [umol/L]) is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Biochemistry Parameter- eGFR	Estimated glomerular filtration rate (eGFR) (milliliters per minute per 1.73 square meters [mL/min/1.73m^2])is calculated using the equation from the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Change from baseline (week 0) to week 52 in eGFR is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Biochemistry Parameter- Albumin	Change from baseline (week 0) to week 52 in albumin (g/dL) is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Biochemistry Parameter- Calcium	Change from baseline (week 0) to week 52 in calcium (mmol/L) is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Biochemistry Parameter- Potassium	Change from baseline (week 0) to week 52 in potassium (mmol/L) is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Biochemistry Parameter- Sodium	Change from baseline (week 0) to week 52 in sodium (mmol/L) is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Calcitonin	Change from baseline (week 0) to week 52 in calcitonin (nanograms per liter) is presented as ratio to baseline. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Pulse	Change from baseline (week 0) to week 52 in pulse is presented based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in ECG	The electrocardiogram (ECG) was assessed by the investigator at baseline (week 0) and week 52 and categorised as normal, abnormal NCS or abnormal CS. Number of participants in each ECG category at baseline and week 52 were presented. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Change in Physical Examination	Physical examination parameters are categorised as general appearance; nervous system (central and peripheral); cardiovascular system; gastrointestinal system; skin; respiratory system; lymph node palpation; thyroid gland; left foot; right foot; left leg and right leg. The number of participants assessed as normal, abnormal not clinically significant (NCS) and abnormal clinically significant (CS) at baseline (week -2) and week 52 is presented based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week -2, week 52
Eye Examination	Fundus photography or a dilated fundoscopy was performed by the investigator at baseline (week 0) and week 52. The results of the examination were interpreted for each eye (left/right) are categorised as normal, abnormal NCS or abnormal CS. Number of participants in each category at baseline and week 52 were presented. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Week 0, week 52
Total Number of Treatment-emergent Severe or Blood Glucose-confirmed Symptomatic Hypoglycaemic Episodes	Hypoglycaemic episodes defined as treatment-emergent if the onset of the episode occurs within the on-treatment observation period. Severe or BG-confirmed symptomatic hypoglycaemia is an episode that is severe according to the American Diabetes Association classification or blood glucose-confirmed by a plasma glucose value <3.1 mmol/L (56 mg/dL) with symptoms consistent with hypoglycaemia. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Weeks 0-57
Participants With Treatment-emergent Severe or Blood Glucose-confirmed Symptomatic Hypoglycaemic Episodes	Number of participants with treatment emergent severe or blood glucose-confirmed symptomatic hypoglycaemic episodes. Hypoglycaemic episodes defined as treatment-emergent if the onset of the episode occurs within the on-treatment observation period. Severe or BG-confirmed symptomatic hypoglycaemia is an episode that is severe according to the American Diabetes Association classification or blood glucose-confirmed by a plasma glucose value <3.1 mmol/L (56 mg/dL) with symptoms consistent with hypoglycaemia. Results are based on the 'on-treatment' observation period which started at the date of first dose of trial product and include the period after initiation of rescue medication, if any and excludes the period after premature trial product discontinuation, if any.	Weeks 0-57
Change in Short Form 36 Health Survey (SF-36): Sub-domains	SF-36 is a 36-item patient-reported survey of patient health that measures the participant's overall health-related quality of life (HRQoL). SF-36v2™ questionnaire measured the HRQoL on 8 domains on individual scale ranges. The scores 0-100 (where higher scores indicated a better HRQoL) from the SF-36 were converted to norm-based scores to enable a direct interpretation in relation to the distribution of the scores in the 2009 U.S. general population. A norm-based score of 50 corresponds to the mean score and 10 corresponds to the standard deviation of the 2009 U.S. general population. Change from baseline (week 0) to week 52 in the sub-domain scores is presented. A positive change score indicate an improvement since baseline. Results are based on the 'on-treatment without rescue medication' observation period.	Week 0, week 52
Change in SF-36: Physical Component Summary (PCS)	Change from baseline (week 0) to week 52 in short form 36 v2.0 acute domain PCS. SF-36v2™ questionnaire measured the HRQoL on 8 domains on individual scale ranges. It consists of 2 component summary measures that further summarize 8 health domain scales. The PCS measure is derived from domain scales of physical functioning, role-physical, bodily pain, and general health. The scores 0-100 (where higher scores indicated a better HRQoL) from the SF-36 were converted to norm-based scores to enable a direct interpretation in relation to the distribution of the scores in the 2009 U.S. general population. A norm-based score of 50 corresponds to the mean score and 10 corresponds to the standard deviation of the 2009 U.S. general population. A positive change score indicates an improvement since baseline. Results are based on the 'on-treatment without rescue medication' observation period.	Week 0, week 52
Change in SF-36: Mental Component Summary (MCS)	Change from baseline (week 0) to week 52 in short form 36 v2.0 acute domain MCS. SF- 36v2™ questionnaire measured the HRQoL on 8 domains on individual scale ranges. The MCS measure is derived from domain scales of vitality, social functioning, role emotional and mental health. The scores 0-100 (where higher scores indicated a better HRQoL) from the SF-36 were converted to norm-based scores to enable a direct interpretation in relation to the distribution of the scores in the 2009 U.S. general population. A norm-based score of 50 corresponds to the mean score and 10 corresponds to the standard deviation of the 2009 U.S. general population. A positive change score indicates an improvement since baseline. Results are based on the 'on-treatment without rescue medication' observation period.	Week 0, week 52
Change in Diabetes Treatment Satisfaction Questionnaire (DTSQ): Treatment Satisfaction Summary Score (Sum of 6 of 8 Items) and the 8 Items Separately	Change from baseline (week 0) in DTSQ was evaluated at week 52. The DTSQs items are scored on a 7-point graded response scale ranging from 6 to 0. Higher scores indicate higher levels of treatment satisfaction for DTSQs items 1, 4 -8. For items 2 and 3 a higher score indicates a higher patient perceived experience of high blood sugars and low blood sugars, respectively. Thus, lower scores indicate a perception of blood glucose levels being "none of the time" unacceptably high (item 2) or low (item 3). The domain score of total treatment satisfaction (total treatment satisfaction score) was computed by adding the six items scores 1, 4-8. The score ranges 0-36. A higher treatment satisfaction score indicates a higher level of treatment satisfaction. Results are based on the 'on-treatment without rescue medication' observation period.	Week 0, week 52
Change in Control of Eating Questionnaire (CoEQ): Domains	The CoEQ comprised 19 items to assess the intensity and type of food cravings, as well as subjective sensation of appetite and mood, with the 4 domains: 'craving control', 'craving for sweet', 'craving for savoury' and 'positive mood'. The 19 items were scored on an 11-point graded response scale ranging from 10 to 0, with items relating to each of the 4 domains being averaged to create a final score. A low score in the domains 'craving for sweet and 'craving for savoury' represents a low level of craving; whereas a high score in the domains 'craving control' and 'positive mood' represents good control and a good mood, respectively. Results are based on the 'on-treatment without rescue medication' observation period.	Week 0, week 52
Change in CoEQ: Individual Items	The CoEQ comprised 19 items to assess the intensity and type of food cravings, as well as subjective sensation of appetite and mood, with the 4 domains: 'craving control', 'craving for sweet', 'craving for savoury' and 'positive mood'. The 19 items were scored on an 11-point graded response scale ranging from 10 to 0, with items relating to each of the 4 domains being averaged to create a final score. A low score in the domains 'craving for sweet and 'craving for savoury' represents a low level of craving; whereas a high score in the domains 'craving control' and 'positive mood' represents good control and a good mood, respectively. Results are based on the 'on-treatment without rescue medication' observation period.	Week 0, week 52

Collaborators and Investigators

• Sponsor: Novo Nordisk A/S

Publications and helpful links

General Publications

• Lingvay I, Capehorn MS, Catarig AM, Johansen P, Lawson J, Sandberg A, Shaw R, Paine A. Efficacy of Once-Weekly Semaglutide vs Empagliflozin Added to Metformin in Type 2 Diabetes: Patient-Level Meta-analysis. J Clin Endocrinol Metab. 2020 Dec 1;105(12):e4593-604. doi: 10.1210/clinem/dgaa577.
• Lingvay I, Catarig AM, Frias JP, Kumar H, Lausvig NL, le Roux CW, Thielke D, Viljoen A, McCrimmon RJ. Efficacy and safety of once-weekly semaglutide versus daily canagliflozin as add-on to metformin in patients with type 2 diabetes (SUSTAIN 8): a double-blind, phase 3b, randomised controlled trial. Lancet Diabetes Endocrinol. 2019 Nov;7(11):834-844. doi: 10.1016/S2213-8587(19)30311-0. Epub 2019 Sep 17.
• McCrimmon RJ, Catarig AM, Frias JP, Lausvig NL, le Roux CW, Thielke D, Lingvay I. Effects of once-weekly semaglutide vs once-daily canagliflozin on body composition in type 2 diabetes: a substudy of the SUSTAIN 8 randomised controlled clinical trial. Diabetologia. 2020 Mar;63(3):473-485. doi: 10.1007/s00125-019-05065-8. Epub 2020 Jan 2.

Study record dates

Study Major Dates

• Study Start (Actual): March 15, 2017
• Primary Completion (Actual): October 16, 2018
• Study Completion (Actual): November 16, 2018

Study Registration Dates

• First Submitted: March 14, 2017
• First Submitted That Met QC Criteria: April 26, 2017
• First Posted (Actual): May 2, 2017

Study Record Updates

• Last Update Posted (Actual): January 21, 2020
• Last Update Submitted That Met QC Criteria: January 8, 2020
• Last Verified: January 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases; Diabetes Mellitus; Diabetes Mellitus, Type 2; Hypoglycemic Agents; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Sodium-Glucose Transporter 2 Inhibitors; Canagliflozin
• Other Study ID Numbers: NN9535-4270; 2016-000989-35 (EudraCT Number); U1111-1180-3651 (Other Identifier: World Health Organization (WHO))

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: According to the Novo Nordisk disclosure commitment on novonordisk-trials.com

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No