Efficacy and Safety of Semaglutide for the Management of Obese Patients With Type 2 Diabetes and Chronic Heart Failure in Real-World Clinical Practice

Luis M. Pérez‐Belmonte; Jaime Sanz‐Cánovas; María Dolores García de Lucas; Michele Ricci; Beatriz Avilés; Lidia Cobos-Palacios; Miguel A. Pérez‐Velasco; Almudena López‐Sampalo; M. Rosa Bernal‐López; Sergio Jansen‐Chaparro; José Pablo Miramontes‐González; Ricardo Gómez‐Huelgas

doi:10.3389/fendo.2022.851035

June 24, 2022Frontiers in EndocrinologyOpen Access

Efficacy and Safety of Semaglutide for the Management of Obese Patients With Type 2 Diabetes and Chronic Heart Failure in Real-World Clinical Practice

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Why the study?

The impact of glucagon-like peptide-1 receptor agonists on patients with heart failure has not been fully described.

Does once-weekly semaglutide improve heart failure health status, symptoms, and glycemic control in obese patients with type 2 diabetes and chronic heart failure?

Structured PICO

Does once-weekly semaglutide improve heart failure health status, symptoms, and glycemic control in obese patients with type 2 diabetes and chronic heart failure?

P

Population

136 obese outpatients with type 2 diabetes and chronic heart failure (mean age 72.6, 54.4% male, mean LVEF 52.5%, 39.7% with LVEF <40%) in Spain.

I

Intervention

Semaglutide once-weekly (0.25 mg for 4 weeks, then increased to 0.5 mg or 1.0 mg maintenance dose) for 12 months.

O

Outcome

Clinical efficacy in heart failure health status, determined by improvement in the total symptom score on the Kansas City Cardiomyopathy Questionnaire (KCCQ), reduction in New York Heart Association (NYHA) classification, and reduction in NT-pro-BNP levels at 12 months.patient reported

In a real-world cohort of obese patients with type 2 diabetes and chronic heart failure, once-weekly semaglutide significantly improved heart failure symptoms, functional class, and NT-proBNP levels over 12 months.

Implication

Semaglutide may improve HF status and glycemia in obese T2D with HF; hypothesis-generating, prospective RCTs needed before practice change.

Abstract

Background: The impact of glucagon-like peptide-1 receptor agonists on patients with heart failure has not been fully described. Our main objective was to evaluate the safety and clinical and glycemic efficacy of once-weekly semaglutide in obese patients with type 2 diabetes and heart failure. Methods: In this observational, retrospective, real-world study, we enrolled outpatients with type 2 diabetes, obesity, and heart failure who started semaglutide and were followed-up on at 3, 6, and 12 months. Results: A total of 136 patients were included. From baseline to 12 months, there was a significant improvement on the Kansas City Cardiomyopathy Questionnaire total symptom score (59.0 ± 24.1 vs 79.9 ± 28.4 points, p<0.01), a reduction in the proportion of patients with New York Heart Association functional class III (40.4% to 16.2%, p<0.01), and a reduction in N-terminal pro-brain natriuretic peptide levels (969.5 ± 653.5 vs 577.4 ± 322.1 pg/mL, p<0.01). Emergency department visits due to heart failure, hospitalizations due to heart failure, and all-cause hospitalizations also declined. Additionally, significant reductions in glycated hemoglobin (-1.4%) and body weight (-12.7 kilograms) were observed as well as a de-intensification of antidiabetic therapy. Moreover, semaglutide was safe and well-tolerated. Conclusion: In obese patients with type 2 diabetes and heart failure, the use of once-weekly semaglutide was safe and clinically efficacious, improving health and functional status. Nevertheless, more strong evidence on glucagon-like peptide-1 receptor agonists in heart failure is required.