Oral Semaglutide Versus Empagliflozin in Patients With Type 2 Diabetes Uncontrolled on Metformin: The PIONEER 2 Trial

OBJECTIVE

Efficacy and safety of the glucagon-like peptide 1 (GLP-1) analog oral semaglutide and the sodium-glucose cotransporter 2 inhibitor empagliflozin were compared in patients with type 2 diabetes uncontrolled on metformin.

RESEARCH DESIGN AND METHODS

Patients were randomized to once-daily open-label treatment with oral semaglutide 14 mg (n = 412) or empagliflozin 25 mg (n = 410) in a 52-week trial. Key end points were change from baseline to week 26 in HbA_1c (primary) and body weight (confirmatory secondary). Two estimands addressed efficacy-related questions: treatment policy (regardless of trial product discontinuation or rescue medication) and trial product (on trial product without rescue medication) in all randomized patients.

RESULTS

Four hundred (97.1%) patients in the oral semaglutide group and 387 (94.4%) in the empagliflozin group completed the trial. Oral semaglutide provided superior reductions in HbA_1c versus empagliflozin at week 26 (treatment policy -1.3% vs. -0.9% [-14 vs. -9 mmol/mol], estimated treatment difference [ETD] -0.4% [95% CI -0.6, -0.3] [-5 mmol/mol (-6, -3)]; P < 0.0001). The treatment difference in HbA_1c significantly favored oral semaglutide at week 26 for the trial product estimand (-1.4% vs. -0.9% [-15 vs. -9 mmol/mol], ETD -0.5% [95% CI -0.7, -0.4] [-6 mmol/mol (-7, -5)]; P < 0.0001) and at week 52 for both estimands (P < 0.0001). Superior weight loss was not confirmed at week 26 (treatment policy), but oral semaglutide was significantly better than empagliflozin at week 52 (trial product -4.7 vs. -3.8 kg; P = 0.0114). Gastrointestinal adverse events were more common with oral semaglutide.

CONCLUSIONS

Oral semaglutide was superior to empagliflozin in reducing HbA_1c but not body weight at 26 weeks in patients with type 2 diabetes uncontrolled on metformin. At week 52, HbA_1c and body weight (trial product estimand) were significantly reduced versus empagliflozin. Oral semaglutide was well tolerated within the established safety profile of GLP-1 receptor agonists.

Emergency teams in Danish emergency departments

INTRODUCTION

The use of designated emergency teams for cardiac arrest and trauma patients is widely implemented. However, the use of designated teams in Danish emergency departments (EDs) has not been investigated. Our aim was to investigate the use and staffing of emergency teams in Danish EDs.

MATERIAL AND METHODS

A cross-sectional questionnaire study was sent to all 20 Danish EDs designated for emergency care.

RESULTS

The response rate was 95% (n = 19). Three EDs were excluded due to incomplete data. All EDs (n = 16) received critically ill patients, cardiac arrests and trauma patients. In all EDs, a designated team responded to cardiac arrest (CAT) and trauma patients (TT). Only 31% of EDs had access to a designated medical emergency team (MET). CAT consisted of a median of six (range 5-10) different personnel groups. Of these, three (1-6) were physicians and only one (0-2) was a senior physician. TTs consisted of a median of nine (7-11) different personnel groups. Of these, four (2-6) were physicians, and three (2-4) were senior physicians. In 25% of the EDs, there was no access to a MET. In 31% of the EDs, an ad hoc-team was created. In 14%, a team was created by the attending emergency physician. The staffing of ad hoc-teams relied on diagnosis, symptoms and triage scores.

CONCLUSION

Designated teams for patients in cardiac arrest and trauma patients are available in all Danish EDs. More senior staff form part of trauma teams than cardiac arrest teams. There is limited access to designated teams caring for critically ill medical patients in Danish EDs.

The use of triage in Danish emergency departments

INTRODUCTION

The emergency departments (EDs) handle approximately 1,000,000 contacts annually. Danish health care is undergoing reorganization that involves the creation of fewer and larger EDs to handle these contacts. There is therefore a need to prioritize the use of resources to optimize treatment. We thus wanted to investigate if Danish EDs are using triage systems and, if so, which systems they are using.

MATERIAL AND METHODS

We performed a cross-sectional study on triage at all EDs in the 20 Danish hospitals that have been designated for emergency care.

RESULTS

The response rate was 100% (n = 20). We found that triage was used at 75% (n = 15) of the EDs. Adaptive process triage (ADAPT) was the most frequently used validated triage system (25% (n = 5)), while 40% (n = 8) used non-validated systems. Triage was performed by nurses at 73% (n = 11) of the EDs using triage.

CONCLUSION

Triage systems were used in 75% of Danish EDs. ADAPT was the primary triage system in 25% of the EDs, while 40% used non-validated triage systems. An improvement in the quality of health care in Danish EDs may possibly be achieved by implementing validated triage, i.e. ADAPT.

FUNDING

not relevant.

TRIAL REGISTRATION

not relevant.