Retrospective comparison of the clinical effects of oral semaglutide and SGLT2 inhibitors treatment in patients with type 2 diabetes.

INTRODUCTION: Recent studies have demonstrated that both oral semaglutide and sodium-glucose cotransporter 2 inhibitors (SGLT2is) have beneficial effects on glycemic and weight management as well as providing renal and cardiovascular protection. However, direct comparisons of the effects of these two drugs in clinical practice remain limited. MATERIALS AND METHODS: This study is a single-center, retrospective, observational study. Patients with type 2 diabetes who were initiated on oral semaglutide or SGLT2is and continued treatment for 6 months or more were retrospectively analyzed and compared. RESULTS: The semaglutide group (84 patients) and the SGLT2is group (231 patients) showed similar, significant reductions in glycated hemoglobin (HbA1c) (semaglutide: -0.88 ± 0.14%; P < 0.01, and SGLT2is: -0.86 ± 0.06%; P < 0.01, at 6 months), body weight (semaglutide: -2.58 ± 0.37 kg; P < 0.01, and SGLT2is: -2.30 ± 0.18 kg; P < 0.01, at 6 months), and fat mass (semaglutide: -2.20 ± 0.50 kg; P < 0.01, and SGLT2is: -1.93 ± 0.44 kg; P < 0.01, at 6 months), being decreased similarly and significantly in both groups. On the other hand, there was a significant reduction in skeletal muscle mass only in the SGLT2is group (semaglutide: -0.10 ± 0.30 kg; P = 0.74, and SGLT2is: -0.40 ± 0.14 kg; P < 0.01 at 6 months). CONCLUSIONS: While both drugs elicited comparable effects on glycemic management and body weight reduction in patients with type 2 diabetes, caution is needed when using SGLT2is in patients at potential risk for sarcopenia, as they may lead to less favorable changes in skeletal muscle mass compared to oral semaglutide.