Clinical Features, Cardiovascular Risk Profile, and Therapeutic Trajectories of Patients with Type 2 Diabetes Candidate for Oral Semaglutide Therapy in the Italian Specialist Care
Mario Luca Morieri, Riccardo Candido, Simona Frontoni, Olga Disoteo, Anna Solini, Gian Paolo Fadini, for the PIONEERING EXPERIENCE study group, Francesco Bellanti, Massimiliano Caprio, Michele Cutolo, Gloria Formoso, Elisa Forte, Vera Frison, Giovanna Gregori, Cristina Lencioni, Gaetano Leto, S Mandica, Alberto Marangoni, Pasqualina Memoli, G Memoli, Carlo Negri, Laura Nollino, Andrea Perrelli, Sebastio Perrini, Flavia Prodam, Alberto Rebora, Daniela Sansone, Marcello Sciaraffia, Silvio Settembrini, G Sodo, F. Tassone, Valentina Todisco, Antonio Vetrano, Giacomo Accardo, Valeria Albanese, Irene Alemanno, Stefano Allasia, Rosario Alosa, Anna Altomari, Anna Maria Letizia Amato, E. Ambrosetti, Angela Angarano, Stefania Angotti, Roberto Anichini, Fabio Baccetti, M. Balbo, E Balestra, Sara Balzano, Maria Vittoria Barone, Walter Baronti, Veronica Basso, Guglielmo Beccuti, Iaele Maria Bellone, Alessandra Bertolotto, Michela Bettio, Cristina Bittante, Nadia Bonelli, Marzia Bongiovanni, Benedetta Maria Bonora, Barbara Bonsembiante, Laura Borgognoni, Daniela Bracaglia, Antonia Francesca Braione, Clementina Brancario, Sabrina Braucci, L. Briatore, Elisabetta Brun, Valeria Cambria, Elena Cantino, Paolo Capitanata, Sergio Cappello, Marina Caputo, Barbara Carabba, Alberto Carpenito, Marco Castellana, Anna Castrovilli, Donato Cataldo, Giuliana Cazzetta, Francesca Cecoli, Nino Cristiano Chilelli, Marco Cianciullo, Federica Coccia, Sara Colarusso, C Colella, Isabella Colletti, Sara Coluzzi, Marisa Conte, Marco Corigliano, Alessandra Cosma, Silvana Costa, Pantaleo Daniele, Maria D’aurizio, Alessandra De Bellis, Lorenzo De Candia, Giovanni Gennaro, E De Luca, Claudia De Natale, Giuseppina Simone, Raffaele De Simone, Andrea Del Buono
Abstract
INTRODUCTION: This study aimed to address therapeutic inertia in the management of type 2 diabetes (T2D) by investigating the potential of early treatment with oral semaglutide. METHODS: A cross-sectional survey was conducted between October 2021 and April 2022 among specialists treating individuals with T2D. A scientific committee designed a data collection form covering demographics, cardiovascular risk, glucose control metrics, ongoing therapies, and physician judgments on treatment appropriateness. Participants completed anonymous patient questionnaires reflecting routine clinical encounters. The preferred therapeutic regimen for each patient was also identified. RESULTS: The analysis was conducted on 4449 patients initiating oral semaglutide. The population had a relatively short disease duration (42% < 5 years), and a minority (15.6%) had a history of cardiovascular events. Importantly, oral semaglutide was started in subjects with various disease durations and background therapies. Notably, its initiation was accompanied by de-prescription of sulfonylureas, pioglitazone, DPP-4 inhibitors, and insulin. Choice of oral semaglutide was influenced by patient profiles and ongoing glucose-lowering regimens. Factors such as younger age, higher HbA1c, and ongoing SGLT-2 inhibitor therapy drove the choice of oral semaglutide with the aim of improving glycemic control. Projected glycemic effectiveness analysis revealed that oral semaglutide could potentially lead HbA1c to target in > 60% of patients, and more often than sitagliptin or empagliflozin. CONCLUSION: The study supports the potential of early implementation of oral semaglutide as a strategy to overcome therapeutic inertia and enhance T2D management.