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      Semaglutide improves health‐related quality of life versus placebo when added to standard of care in patients with type 2 diabetes at high cardiovascular risk (SUSTAIN 6)

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          Abstract

          Aim

          To assess what drives change in health‐related quality of life (HRQoL) in type 2 diabetes in the SUSTAIN 6 trial and identify potential mediators of the treatment effect of semaglutide on HRQoL scores.

          Materials and Methods

          The Short Form (SF)‐36v2® questionnaire [comprising physical component summary (PCS) and mental component summary (MCS)] was used to assess changes in HRQoL from baseline to week 104, by treatment, in a prespecified analysis. This post‐hoc analysis assessed change in PCS and MCS using the following factors as parameter/covariate, using descriptive statistics and linear regressions: major adverse cardiac events, hypoglycaemia, gastrointestinal adverse events, at least one episode of nausea, vomiting or diarrhoea, and change in glycated haemoglobin (HbA1c), body weight, blood pressure, heart rate and estimated glomerular filtration rate.

          Results

          Mean change in overall PCS score was +1.0 with semaglutide versus +0.4 with placebo, and +0.5 versus −0.2 for MCS. The treatment effect of semaglutide versus placebo (unadjusted estimate) was 0.7 [(95% confidence interval 0.1, 1.2); P = 0.018] on PCS and this was reduced when adjusted for change in HbA1c [0.4 (−0.2, 1.0), P = .167] and body weight [0.3 (−0.3, 0.9), P = .314]. The unadjusted treatment effect on MCS [0.7 (−0.0, 1.5), P = .054] was only reduced when adjusted for change in HbA1c [0.3 (−0.4, 1.1), P = .397]. When adjusting for all other parameters separately, the estimated effect of semaglutide on PCS and MCS qualitatively did not change.

          Conclusions

          Semaglutide improved HRQoL versus placebo; greater improvements with semaglutide versus placebo were possibly mediated, in part, by change in HbA1c and body weight.

          Clinicaltrials.gov: NCT01720446 (SUSTAIN 6).

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          Most cited references17

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          Oral Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes

          Establishing cardiovascular safety of new therapies for type 2 diabetes is important. Safety data are available for the subcutaneous form of the glucagon-like peptide-1 receptor agonist semaglutide but are needed for oral semaglutide.
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            Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7): a randomised, open-label, phase 3b trial

            Despite common mechanisms of actions, glucagon-like peptide-1 receptor agonists differ in structure, pharmacokinetic profile, and clinical effects. This head-to-head trial compared semaglutide with dulaglutide in patients with inadequately controlled type 2 diabetes.
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              A systematic review of reviews: exploring the relationship between obesity, weight loss and health‐related quality of life

              Summary This is the first systematic review of reviews to assess the effect of obesity and weight loss on health‐related quality of life (HRQoL). We identified 12 meta‐analyses/systematic reviews published between January 2001 and July 2016. They addressed the following themes: (i) the relationship between weight/body mass index and HRQoL (baseline/pre‐intervention; n = 2). (ii) HRQoL after weight loss (varied interventions and/or study design; n = 2). (iii) HRQoL after weight loss (randomized controlled trials only; n = 2). (iv) HRQoL after bariatric surgery (n = 6). We found that in all populations, obesity was associated with significantly lower generic and obesity‐specific HRQoL. The relationship between weight loss and improved HRQoL was consistently demonstrated after bariatric surgery, perhaps due to a greater than average weight loss compared with other treatments. Improved HRQoL was evident after non‐surgical weight loss, but was not consistently demonstrated, even in randomized controlled trials. This inconsistency may be attributed to variation in quality of reporting, assessment measures, study populations and weight‐loss interventions. We recommend longer‐term studies, using both generic and obesity‐specific measures, which go beyond HRQoL in isolation to exploring mediators of HRQoL changes and interactions with other variables, such as comorbidities, fitness level and body image.
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                Author and article information

                Contributors
                esteban.jodar@gmail.com
                Journal
                Diabetes Obes Metab
                Diabetes Obes Metab
                10.1111/(ISSN)1463-1326
                DOM
                Diabetes, Obesity & Metabolism
                Blackwell Publishing Ltd (Oxford, UK )
                1462-8902
                1463-1326
                27 April 2020
                August 2020
                : 22
                : 8 ( doiID: 10.1111/dom.v22.8 )
                : 1339-1347
                Affiliations
                [ 1 ] Faculty of Medicine Universidad Europea de Madrid Madrid Spain
                [ 2 ] Department of Endocrinology and Nutrition Service Hospital Universitario QuironSalud Madrid Madrid Spain
                [ 3 ] Novo Nordisk A/S Søborg Denmark
                [ 4 ] Behavioral Diabetes Institute San Diego, California
                [ 5 ] Department of Psychiatry University of California San Diego La Jolla, California
                [ 6 ] Department of Clinical Medicine SEMPR, Universidade Federal do Paraná Curitiba Brazil
                [ 7 ] Steno Diabetes Center Copenhagen University of Copenhagen Hellerup Denmark
                [ 8 ] Department of Endocrinology Physicians East Greenville, North Carolina
                [ 9 ] Diabetes Research Unit Cymru Swansea University Medical School Swansea UK
                Author notes
                [*] [* ] Correspondence

                Professor E. Jódar, MD, PhD, Universidad Europea de Madrid, Calle Tajo, s/n, 28670 Villaviciosa de Odón, Madrid, Spain.

                Email: esteban.jodar@ 123456gmail.com

                Author information
                https://orcid.org/0000-0002-1234-8560
                https://orcid.org/0000-0002-0456-6787
                https://orcid.org/0000-0001-6693-9860
                https://orcid.org/0000-0001-8519-4964
                Article
                DOM14039
                10.1111/dom.14039
                7383680
                32227613
                da572783-6ba1-4ac8-b35e-2c219cd6c9bb
                © 2020 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 23 December 2019
                : 18 March 2020
                : 26 March 2020
                Page count
                Figures: 2, Tables: 2, Pages: 9, Words: 6595
                Funding
                Funded by: Novo Nordisk , open-funder-registry 10.13039/501100004191;
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                August 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.6 mode:remove_FC converted:27.07.2020

                Endocrinology & Diabetes
                cardiovascular disease,glp‐1 analogue,hypoglycaemia,incretin therapy,type 2 diabetes,weight control

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