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Training
excellence
award
Adele Linthwaite, a senior healthcare
professional working for University
Hospitals Coventry and Warwickshire
NHS Trust, has become the first
recipient of Spirit Health's new
Training Excellence Award, which
celebrates dedication to improving
diabetes care through education
and training. This will now become
an annual award, recognising
exceptional individuals who share
Spirit Health's commitment to
empowering people to take control of
their health.
www.spirit-health.com
Real-world results
differ from trials
New research has found that, in the
real world, the use of semaglutide
(Wegovy) and tirzepatide (Zepbound)
produce far less weight loss than in
clinical trials, largely because people
discontinue using them early or use
lower maintenance doses.
Data from electronic health
records of patients seen during
2021-2023 at the Cleveland
Clinic's Ohio and Florida centres
also yielded some surprises:
Over 80% of patients were using
low maintenance doses of the
medications (ie, the treatment
dose used for the longest period
of time). Also, even after early
discontinuation (within three
months), the rapid weight regain
seen in some of the trials were not
evident. However, improvements
in A1c were also seen among
those with prediabetes even after
discontinuation.
Lead author Hamlet Gasoyan,
PhD, a researcher with Center
for Value-Based Care Research,
Cleveland Clinic, Cleveland, told
Medscape Medical News that the
finding of the prevalent use of
low maintenance doses and the
association between that and the
clinical outcomes was a surprise.
"We did not expect to see such a
stark difference between what is
happening in clinical trials vs in the
real world," he noted.
The study included electronic
health record data from 7881
adults with overweight or obesity
but not diabetes who initiated
injectable semaglutide during
2021-2023. During the first year,
21.6% on semaglutide and 16.4%
on tirzepatide discontinued the
drug early (within 3 months of
initiating), while 31.4% and 34.1%,
respectively, discontinued later
(within 3-12 months). The rest
stayed on the drug beyond a year.
Most of the patients, 80.8%, were on
low maintenance doses, defined as
below 1.7 mg semaglutide and below
10.0 mg for tirzepatide.
Of 6477 individuals with oneyear
data available, the mean overall
percentage weight reduction was
only 8.7% (7.7% with semaglutide
and 12.4% with tirzepatide). In
comparison, the average weight
loss in the phase 3 clinical trials
had been 14.9% for once-weekly
semaglutide 2.4 mg, 15.0% for
tirzepatide 5 mg, and 20.9% for
tirzepatide 15 mg.
Although the patients who
discontinued the drugs lost
significantly less weight than those
who continued taking them, "weight
trajectories remained surprisingly
stable after discontinuation
throughout the study follow-up
period. This contrasts what has
been observed after medication
discontinuation at the end of
randomized trials," Gasoyan and
colleagues wrote.
The team is also planning to
report findings for why patients
discontinued the medications.
"We are gathering information
on independent predictors that
hopefully in the future could help
us develop a prediction tool to give
relatively reasonable estimates on
what a patient can expect at the time
of treatment initiation," Gasoyan told
Medscape Medical News.