Effectiveness and safety of daily oral semaglutide in people with type 2 diabetes mellitus switching from sulfonylureas: A real‐world retrospective study

Hypoglycaemia is a serious side effect in the treatment of type 2 diabetes mellitus (T2DM), especially when using insulin and insulin secretagogues such as sulfonylureas. Current guidelines recommend reducing or discontinuing these medications in high-risk populations. This study assessed the real-world effectiveness and safety of oral semaglutide in T2DM patients who suspended or reduced sulfonylurea dosages in favour of oral semaglutide. In this retrospective, multicentre cohort study, the primary endpoint was the change in glycated haemoglobin (HbA1c) from baseline to an average follow-up period of 37 weeks. Secondary endpoints included changes in fasting blood glucose, body weight, the proportion of patients achieving HbA1c ≤7%, and combined reductions in HbA1c (≥1%) and body weight (≥5%). Safety and exploratory endpoints were also evaluated. The study included 104 patients (mean age: 68.9 ± 9.9 years). Treatment discontinuation occurred in 9.6% of patients, and 12.5% reported adverse events, primarily gastrointestinal; no hypoglycaemic events were reported. HbA1c significantly decreased from 7.62% to 7.42% (p = 0.04, mean reduction of 0.22%) and the proportion of patients achieving HbA1c ≤7% increased from 29.8% to 36.3%. Body weight was significantly reduced by 3.03 kg (p < 0.001). Significant reductions (p < 0.05) were observed in fasting blood sugar, waist circumference, diastolic blood pressure, total cholesterol and albumin-to-creatinine ratio, while HDL cholesterol and estimated glomerular filtration rate increased. The 10-year cardiovascular risk score significantly decreased from 17.0% to 12.9% (p < 0.001). Real-world data suggest that oral semaglutide is an effective and safe alternative to sulfonylureas for T2DM patients, with no reported hypoglycaemic episodes.