Objective  To compare the effectiveness and safety of semaglutide with dulaglutide in patients diagnosed with type 2 diabetes.

Methods  A multicenter retrospective cohort study was conducted to include patients with type 2 diabetes who received semaglutide or dulaglutide treatment at three hospitals between April 2021 and July 2023 in the study. The patients were divided into the semaglutide group (SEMA group) and the dulaglutide group (DULA group) based on their treatment. Propensity score matching was used to pair the two groups in a 1 ∶ 1 ratio, aligning them based on baseline characteristics such as gender, age, body mass index, blood glucose levels, duration of diabetes, and complications. Various parameters including fasting blood glucose, 2-hour postprandial blood glucose, glycosylated hemoglobin (HbA1c), serum creatinine, urea nitrogen levels, estimated glomerular filtration rate (eGFR), urinary albumin/creatinine ratio (UACR), and occurrences of adverse reactions were assessed at 3, 6, 9, and 12 months after the treatment.

Results  After propensity score matching, 98 patients were included in both the SEMA and DULA groups, showing no statistically significant differences in baseline characteristics between the groups (P>0.05). At each follow-up point, the fasting blood glucose, 2-hour postprandial blood glucose, and HbA1c levels of both groups showed a significant decrease compared to the baseline (P≤0.05). The inter-group comparison revealed no statistically significant differences in the changes in fasting blood glucose, 2-hour postprandial blood glucose, and HbA1c levels between the two groups (P>0.05). At the 6th month, the SEMA group exhibited a statistically significant higher rate of HbA1c<7% compared to the DULA group (P<0.05). In the SEMA group, serum creatinine and urea nitrogen decreased significantly at the 6th month compared to baseline, while eGFR showed an increase at the 3rd and 6th month, and UACR decreased, all with statistical significance (P<0.05). In the DULA group, there was a statistically significant increase in serum creatinine and decrease at the 3rd and 6th months in eGFR, respectively. Additionally, urea nitrogen levels decreased significantly at the 9th month, all differences were statistically significant (P<0.05). The inter-group comparison revealed that at the 3rd and 6th month, the SEMA group exhibited a greater reduction in serum creatinine levels compared to the DULA group. Additionally, the SEMA group demonstrated a more pronounced increase in eGFR levels than the DULA group, with statistical significance (P<0.05). At the 6th month, the SEMA group exhibited a significantly greater decrease in UACR and a significantly lower incidence of renal insufficiency compared to the DULA group (P<0.05). There were no significant difference in the incidence of adverse reactions between the two groups (P>0.05).

Conclusion  Semaglutide and dulaglutide can significantly improve blood glucose control, exhibit comparable effectiveness and safety in lowering blood glucose levels, and semaglutide has a potentially protective effect on renal function.

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