Kanungo Institute of Diabetes Specialities

Abstract Objectives To evaluate the efficacy and safety of Synthetic Semaglutide Injection manufactured by Sun Pharma (Test arm) with Ozempic® Injection (Reference arm) in Indian patients with Type 2 Diabetes Mellitus in three subgroups based on Age: <40 years (Subgroup 1 [S1]), 40 to <50 years (Subgroup 2 [S2]), ≥50 years (Subgroup 3 [S3]) Materials and Methods This was a phase III, multicentre, randomized, open-label, active controlled study. Total 314 adults (18-65 years) with T2DM (HbA1c: 7.0-10.5%) on diet/exercise uncontrolled with stable metformin dose (≥1500 mg or maximum tolerated dose) for ≥12 weeks were enrolled. Eligible patients were randomized in a 1:1 ratio and received Test product or Reference product, subcutaneous injections in a weekly dose of 0.25 mg to 2 mg for 24 weeks. [CTRI Registration number: CTRI/2025/02/080592] Results At baseline, distribution of patients was as follows: 54 patients aged <40 years (S1), 107 patients aged 40 to <50 years (S2) and 153 patients aged ≥50 years (S3). HbA1c reduction (±SD) from baseline to Week 24 in Test arm was comparable to Reference arm across all 3 age subgroups: S1: −1.85 ± 0.70% vs—2.20 ± 0.80% (P = .2220), S2:—2.05 ± 0.87% vs −1.92 ± 0.96% (P = .4542), S3: −2.10 ± 0.83% vs −1.88 ± 0.90% (P = .1557). Significant reduction from baseline in HbA1c was observed across all three sub-groups at Week 24 in both the study arms. Significant reductions in post-prandial and fasting blood glucose levels at Week 24 were seen in both study arms and the changes were comparable across all three age subgroups. Proportion of patients achieving HbA1c <7.0% were comparable between the Test and Reference arms, S1: 19 (86.4%) vs 24 (82.8%) (P = .3426), S2: 36 (72.0%) vs 34 (70.8%) (P = .8843), S3: 51 (72.9%) vs 50 (72.5%) (P = .6315) across all three age subgroups. Three patients experienced hypoglycaemia. None of the patients required rescue medication. The incidence of treatment-emergent adverse events (TEAEs) was similar in both arms. Most common TEAEs were gastrointestinal events (Diarrhoea, Nausea, Vomiting) in all three subgroups. Study medications were well tolerated. Conclusions Semaglutide injection (Test Product) demonstrated comparable glycaemic control to Reference product in T2DM patients uncontrolled on metformin monotherapy across all age groups.

Abstract Objectives To evaluate the efficacy and safety of Synthetic Semaglutide Injection manufactured by Sun Pharma (Test arm) with Ozempic® Injection (Reference arm) in Indian patients with Type 2 Diabetes Mellitus (T2DM) in three subgroups based on BMI: <23 kg/m2 (Subgroup 1 [S1]), 23 to <25 kg/m2 (Subgroup 2 [S2]), ≥25 kg/m2 (Subgroup 3 [S3]). Materials and Methods This was a phase III, multicentre, randomized, open-label, active controlled study. Total 314 adults (18-65 years) with T2DM (HbA1c: 7.0-10.5%) on diet/exercise uncontrolled with stable metformin dose (≥1500 mg or maximum tolerated dose) for ≥12 weeks were enrolled. Eligible patients were randomized in a 1:1 ratio and received Test product or Reference product, subcutaneous injections in a weekly dose of 0.25 mg to 2 mg for 24 weeks. [CTRI Registration number: CTRI/2025/02/080592]. Results At baseline, distribution of patients was as follows: 38 patients with BMI <23 kg/m2(S1), 72 patients with BMI 23 to <25 kg/m2(S2) and 204 patients with BMI ≥25 kg/m2(S3). HbA1c reduction from baseline to Week 24 in Test arm was comparable to comparator arm: S1: −2.26 ± 0.91% vs −1.89 ± 0.87% (P = .2028), S2: −2.21 ± 0.76% vs −2.25 ± 0.74% (P = .9033), S3: −1.95 ± 0.82% vs −1.85 ± 0.95% (P = .4848). Significant reduction from baseline HbA1c was observed across all three sub-groups at Week 24 in both the study arms. Significant reductions in post-prandial and fasting blood glucose levels at Week 24 were seen in both the study arms and the changes were comparable across all three BMI subgroups. Proportion of patients achieving HbA1c <7.0% were comparable between the Test and Comparator arms, S1:15 (88.2%) vs 13 (76.5%) (P = .3697), S2: 23 (74.2%) vs 27 (75.0%) (P = .7267), S3: 68 (72.3%) vs 68 (73.1%) (P = .9184) across all three BMI subgroups. Three patients experienced hypoglycaemia. None of the patients required rescue medication. The incidence of treatment-emergent adverse events (TEAEs) was similar in both arms. Most common TEAEs were gastrointestinal events (Diarrhoea, Nausea, Vomiting) in all three subgroups. Study medications were well tolerated. Conclusions Semaglutide injection (Test product) demonstrated comparable glycaemic control to Reference product in T2DM patients uncontrolled on metformin monotherapy across all three BMI subgroups of normal weight, overweight and obese patients.

Abstract Objectives To evaluate the efficacy and safety of Synthetic Semaglutide Injection manufactured by Sun Pharma (Test arm) with Ozempic® Injection (Reference arm) in Indian patients with type 2 diabetes mellitus (T2DM) with mild renal impairment (eGFR 60 to <90 mL/min/1.73 m2). Materials and Methods This was a phase III, multicentre, randomized, open-label, active controlled study. Total 314 adults (18-65 years) with T2DM (HbA1c: 7.0-10.5%) on diet/exercise uncontrolled with stable metformin dose (≥1500 mg or maximum tolerated dose) for ≥12 weeks were enrolled. Eligible patients were randomized in a 1:1 ratio and received Test product (manufactured by Sun Pharma) or Reference product, subcutaneous injections in a weekly dose of 0.25 mg to 2 mg for 24 weeks. [CTRI Registration number: CTRI/2025/02/080592]. Results This subgroup analysis included total 109 patients (Test arm [n=55] and Reference arm[n=54]) with mild renal impairment (eGFR 60 to <90 mL/min/1.73 m2). HbA1c reduction (± SD) from baseline to Week 24 was comparable to comparator in this subgroup: −1.95 ± 0.72% vs −1.77 ± 0.88% (P = .3920). Significant reduction from baseline HbA1c was observed in both test arm and reference arm at Week 24. Significant reductions in post-prandial and fasting blood glucose levels at Week 24 were seen in both the study arms and the changes were comparable in this subgroup. Proportion of patients achieving HbA1c <7.0% from baseline to Week 24 were comparable between the Test arm and reference arm 42 (76.4%) vs 42 (77.8%) (P = .7191). One patient experienced hypoglycaemia. None of the patients required rescue medication. The incidence of treatment-emergent adverse events (TEAEs) was similar in both arms (Test arm = 66.2% and Reference arm = 69.5%). Most common TEAEs were gastrointestinal events (Diarrhoea, Nausea, Vomiting). Study medications were well tolerated. Conclusions Semaglutide injection (Test Product) demonstrated comparable glycaemic control to Reference product in T2DM patients uncontrolled on metformin monotherapy with mild renal impairment.

AIM:To evaluate the efficacy, safety and immunogenicity of semaglutide injection (synthetic) (Test group) compared with the Reference semaglutide injection [Ozempic, (Reference group)] in Indian patients with Type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS:This Phase III, randomised, open-label, multi-centre, parallel-group, active-controlled non-inferiority study was conducted across 35 centres in India. Adults aged 18-65 years with T2DM and baseline glycated haemoglobin (HbA1c) ≥ 7.0% to ≤ 10.5% despite stable metformin therapy and diet & exercise control were randomised (1:1) to receive subcutaneous injections of Test semaglutide or Reference semaglutide once weekly for 24 weeks, using an identical dose-escalation regimen (from 0.25 to 2.0 mg per week). The primary endpoint was change in HbA1c from baseline to Week 24. Secondary endpoints included changes in fasting and post-prandial blood glucose, bodyweight and HbA1c < 7.0% achievers, safety and immunogenicity. RESULTS:A total of 314 patients were randomised, and 290 patients completed the study. At Week 24, both treatments produced significant and comparable reductions in HbA1c (Test: -2.04%, Reference: -1.95%; p < 0.0001 within groups). The least-squares mean difference (Test-Reference) was -0.09% (95% CI: -0.26 to 0.09), meeting the pre-specified non-inferiority criterion. Improvements in fasting and post-prandial blood glucose, patients achieving HbA1c < 7.0% and bodyweight were similar between the two groups. The most common treatment-emergent adverse events were predominantly mild-to-moderate gastrointestinal events (Test vs. Reference: 43.3% vs. 46.5%). No anti-drug or neutralising antibodies were detected. CONCLUSIONS:The Test synthetic semaglutide injection demonstrated non-inferior glycaemic efficacy, comparable safety in comparison to Reference semaglutide, supporting its use as an effective therapeutic option for patients with T2DM. Prospectively registered on the Clinical Trials Registry-India, CTRI/2025/02/080592 [Registered on: 14/02/2025], URL: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTIwODUw&Enc=&userName=.

Hyperglycemia is a common complication in critically ill patients. It is associated with an increased length of hospital stay, infection, and mortality rate. Hence, management of hyperglycemia in critical care settings is important. A literature search from inception till July 2019 using relevant keywords (hyperglycemia and critical illness) was performed with Medline (PubMed), and all the pertinent articles were selected to extract the literature describing the management of hyperglycemia in critically ill patients. Extensive evidence is available, which conclusively demonstrates that hyperglycemia is a marker of severity of illness in critically ill patients. Studies support the use of intensive insulin therapy in critically ill patients both with and without diabetes mellitus (DM). Glycemic variability and hypoglycemia contribute to the worsening condition. Hence, it is important to use the tools that monitor glycemic variability and hypoglycemia in critical care setting. In addition, consideration should be given for an insulin therapy, which lowers the glycemic variability and avoids hypoglycemia. While using insulins, nutrition plays an important role. Evidence supports the use of enteral nutrition over parenteral nutrition due to the low risk of infections and mortality. A transition from intravenous to subcutaneous (SC) insulin is required in certain patients for whom SC basal–bolus insulin therapy is preferred over a sliding-scale insulin regimen. Appropriate glycemic target and determining glycemic threshold for initiating insulin therapy are essential for the management of hyperglycemia in critically ill patients. Moreover, continuous blood glucose monitoring and appropriate medical nutrition therapy improve the patient outcomes.