New results from the REACH study, shared at the European Association for the Study of Diabetes (EASD) Annual Meeting in Vienna, Austria, indicate that semaglutide might lower the chances of serious heart problems in older adults with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD) compared to dulaglutide.

The study examined data from 58,336 Medicare enrollees in the United States, all of whom were 66 years or older and had type 2 diabetes or ASCVD. Participants were recruited from Medicare fee-for-service claims databases and were evenly divided into two groups: 29,168 patients starting once-weekly semaglutide and 29,168 starting dulaglutide.

The researchers employed a target-trial emulation framework, which reduces bias when analysing real-world health data. This method allows researchers to more accurately analyse outcomes for individuals that are frequently under-represented in randomised controlled trials, notably older adults with numerous health issues.

According to Novo Nordisk's statement, people treated with semaglutide had a 23% lower risk of major adverse cardiovascular events (MACE)—a composite measure that includes heart attack, stroke, or death from cardiovascular causes—than those receiving dulaglutide.

In a larger assessment that includes hospitalisation for unstable angina, heart failure, or death from any cause (known as five-point MACE), semaglutide was associated with a 25% risk reduction compared to dulaglutide.

Atherosclerotic cardiovascular disease is one of the most common consequences of type 2 diabetes, increasing the risk of heart attack and stroke. While prior randomised controlled trials have demonstrated the cardiovascular effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), direct comparisons among medicines in this pharmacological class are scarce.

The REACH research is the first direct real-world comparison of cardiovascular outcomes between semaglutide and dulaglutide in a large US Medicare population. Researchers stated that the findings serve to cover a key evidence gap, particularly for older individuals with several comorbid illnesses, who are not generally well represented in clinical trials.

The findings presented at EASD rely on observational, real-world data instead of randomised clinical trials. While such studies can offer invaluable perspectives on how therapies work in real-world healthcare settings, they cannot demonstrate causation with the same precision as randomised trials. The authors underscored the importance of understanding these findings within the context of the study design.

People commonly use GLP-1 receptor agonists like semaglutide and dulaglutide to treat type 2 diabetes. Aside from blood sugar control, they are increasingly being investigated for their possible impact on cardiovascular outcomes and kidney health.

The REACH trial adds to a growing body of evidence suggesting that these medications may protect against cardiovascular events in high-risk groups. Such findings are especially important for policymakers and doctors considering the global increase in the prevalence of diabetes and cardiovascular disease among older persons.