Progression to type 2 diabetes among post-myocardial infarction patients with overweight or obesity: a real-world...

Semaglutide has demonstrated the ability to reduce the risk of progression to type 2 diabetes in patients with myocardial infarction and overweight or obesity without diabetes. However, implementation of semaglutide treatment in daily clinical care is challenging due to costs and limited supply. Thus, it is essential to identify patients who are most likely to benefit from this treatment. Therefore, we aimed to investigate the 5-year risk of progression to type 2 diabetes in SELECT-eligible patients with a recent myocardial infarction and overweight or obesity without diabetes, and to assess the estimated preventive potential of semaglutide in a real-world cohort.

We included patients registered in the Western Denmark Heart Registry with first-time myocardial infarction and body mass index (BMI) ≥ 27 kg/m² without diabetes, thus meeting the eligibility criteria of the SELECT trial. The cohort was grouped by glycemic status at baseline: HbA1c 6.0-6.4% (prediabetes_6.0-6.4%), 5.7-6.4% (prediabetes_5.7-6.4%), or < 5.7% (normoglycemia). A Cox proportional hazards regression model was used to calculate cause-specific hazard ratios (HR), adjusted for sex, age, hypertension, and smoking. The main endpoint was progression to type 2 diabetes. The 5-year number-needed-to-treat (NNT₅) with semaglutide was estimated based on the SELECT trial.

The cohort comprised 7398 patients with median follow-up of 4.7 (Q1-Q3 2.8-5.0) years. At baseline, 1385 (19%) patients had prediabetes_6.0-6.4%, 3751 (51%) had prediabetes_5.7-6.4%, and 3647 (49%) had normoglycemia. The median BMI was similar across the groups: 30 kg/m² (Q1-Q3 28-33), 30 kg/m² (Q1-Q3 28-32), and 29 kg/m² (Q1-Q3 28-31). The 5-year risks of progression to type 2 diabetes were 54%, 30%, and 5%, respectively. Compared with normoglycemia, those with prediabetes_6.0-6.4% were associated with an 18-fold increased risk of progression to type 2 diabetes (HR 18.3, 95% CI 15.2-22.1) and the estimated NNT₅ with semaglutide to prevent one case of type 2 diabetes was 2.7 in this subgroup.

In real-world patients with recent myocardial infarction and overweight or obesity, prediabetes was much stronger associated with progression to type 2 diabetes than previously reported in the SELECT trial. Further, we estimated that treatment with semaglutide might be able to substantially reduce progression to type 2 diabetes.