Poor glycemic control in older adults with type 2 diabetes mellitus (T2DM) remains closely associated with progressive microvascular complications, including diabetic kidney disease. A randomized controlled trial published in International Journal of Endocrinology evaluated whether adding semaglutide to insulin therapy improves glycemic control and renal function markers in older adults with T2DM.

The study included 220 older adults with T2DM enrolled between January 2023 and May 2024. Participants were randomly assigned to receive either insulin therapy alone or semaglutide combined with insulin therapy. Outcomes included blood glucose indices, insulin function markers, vascular parameters, renal function markers, body weight, and safety outcomes.

Findings

• Semaglutide plus insulin therapy reduced FPG, 2hPG, HbA1c, and HOMA-IR compared with insulin therapy alone (all p < 0.05).
• HOMA-β, nitric oxide (NO), and estimated glomerular filtration rate (eGFR) improved in the semaglutide group.
• Vascular endothelial growth factor (VEGF), endothelin-1 (ET-1), 24-hour urinary protein excretion (24hUpr), and urinary albumin-creatinine ratio (UACR) decreased with semaglutide therapy.
• Greater body weight reduction was observed in the semaglutide group versus the insulin-only group (p < 0.05).
• No significant between-group differences in adverse events were reported.

The findings suggest semaglutide combined with insulin therapy may improve glycemic control, insulin function, vascular markers, and short-term renal parameters in older adults with T2DM without increasing adverse events. Longer-term studies are needed to determine whether these effects translate into sustained renal protection or slower chronic kidney disease progression.