A phase 3 trial published in The Lancet found that cagrilintide–semaglutide (CagriSema) achieved statistically significant and clinically relevant reductions in HbA1c when added to basal insulin in adults with type 2 diabetes. The study, known as REIMAGINE 3, was a randomised, double-blind, placebo-controlled, multicentre trial testing two dose levels: 2.4 mg each and 1.0 mg each. Both doses met the primary endpoint with no additional risk of hypoglycaemia.
Many patients on basal insulin therapy remain inadequately controlled despite treatment intensification, leaving them vulnerable to microvascular and macrovascular complications. Traditional approaches often rely on complex insulin regimens that can cause hypoglycaemia and weight gain. This trial addresses a pressing need for therapies that improve glycaemic control without those drawbacks.
The reductions in HbA1c were accompanied by robust bodyweight reduction. The safety profile was consistent with that of the GLP-1 receptor agonist class and previous safety data for cagrilintide. These findings support the use of this dual-agonist combination as an add-on to once-daily basal insulin.
The results suggest a potential shift away from escalating complex insulin regimens toward combination therapies that simultaneously address glycaemic control and weight management. Patients and clinicians may have a new option that avoids the undesirable effects of traditional intensification. Further research will likely examine long-term outcomes and broader patient populations.
Commentary in The Lancet noted the high proportion of patients on basal insulin who remain uncontrolled, underscoring the clinical relevance of these findings. The data reinforce the need for continued innovation in type 2 diabetes care.