LivingGLP1
parallel randomized trial

FLOW

Effect of Semaglutide Versus Placebo on the Progression of Renal Impairment in Subjects With Type 2 Diabetes and Chronic Kidney Disease

Design

Randomized
3,533
Start year
2019
Treatment
, follow-up 234.81 weeks
Countries
multinational (387 sites)
Sponsor
Novo Nordisk A/S (industry)
Eligibility
age 18 or more; T2D with HbA1c 10% or less; eGFR 50 to 75 with UACR over 300 or eGFR 25 to under 50 with UACR over 100 mg/g

Conduct and analysis

Blinding
double blind
Sequence generation
other adequate
Allocation concealment
central
Outcome adjudication
yes
Primary estimand
treatment policy
Analysis population
full analysis
Missing data
censored at last contact

Arms

ArmTreatmentBackgroundRandomizedAnalyzedCompleted treatment
A1Semaglutide 1.0 mg subcutaneous once weekly
Semaglutide 1.0 mg
RAS inhibitor at maximum labeled or tolerated dose with standard care; lifestyle: not reported1,7671,767
A2Placebo
Placebo
RAS inhibitor at maximum labeled or tolerated dose with standard care; lifestyle: not reported1,7661,766

Baseline characteristics

As printed in the trial reports or registry, per arm or for the whole trial.
CharacteristicStatisticSemaglutide 1.0 mg subcutaneous once weekly
A1
Placebo
A2
Whole trial
ALL
agemean (years)66.666.7
agesd (years)9.09.0
asiann439407
blackn7882
bmi
kdigo:high
median (kg/m2)31.431.8
bmi
kdigo:high
q1 (kg/m2)28.027.6
bmi
kdigo:high
q3 (kg/m2)35.036.2
bmi
kdigo:low_moderate
median (kg/m2)31.830.1
bmi
kdigo:low_moderate
q1 (kg/m2)27.527.0
bmi
kdigo:low_moderate
q3 (kg/m2)35.435.0
bmi
kdigo:very_high
median (kg/m2)31.231.3
bmi
kdigo:very_high
q1 (kg/m2)27.427.3
bmi
kdigo:very_high
q3 (kg/m2)35.435.6
diabetes durationmean (years)17.4
diabetes durationsd (years)9.3
egfrmean (mL/min/1.73 m2)47
egfrsd (mL/min/1.73 m2)15
established cvdn1198
established cvdpercent34
femalen519550
hba1cmean (percent)7.8
hba1csd (percent)1.3
hispanicn273283
insulin usen2168
insulin usepercent61
other race american indian alaska nativen916
other race native hawaiian pacific islandern23
other race othern4550
sglt2i usen277273
uacrmedian (mg/g)568
weight
kdigo:high
median (kg)89.889.1
weight
kdigo:high
q1 (kg)76.075.3
weight
kdigo:high
q3 (kg)102.3104.0
weight
kdigo:low_moderate
median (kg)89.085.8
weight
kdigo:low_moderate
q1 (kg)77.673.9
weight
kdigo:low_moderate
q3 (kg)102.097.1
weight
kdigo:very_high
median (kg)87.087.2
weight
kdigo:very_high
q1 (kg)75.074.3
weight
kdigo:very_high
q3 (kg)101.0103.0
whiten11551168

Results

186 adjudicated result lines, grouped by outcome. Open an outcome to see its values.
HbA1c change (6 lines; O01)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
104A1change-9.7 mmol/mol1490treatment policy; full analysis; background:no_sglt2i; R0006943:Results
104A1change-0.86 percent1.351448treatment policy; full analysis; registry:outcomes
104A1change-8.2 mmol/mol277treatment policy; full analysis; background:sglt2i; R0006943:Results
104A2change-0.04 percent1.291427treatment policy; full analysis; registry:outcomes
104A2change-1.0 mmol/mol1493treatment policy; full analysis; background:no_sglt2i; R0006943:Results
104A2change1.2 mmol/mol273treatment policy; full analysis; background:sglt2i; R0006943:Results
Body weight change in kilograms (diabetes) (6 lines; O02)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
104A1change-5.54 kg6.571502treatment policy; full analysis; registry:outcomes
104A1change-6.3 kg1490treatment policy; full analysis; background:no_sglt2i; R0006943:Results
104A1change-6.1 kg277treatment policy; full analysis; background:sglt2i; R0006943:Results
104A2change-1.5 kg1493treatment policy; full analysis; background:no_sglt2i; R0006943:Results
104A2change-1.43 kg6.331468treatment policy; full analysis; registry:outcomes
104A2change-1.1 kg273treatment policy; full analysis; background:sglt2i; R0006943:Results
Level 2 or 3 hypoglycemia (participants) (10 lines; O04)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events1 / 1767not stated; safety; registry:adverse_events
A1events22 / 1767not stated; safety; registry:adverse_events
A1events1 / 1767not stated; safety; registry:adverse_events
A1events0 / 1767not stated; safety; registry:adverse_events
A1events2 / 1767not stated; safety; registry:adverse_events
A2events24 / 1766not stated; safety; registry:adverse_events
A2events1 / 1766not stated; safety; registry:adverse_events
A2events1 / 1766not stated; safety; registry:adverse_events
A2events1 / 1766not stated; safety; registry:adverse_events
A2events4 / 1766not stated; safety; registry:adverse_events
Level 2 or 3 hypoglycemia (episode rate) (2 lines; O04B)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1rate1767treatment policy; full analysis; registry:outcomes
A2rate1766treatment policy; full analysis; registry:outcomes
Systolic blood pressure change (2 lines; O05)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
104A1change-3.9 mmHg17.61511treatment policy; full analysis; registry:outcomes
104A2change-1.4 mmHg18.31472treatment policy; full analysis; registry:outcomes
Acute kidney injury (2 lines; O121)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events124 / 1767not stated; safety; registry:adverse_events
A2events123 / 1766not stated; safety; registry:adverse_events
All cause mortality (32 lines; O20)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1 vs A2hr0.970.53 to 1.77treatment policy; full analysis; uacr:less_than_100; R0015402:Results
A1events227 / 1767treatment policy; full analysis; R0015402:Abstract
A1 vs A2hr0.800.67 to 0.95treatment policy; full analysis; R0018451:Abstract
A1events83 / 667treatment policy; full analysis; egfr:30_to_less_than_45; R0015402:Results
A1 vs A2hr0.710.54 to 0.94treatment policy; full analysis; egfr:30_to_less_than_45; R0015402:Results
A1events63 / 515treatment policy; full analysis; egfr:45_to_less_than_60; R0015402:Results
A1 vs A2hr0.810.58 to 1.13treatment policy; full analysis; egfr:45_to_less_than_60; R0015402:Results
A1events44 / 366treatment policy; full analysis; egfr:60_or_more; R0015402:Results
A1 vs A2hr1.020.67 to 1.57treatment policy; full analysis; egfr:60_or_more; R0015402:Results
A1events37 / 218treatment policy; full analysis; egfr:less_than_30; R0015402:Results
A1 vs A2hr0.720.46 to 1.12treatment policy; full analysis; egfr:less_than_30; R0015402:Results
A1events48 / 384treatment policy; full analysis; uacr:100_to_less_than_300; R0015402:Results
A1 vs A2hr1.280.84 to 1.97treatment policy; full analysis; uacr:100_to_less_than_300; R0015402:Results
A1events43 / 312treatment policy; full analysis; uacr:1000_to_less_than_2000; R0015402:Results
A1 vs A2hr0.790.53 to 1.18treatment policy; full analysis; uacr:1000_to_less_than_2000; R0015402:Results
A1events36 / 261treatment policy; full analysis; uacr:2000_or_more; R0015402:Results
A1 vs A2hr0.470.31 to 0.70treatment policy; full analysis; uacr:2000_or_more; R0015402:Results
A1 vs A2hr0.700.57 to 0.85treatment policy; full analysis; uacr:300_or_more; R0018451:Abstract
A1events78 / 632treatment policy; full analysis; uacr:300_to_less_than_1000; R0015402:Results
A1 vs A2hr0.780.58 to 1.04treatment policy; full analysis; uacr:300_to_less_than_1000; R0015402:Results
A1events22 / 177treatment policy; full analysis; uacr:less_than_100; R0015402:Results
A1 vs A2hr1.170.83 to 1.65treatment policy; full analysis; uacr:less_than_300; R0018451:Abstract
A2events62 / 230treatment policy; full analysis; uacr:2000_or_more; R0015402:Results
A2events55 / 328treatment policy; full analysis; uacr:1000_to_less_than_2000; R0015402:Results
A2events118 / 691treatment policy; full analysis; egfr:30_to_less_than_45; R0015402:Results
A2events38 / 379treatment policy; full analysis; uacr:100_to_less_than_300; R0015402:Results
A2events40 / 182treatment policy; full analysis; egfr:less_than_30; R0015402:Results
A2events103 / 656treatment policy; full analysis; uacr:300_to_less_than_1000; R0015402:Results
A2events42 / 353treatment policy; full analysis; egfr:60_or_more; R0015402:Results
A2events279 / 1766treatment policy; full analysis; R0015402:Abstract
A2events21 / 173treatment policy; full analysis; uacr:less_than_100; R0015402:Results
A2events79 / 540treatment policy; full analysis; egfr:45_to_less_than_60; R0015402:Results
Three point MACE (3 lines; O21)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1 vs A2hr0.820.68 to 0.98treatment policy; full analysis; R0018451:Abstract
A1events212 / 1767while on treatment; full analysis; registry:outcomes
A2events254 / 1766while on treatment; full analysis; registry:outcomes
Kidney composite outcome (6 lines; O22)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events32 / 277treatment policy; full analysis; background:sglt2i; R0006943:Results
A1events186 / 1490treatment policy; full analysis; background:no_sglt2i; R0006943:Results
A1 vs A2hr0.750.61 to 0.90treatment policy; full analysis; background:no_sglt2i; R0006943:Results
A1 vs A2hr1.180.71 to 1.98treatment policy; full analysis; background:sglt2i; R0006943:Results
A2events27 / 273treatment policy; full analysis; background:sglt2i; R0006943:Results
A2events233 / 1493treatment policy; full analysis; background:no_sglt2i; R0006943:Results
Kidney composite including cardiovascular death (3 lines; O22D)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events331 / 1767treatment policy; full analysis; R0015402:Abstract
A1 vs A2hr0.760.66 to 0.88treatment policy; full analysis; R0015402:Abstract
A2events410 / 1766treatment policy; full analysis; R0015402:Abstract
Hospitalization for heart failure (10 lines; O23)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events2 / 1767not stated; safety; acute left ventricular failure; registry:adverse_events
A1events48 / 1767not stated; safety; cardiac failure; registry:adverse_events
A1events27 / 1767not stated; safety; cardiac failure acute; registry:adverse_events
A1events18 / 1767not stated; safety; cardiac failure chronic; registry:adverse_events
A1events33 / 1767not stated; safety; cardiac failure congestive; registry:adverse_events
A2events18 / 1766not stated; safety; cardiac failure chronic; registry:adverse_events
A2events6 / 1766not stated; safety; acute left ventricular failure; registry:adverse_events
A2events66 / 1766not stated; safety; cardiac failure; registry:adverse_events
A2events26 / 1766not stated; safety; cardiac failure acute; registry:adverse_events
A2events49 / 1766not stated; safety; cardiac failure congestive; registry:adverse_events
Serious adverse events (2 lines; O25)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events877 / 1767not stated; safety; registry:adverse_events
A2events950 / 1766not stated; safety; registry:adverse_events
Discontinuation due to adverse events (2 lines; O26)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events0 / 1767not stated; randomized; registry:flow
A2events0 / 1766not stated; randomized; registry:flow
Nausea (2 lines; O27A)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events6 / 1767not stated; safety; registry:adverse_events
A2events1 / 1766not stated; safety; registry:adverse_events
Vomiting (2 lines; O27B)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events11 / 1767not stated; safety; registry:adverse_events
A2events5 / 1766not stated; safety; registry:adverse_events
Diarrhea (2 lines; O27C)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events10 / 1767not stated; safety; registry:adverse_events
A2events4 / 1766not stated; safety; registry:adverse_events
Constipation (2 lines; O27D)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events3 / 1767not stated; safety; registry:adverse_events
A2events5 / 1766not stated; safety; registry:adverse_events
Discontinuation due to gastrointestinal adverse events (2 lines; O27E)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events0 / 1767not stated; randomized; registry:flow
A2events0 / 1766not stated; randomized; registry:flow
Gallbladder and biliary disease (26 lines; O28)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events1 / 1767not stated; safety; cholecystitis chronic; registry:adverse_events
A1events5 / 1767not stated; safety; cholecystitis; registry:adverse_events
A1events1 / 1767not stated; safety; gallbladder empyema; registry:adverse_events
A1events0 / 1767not stated; safety; post cholecystectomy syndrome; registry:adverse_events
A1events1 / 1767not stated; safety; biliary tract infection; registry:adverse_events
A1events3 / 1767not stated; safety; bile duct stone; registry:adverse_events
A1events13 / 1767not stated; safety; cholelithiasis; registry:adverse_events
A1events3 / 1767not stated; safety; cholangitis acute; registry:adverse_events
A1events1 / 1767not stated; safety; cholangitis infective; registry:adverse_events
A1events1 / 1767not stated; safety; cholangitis; registry:adverse_events
A1events0 / 1767not stated; safety; hydrocholecystis; registry:adverse_events
A1events1 / 1767not stated; safety; gallbladder enlargement; registry:adverse_events
A1events12 / 1767not stated; safety; cholecystitis acute; registry:adverse_events
A2events0 / 1766not stated; safety; gallbladder empyema; registry:adverse_events
A2events0 / 1766not stated; safety; biliary tract infection; registry:adverse_events
A2events1 / 1766not stated; safety; cholangitis acute; registry:adverse_events
A2events1 / 1766not stated; safety; cholangitis infective; registry:adverse_events
A2events3 / 1766not stated; safety; cholangitis; registry:adverse_events
A2events0 / 1766not stated; safety; gallbladder enlargement; registry:adverse_events
A2events1 / 1766not stated; safety; hydrocholecystis; registry:adverse_events
A2events1 / 1766not stated; safety; post cholecystectomy syndrome; registry:adverse_events
A2events15 / 1766not stated; safety; cholecystitis acute; registry:adverse_events
A2events0 / 1766not stated; safety; cholecystitis chronic; registry:adverse_events
A2events1 / 1766not stated; safety; cholecystitis; registry:adverse_events
A2events4 / 1766not stated; safety; bile duct stone; registry:adverse_events
A2events12 / 1766not stated; safety; cholelithiasis; registry:adverse_events
Acute pancreatitis (8 lines; O29)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events6 / 1767not stated; safety; pancreatitis acute; registry:adverse_events
A1events1 / 1767not stated; safety; obstructive pancreatitis; registry:adverse_events
A1events0 / 1767not stated; safety; pancreatitis necrotising; registry:adverse_events
A1events1 / 1767not stated; safety; pancreatitis; registry:adverse_events
A2events5 / 1766not stated; safety; pancreatitis acute; registry:adverse_events
A2events1 / 1766not stated; safety; obstructive pancreatitis; registry:adverse_events
A2events2 / 1766not stated; safety; pancreatitis necrotising; registry:adverse_events
A2events1 / 1766not stated; safety; pancreatitis; registry:adverse_events
Thyroid cancer (any) (4 lines; O32B)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events1 / 1767not stated; randomized; R0000453:Table 1
A1events1 / 1767not stated; safety; papillary thyroid cancer; registry:adverse_events
A2events1 / 1766not stated; randomized; R0000453:Table 1
A2events1 / 1766not stated; safety; papillary thyroid cancer; registry:adverse_events
Diabetic retinopathy complications (12 lines; O33)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events1 / 1767not stated; safety; blindness unilateral; registry:adverse_events
A1events339 / 1767not stated; safety; diabetic retinopathy; registry:adverse_events
A1events12 / 1767not stated; safety; diabetic retinopathy; registry:adverse_events
A1events1 / 1767not stated; safety; retinopathy proliferative; registry:adverse_events
A1events1 / 1767not stated; safety; retinopathy; registry:adverse_events
A1events3 / 1767not stated; safety; vitreous haemorrhage; registry:adverse_events
A2events0 / 1766not stated; safety; blindness unilateral; registry:adverse_events
A2events325 / 1766not stated; safety; diabetic retinopathy; registry:adverse_events
A2events9 / 1766not stated; safety; diabetic retinopathy; registry:adverse_events
A2events0 / 1766not stated; safety; retinopathy proliferative; registry:adverse_events
A2events0 / 1766not stated; safety; retinopathy; registry:adverse_events
A2events1 / 1766not stated; safety; vitreous haemorrhage; registry:adverse_events
Suicidal ideation or behavior (4 lines; O35A)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events0 / 1767not stated; safety; suicide attempt; registry:adverse_events
A1events1 / not stated; safety; R0040560:Figure 1
A2events3 / 1766not stated; safety; suicide attempt; registry:adverse_events
A2events4 / not stated; safety; R0040560:Figure 1
Gastroparesis (2 lines; O37A)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events1 / 1767not stated; safety; impaired gastric emptying; registry:adverse_events
A2events0 / 1766not stated; safety; impaired gastric emptying; registry:adverse_events
Intestinal obstruction or ileus (14 lines; O37B)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events1 / 1767not stated; safety; subileus; registry:adverse_events
A1events1 / 1767not stated; safety; mechanical ileus; registry:adverse_events
A1events1 / 1767not stated; safety; ileus paralytic; registry:adverse_events
A1events1 / 1767not stated; safety; ileus; registry:adverse_events
A1events2 / 1767not stated; safety; intestinal obstruction; registry:adverse_events
A1events0 / 1767not stated; safety; large intestinal obstruction; registry:adverse_events
A1events3 / 1767not stated; safety; small intestinal obstruction; registry:adverse_events
A2events0 / 1766not stated; safety; ileus paralytic; registry:adverse_events
A2events0 / 1766not stated; safety; ileus; registry:adverse_events
A2events1 / 1766not stated; safety; intestinal obstruction; registry:adverse_events
A2events1 / 1766not stated; safety; large intestinal obstruction; registry:adverse_events
A2events0 / 1766not stated; safety; mechanical ileus; registry:adverse_events
A2events2 / 1766not stated; safety; small intestinal obstruction; registry:adverse_events
A2events0 / 1766not stated; safety; subileus; registry:adverse_events
Pancreatic cancer (8 lines; O38)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1events1 / 1767not stated; safety; adenocarcinoma pancreas; registry:adverse_events
A1events1 / 1767not stated; safety; ductal adenocarcinoma of pancreas; registry:adverse_events
A1events0 / 1767not stated; safety; pancreatic carcinoma metastatic; registry:adverse_events
A1events0 / 1767not stated; safety; pancreatic carcinoma; registry:adverse_events
A2events0 / 1766not stated; safety; ductal adenocarcinoma of pancreas; registry:adverse_events
A2events3 / 1766not stated; safety; pancreatic carcinoma metastatic; registry:adverse_events
A2events1 / 1766not stated; safety; adenocarcinoma pancreas; registry:adverse_events
A2events1 / 1766not stated; safety; pancreatic carcinoma; registry:adverse_events
Kidney composite outcome (kidney disease populations) (6 lines; O50)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
A1 vs A2hr1.180.71 to 1.98treatment policy; full analysis; background:sglt2i; R0006943:Results
A1events186 / 1490treatment policy; full analysis; background:no_sglt2i; R0006943:Results
A1 vs A2hr0.750.61 to 0.90treatment policy; full analysis; background:no_sglt2i; R0006943:Results
A1events32 / 277treatment policy; full analysis; background:sglt2i; R0006943:Results
A2events233 / 1493treatment policy; full analysis; background:no_sglt2i; R0006943:Results
A2events27 / 273treatment policy; full analysis; background:sglt2i; R0006943:Results
eGFR total slope (6 lines; O51)
WeekArmStatisticEstimateSE or SD95% CIEvents / NDetail
234A1 vs A2md1.3 mL/min/1.73 m2/year0.8 to 1.8treatment policy; full analysis; egfr:30_to_less_than_45; R0015402:Results
234A1 vs A2md1.0 mL/min/1.73 m2/year0.5 to 1.6treatment policy; full analysis; egfr:45_to_less_than_60; R0015402:Results
234A1 vs A2md1.2 mL/min/1.73 m2/year0.5 to 1.8treatment policy; full analysis; egfr:60_or_more; R0015402:Results
234A1 vs A2md0.9 mL/min/1.73 m2/year-0.0 to 1.9treatment policy; full analysis; egfr:less_than_30; R0015402:Results
234A1slope-2.19 mL/min/1.73 m2/year0.11767treatment policy; full analysis; registry:outcomes
234A2slope-3.36 mL/min/1.73 m2/year0.11766treatment policy; full analysis; registry:outcomes