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ForumsMetabolic Health & DiabetesSUSTAIN-6 to SELECT — what worked for you? Page 7

SUSTAIN-6 to SELECT — what worked for you?

fiona_VT Sat, Aug 16, 2025 at 4:04 PM 38 replies 1,492 viewsPage 7 of 8
marco_milano
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Jul 2024
Milan, IT
Jan 2, 2026 at 10:26 AM#31
Dr.AddMedPHL said:
Worth knowing that the injection site changes very little.

SUSTAIN-6 was the first CVOT to show cardiovascular benefit with semaglutide, relevant to cardiovascular risk. In 3,297 T2DM patients with high CV risk: MACE HR 0.74 (95% CI 0.58-0.95, p=0.02)[1].

Notable: the retinopathy signal in SUSTAIN-6 (HR 1.76) was subsequently attributed to rapid A1C reduction in patients with pre-existing retinopathy — not a direct drug effect. This has been confirmed in longer-term follow-up studies.

References:
[1] Marso SP, et al. N Engl J Med. 2016;375(19):1834-1844.
Last edited: Jan 2, 2026 at 2:26 PM
5 3kevin_tulsa, Dr.PainCLE, mike_mealprep and 2 others
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greg_boulder
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Jul 2024
Boulder, CO
Jan 13, 2026 at 5:24 AM#32
Dr.AddMedPHL said:
Worth knowing that the injection site changes very little.

This is exactly what I could not find anywhere else. I will report back once I have actually tried it.

6 4fiona_VT, denise_HTX, raj_cambridge and 3 others
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traveltech_sara
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Jan 2025
Remote, USA
Jan 24, 2026 at 12:15 AM#33

Adding the clinical framing, because it changes how the question reads.

I want to bring up the cardiovascular angle on cardiovascular risk.

The SELECT trial demonstrated a 20% reduction in MACE with semaglutide 2.4mg[1]. This is practice-changing because the CV benefit appears to be independent of the degree of weight loss — suggesting direct vascular and anti-inflammatory mechanisms.

For cardiovascular risk, this means we need to think beyond the primary outcome and consider the cardiovascular implications. The all-cause mortality reduction (HR 0.81) is the most clinically meaningful signal.

References:
[1] Lincoff AM, et al. N Engl J Med. 2023;389(24):2221-2232.
Last edited: Jan 24, 2026 at 3:15 AM
7 5wanda_boise, NurseAsh_DET, BenResearch_OR and 4 others
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LibrarianMeg
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Mar 2024
Baltimore, MD
Feb 3, 2026 at 7:00 PM#34
traveltech_sara said:
I want to bring up the cardiovascular angle on cardiovascular risk.

Second this.

8 6JessicaM_2024, TomFromTexas, mike.trainer_LA and 5 others
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dave_SLC
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Aug 2024
Salt Lake City, UT
Feb 14, 2026 at 1:39 PM#35
traveltech_sara said:
I want to bring up the cardiovascular angle on cardiovascular risk.

Positive "side effect" of cardiovascular risk: my blood pressure dropped so much that I'm now off lisinopril entirely! My cardiologist is thrilled.

If you're on BP meds and losing weight on a GLP-1, monitor your BP at home regularly. Hypotension symptoms (dizziness, lightheadedness when standing) mean your BP meds may need reduction. Don't wait for your next scheduled appointment — call your doctor.

9 7Dr.BariatricHTX, LindaRN_retired, tommy_boulder and 6 others
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