The main finding
In one sentence: In 92 adults with type 2 diabetes, 32 weeks of CagriSema lowered HbA1c by 2.2 percentage points and body weight by 15.6%, compared with 1.8 points and 5.1% for semaglutide alone.
Group averages, not an individual prediction. A trial result describes what happened to a defined group over a defined time.
On this page
Why this study matters
CagriSema is an experimental combination of two medicines: cagrilintide, a long-acting version of the hormone amylin, and semaglutide (Wegovy, Ozempic), a GLP-1 receptor agonist. It is not approved in Canada as of September 2026, and this study is research only. Earlier work had shown that the combination helps with weight loss. This trial was the first to ask what it does to blood sugar in people with type 2 diabetes, and it is the study that led to the larger REDEFINE 2 trial. Canadian readers with type 2 diabetes who are following this medicine will want to know both what it showed and how small it was.
Who was in the study
The trial enrolled 92 adults with type 2 diabetes and a BMI of 27 or higher. BMI, or body mass index, is weight in kilograms divided by height in metres squared. Everyone was already taking metformin, with or without an SGLT2 inhibitor, another type of diabetes medicine. The average age was 58 years, and 64% of participants were men. The trial ran for 32 weeks at 17 sites in the USA.
What the researchers did
This was a randomized, double-blind, phase 2 trial with an active comparator. Randomized means people were assigned to groups by chance. Double-blind means neither participants nor staff knew who was getting which treatment. Phase 2 means a mid-stage trial designed to test the idea before a large confirmatory study. An active comparator means the combination was compared with real medicines rather than an inactive placebo.
Participants were assigned in equal numbers to one of three weekly injections: CagriSema (31 people), semaglutide alone (31 people) or cagrilintide alone (30 people). All three were escalated to a dose of 2.4 mg. The primary end point, meaning the main result the trial was designed to test, was the change in HbA1c from the start to week 32. HbA1c is a blood test that reflects average blood sugar over about three months. Body weight, fasting blood sugar, continuous glucose monitoring and safety were secondary end points.
What they found
HbA1c fell in all three groups. The change from baseline to week 32 was -2.2 percentage points with CagriSema, -1.8 with semaglutide and -0.9 with cagrilintide.
CagriSema lowered HbA1c more than cagrilintide alone: the estimated difference was -1.3 percentage points (95% confidence interval -1.7 to -0.8). A confidence interval is the range of values the data are reasonably consistent with. Compared with semaglutide alone, the difference was -0.4 percentage points (95% CI -0.8 to 0.0), which was not statistically significant. In plain terms, the trial could not show that CagriSema beat semaglutide on blood sugar.
Weight change was a secondary outcome. The average change in body weight from baseline to week 32 was -15.6% with CagriSema, -5.1% with semaglutide and -8.1% with cagrilintide. The authors report that the CagriSema result was greater than both single medicines (R32-C70).
| Outcome at 32 weeks | CagriSema | Semaglutide alone | Cagrilintide alone |
|---|---|---|---|
| HbA1c change (percentage points) | -2.2 | -1.8 | -0.9 |
| Body weight change | -15.6% | -5.1% | -8.1% |
| Fasting plasma glucose change (mmol/L) | -3.3 | -2.5 | -1.7 |
| Time in target glucose range, start to week 32 | 45.9% to 88.9% | 32.6% to 76.2% | 56.9% to 71.7% |
Time in range is the share of the day that a continuous glucose monitor shows blood sugar between 3.9 and 10.0 mmol/L.
Side effects and people who stopped
Adverse events were reported by 21 of 31 people (68%) in the CagriSema group, 22 of 31 (71%) in the semaglutide group and 24 of 30 (80%) in the cagrilintide group. Mild or moderate gastrointestinal events, meaning stomach and bowel symptoms, were the most common. No level 2 or level 3 hypoglycaemia (low blood sugar) was reported, and there were no deaths. The published summary we reviewed does not report how many people in each group stopped treatment or left the trial.
What this study does not tell you
- The trial was small: about 30 people per group. Small trials give imprecise estimates and cannot detect uncommon harms.
- It lasted 32 weeks. It says nothing about longer-term blood sugar control, weight, or safety.
- Weight was a secondary outcome. The trial was built to test HbA1c, not weight.
- Everyone was taking metformin, and all sites were in the USA. Results may differ in other groups and settings.
- CagriSema is not approved in Canada as of September 2026.
- Do not compare these percentages with numbers from other trials. Different trials enrol different people and run for different lengths of time.
- The trial was funded by the company developing the medicine.
What it means in Canada
CagriSema is not approved in Canada as of September 2026, so this trial describes a medicine that is still being studied. Semaglutide on its own is a different matter, and you can read about it on our semaglutide in Canada page. For emerging medicines, see our medicines page. For how weight-management medicines are paid for, see public drug coverage by province.
Common questions
What is CagriSema?
CagriSema is cagrilintide plus semaglutide given together as weekly injections, each escalated to 2.4 mg. It is not approved in Canada as of September 2026.
How much weight did people with type 2 diabetes lose on CagriSema in the phase 2 trial?
Over 32 weeks, average weight change was -15.6% with CagriSema, -5.1% with semaglutide alone and -8.1% with cagrilintide alone.
Did CagriSema lower blood sugar more than semaglutide?
HbA1c fell 2.2 percentage points with CagriSema and 1.8 with semaglutide. The difference of -0.4 points (95% CI -0.8 to 0.0) was not statistically significant.
Related reading
Other studies in this library that bear on the same question.
REDEFINE 2: CagriSema in adults with type 2 diabetes
REDEFINE 1: CagriSema for weight loss over 68 weeks
REDEFINE 5: CagriSema versus semaglutide in Japan and Taiwan
STEP 2: semaglutide for weight loss in type 2 diabetes
SURMOUNT-2: tirzepatide for weight loss in type 2 diabetes
Source
Original paper: Juan P Frias, Emerging evidence: CagriSema T2D phase 2, Lancet (London, England), 2023. PubMed: https://pubmed.ncbi.nlm.nih.gov/37364590/. DOI: https://doi.org/10.1016/S0140-6736(23)01163-7. Funding: The trial was funded by Novo Nordisk, the company developing CagriSema. How we summarized it: abstract and extracted data.
This page explains a published study. It is not medical advice and does not describe whether a medicine is right for you. Talk to your doctor, nurse practitioner or pharmacist about your own situation. Reviewed and signed by two pharmacists registered in British Columbia, 2026-09-18.
Evidence records behind this page
Each record is a row in the clinical evidence file, taken from the published paper named above. The caution column is the limit the researcher recorded for that number.
This table scrolls sideways.
| Record | What the paper reports | Type | Population | Caution | Source |
|---|---|---|---|---|---|
| R32-C70 | In a 92-person type 2 diabetes phase 2 trial, average 32-week weight changes were -15.6% with combined cagrilintide-semaglutide, -5.1% with semaglutide and -8.1% with cagrilintide; each component's target dose was 2.4 mg weekly. | direct evidence | Adults with T2D, BMI at least 27, on metformin with or without SGLT2 inhibitor | Small phase 2 trial at 17 US sites; 32 weeks; weight secondary. Canadian approval status not verified; author affiliations not extracted. | PubMed 37364590 |