Phase 3 · Semaglutide

COMBINE 1 trial results

A 52 Week Study Comparing the Efficacy and Safety of Once Weekly IcoSema and Once Weekly Insulin Icodec, Both Treatment Arms With or Without Oral Anti Diabetic Drugs, in Participants With Type 2 Diabetes Inadequately Controlled With Daily Basal Insulin.

Change in Glycated Haemoglobin (HbA1c) (Percentage point of HbA1c), Baseline (Week 0), Week 52. IcoSema: -1.60; Insulin Icodec: -0.90.

Participants
1,291
Status
completed
Completed
2024-04-23
Sponsor
Novo Nordisk A/S

As posted on ClinicalTrials.gov (NCT05352815), updated at source Dec 4, 2025. Read again whenever the registry updates it. Registry figures can differ from a published paper, which may use another analysis.

Primary outcome

What COMBINE 1 measured first

Change in Glycated Haemoglobin (HbA1c)Percentage point of HbA1c · Baseline (Week 0), Week 52 · mean
IcoSeman=598Insulin Icodecn=605
-1.60(0.99)-0.90(1.01)
Side effects by arm

Side effects in COMBINE 1

Percent of participants affected, Week 0 to week 57. The most common events the registry lists.

EventIcodecIcoSema
Any serious event10.7%9.2%
Nausea3.7%23.8%
Diarrhoea7.1%15.8%
Upper respiratory tract infection10.7%8.4%
Vomiting2.6%10.6%
COVID-199.5%10.4%
Nasopharyngitis7.9%5.9%
Dyspepsia1.6%6.8%
Diabetic retinopathy5.4%6.4%
Constipation1.2%6.1%
Decreased appetite0.2%5.9%
Dizziness3%5.7%
Headache3.1%5.1%
Secondary outcomes

What else it measured

Change in Body WeightKilogram (Kg) · Baseline (Week 0), Week 52 · mean
IcoSeman=606Insulin Icodecn=610
-3.71(4.87)1.96(4.76)
Number of Clinically Significant Hypoglycaemic Episodes (Level 2) (Less Than 3.0 Millimoles Per Litre [mmol/L] (54 Milligram Per Decilitre [mg/dL]), Confirmed by Blood Glucose [BG] Meter) or Severe Hypoglycaemic Episodes (Level 3)Episodes · From baseline week 0 to week 57 · number
IcoSeman=644Insulin Icodecn=644
91424
Percentage of Time in Range 3.9-10.0 mmol/L (70-180 mg/dL) Using Continuous Glucose Monitoring (CGM) System, Dexcom G6Percentage of time · From week 48 to week 52 · mean
IcoSeman=481Insulin Icodecn=488
75.9(16.1)61.9(18.1)
Percentage of Time Spent < 3.0 mmol/L (54 mg/dL) Using Continuous Glucose Monitoring (CGM) System, Dexcom G6Percentage of time · From week 48 to week 52 · mean
IcoSeman=481Insulin Icodecn=488
0.27(0.55)0.33(0.82)
Percentage of Time Spent > 10.0 mmol/L (180 mg/dL) Using Continuous Glucose Monitoring (CGM) System, Dexcom G6Percentage of time · From week 48 to week 52 · mean
IcoSeman=481Insulin Icodecn=488
23.2(16.3)36.7(18.7)
Change in Fasting Plasma Glucose (FPG)Millimoles per litre (mmol/L) · Baseline (Week 0), Week 52 · mean
IcoSeman=552Insulin Icodecn=572
-1.90(3.01)-1.65(2.96)
Weekly Basal Insulin DoseUnits of insulin · From week 50 to week 52 · mean
IcoSeman=575Insulin Icodecn=596
170.6(83.3)366.5(225.5)
Number of Clinically Significant Hypoglycaemic Episodes (Level 2) (<3.0 mmol/L (54 mg/dL), Confirmed by BG Meter)Episodes · From baseline week 0 to week 57 · number
IcoSeman=644Insulin Icodecn=644
90419
Number of Severe Hypoglycaemic Episodes (Level 3)Episodes · From baseline week 0 to week 57 · number
IcoSeman=644Insulin Icodecn=644
15
The trial

How COMBINE 1 was run

This study will compare the new medicine IcoSema, which is a combination of insulin icodec and semaglutide, taken once a week, to insulin icodec taken once a week in people with type 2 diabetes. The study will look at how well IcoSema controls blood sugar level in people with type 2 diabetes compared to insulin icodec. Participants will either get IcoSema or insulin icodec. Which treatment participants get is decided by chance. IcoSema and insulin icodec are both new medicines that doctors cannot prescribe. Participants will get IcoSema or insulin icodec, which participants must inject once a week with a pen, which has a small needle, in a skin fold in the thigh, upper arm, or stomach. The study will last for about 1 year and 1 month. Participants will have 21 clinic visits, 31 phone/video calls with the study doctor, and 4 contacts with the site that can either be clinic visits or phone/video calls At 11 clinic visits participants will have blood samples taken. At 7 clinic visits participants cannot eat or drink (except for water) for 8 hours before the visit. Women cannot take part if pregnant, breast-feeding or plan to get pregnant during the study period. Not applicable for China: Participants will be asked to wear a sensor that measures their blood sugar level all the time during a 5 week period at the end of the study.

  • IcoSema
  • Insulin icodec
Who could join the trial

Key inclusion criteria 1. Male or female and age above or equal to 18 years at the time of signing informed consent. 2. Diagnosed with type 2 diabetes mellitus 180 days or more before screening. 3. HbA1c of 7.0 10.0% (53.0 85.8 mmol/mol) (both inclusive) as assessed by central laboratory on the day of screening. 4. Treated with once daily or twice daily basal insulin (neutral protamine hagedorn insulin, insulin degludec, insulin detemir, insulin glargine 100 units/mL, or insulin glargine 300 units/mL) 20- 80 units/day for 90 days or more before screening. Short term bolus insulin treatment for a maximum of 14 days before screening is allowed, as is prior insulin treatment for gestational diabetes. The treatment can be with or without any of the following anti diabetic drugs with stable doses for 90 days or more before screening: * Metformin * Sulfonylureas (a) * Meglitinides (glinides) (a) * DPP 4 inhibitors (a) * Sodium glucose co transporter 2 inhibitors * Alpha glucosidase inhibitors * Thiazolidinediones * Marketed oral combination products only including the products listed above. 5. Body mass index (BMI) below or equal to 40.0 kg/m\^2. (a) Sulfonylureas, meglitinides (glinides) and DPP 4 inhibitors must be discontinued at randomisation. Key exclusion criteria 1. Female who is pregnant, breast-feeding or intends to become pregnant or is of childbearing potential and not using a highly effective contraceptive method. 2. Anticipated initiation or change in concomitant medication (for more than 14 consecutive days) known to affect weight or glucose metabolism (e.g. treatment with orlistat, thyroid hormones, or systemic corticosteroids). 3. Treatment with any medication for the indication of diabetes or obesity other than stated in the inclusion criteria within 90 days before screening. 4. Any episodes (as declared by the participant or in the medical records.) of diabetic ketoacidosis within 90 days before screening. 5. Presence or history of pancreatitis (acute or chronic) within 180 days before screening. 6. Any of the following: Myocardial infarction, stroke, hospitalization for unstable angina pectoris or transient ischaemic attack within 180 days before screening. 7. Chronic heart failure classified as being in New York Heart Association Class IV at screening. 8. Recurrent severe hypoglycaemic episodes within the last year (12 months) as judged by the investigator. 9. Uncontrolled and potentially unstable diabetic retinopathy or maculopathy. Verified by a fundus examination performed within the past 90 days before screening or in the period between screening and randomisation. Pharmacological pupil dilation is a requirement unless using a digital fundus photography camera specified for non-dilated examination.

Published papers

Papers from COMBINE 1

Trial averages do not predict what one person will experience. Results are shown as the registry posts them, without interpretation.

GLPcompare is an informational data platform, not a medical provider or pharmacy. Nothing here is medical advice, a diagnosis, or a recommendation to start, stop, or change any treatment. Data is aggregated from public sources and can be incomplete or out of date. Always confirm with a licensed clinician and the current FDA label.