---
title: "Safiglipron vs dapagliflozin in type 2 diabetes: phase 3 randomized double-blind OUTSTAND-2 results"
id: "nature-0-oral-small-molecule-glp-1ra-safiglipron-versus-dapagliflozin-in-type-2-diabetes"
canonical_url: "https://medichelpline.com/clinical-feed/nature-0-oral-small-molecule-glp-1ra-safiglipron-versus-dapagliflozin-in-type-2-diabetes"
content_type: "clinical_feed_article"
specialty: "Endocrinology"
source_name: "Nature Medicine"
source_url: "https://www.nature.com/articles/s41591-026-04713-y"
published_at: "2026-10-05T10:49:34.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Safiglipron vs dapagliflozin in type 2 diabetes: phase 3 randomized double-blind OUTSTAND-2 results
## Provenance & Clinical Metadata
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- **Specialty:** [Endocrinology](https://medichelpline.com/clinical-feed/endocrinology.md)
- **Primary Source:** Nature Medicine
- **Source URL:** [Original Journal Publication](https://www.nature.com/articles/s41591-026-04713-y)
- **Published At:** 2026-10-05T10:49:34.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- OUTSTAND-2 was a multicenter, randomized, double-blind, double-dummy, active-comparator-controlled phase 3 trial in China comparing once-daily oral **safiglipron** (30, 60, 90 mg) with **dapagliflozin** 10 mg in adults with type 2 diabetes inadequately controlled on metformin. - 810 participants were randomized (mean baseline **HbA1c** 8.60%, median diabetes duration 5.0 years, 35.7% women); 809 received study treatment and comprised the safety population. - Primary endpoint: change from baseline in **HbA1c** at week 32 under a prespecified non-inferiority estimand (non-inferiority margin 0.4%). All three safiglipron doses met non-inferiority versus dapagliflozin. - Treatment differences in HbA1c versus dapagliflozin at week 32: −0.30% (30 mg), −0.22% (60 mg) and −0.40% (90 mg) with reported 95% CIs; all P < 0.0001 for non-inferiority. - Under the treatment-policy estimand, safiglipron 90 mg met the prespecified criterion for superiority versus dapagliflozin (difference −0.25%; one-sided P = 0.0067); 60 mg did not meet superiority and testing stopped thereafter. - HbA1c target attainment (HbA1c <7.0%): 54.9–63.5% with safiglipron versus 36.5% with dapagliflozin. For HbA1c ≤6.5%: 38.9–48.6% versus 16.1%, respectively. - Mean body-weight changes at week 32: −2.35% (safiglipron 30 mg), −3.55% (60 mg), −4.17% (90 mg) and −3.60% (dapagliflozin). - Other metabolic measures (FPG, seven-point SMBG, waist circumference, HOMA-β, HOMA-IR, patient treatment satisfaction) showed varying degrees of improvement with both agents. - Rescue therapy use was low (0.5–1.5% with safiglipron groups vs 0% with dapagliflozin). - Gastrointestinal adverse events were more frequent with safiglipron and were mostly mild or moderate. Treatment discontinuations due to adverse events occurred in 4.0%, 4.0%, 3.9% and 1.5% of participants in the safiglipron 30, 60, 90 mg and dapagliflozin groups, respectively. - The trial supports **safiglipron** as an effective oral small-molecule **GLP-1** receptor agonist option for adults with type 2 diabetes inadequately controlled with metformin. Details beyond the reported endpoints (long-term cardiorenal outcomes, subgroup analyses) were not reported in the source.
## Clinical Analysis & Structured Key Points
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[articles](https://www.nature.com/nm/articles?type=article) 4. article Oral small-molecule GLP-1RA safiglipron versus dapagliflozin in type 2 diabetes: a randomized, double-blind, active-comparator-controlled phase 3 trial [ Download PDF ](https://www.nature.com/articles/s41591-026-04713-y.pdf) [ Download PDF ](https://www.nature.com/articles/s41591-026-04713-y.pdf) * Article * [Open access](https://www.springernature.com/gp/open-science/about/the-fundamentals-of-open-access-and-open-research) * Published: 05 October 2026 # Oral small-molecule GLP-1RA safiglipron versus dapagliflozin in type 2 diabetes: a randomized, double-blind, active-comparator-controlled phase 3 trial * [Lixin Guo (郭立新)](https://www.nature.com/articles/s41591-026-04713-y#auth-Lixin-Guo-Aff1) [ORCID: orcid.org/0000-0001-6863-1798](https://orcid.org/0000-0001-6863-1798)[1](https://www.nature.com/articles/s41591-026-04713-y#Aff1), * [Dongni Yu (于冬妮)](https://www.nature.com/articles/s41591-026-04713-y#auth-Dongni-Yu-Aff1)[1](https://www.nature.com/articles/s41591-026-04713-y#Aff1), * [Yimei Xu (徐奕玫)](https://www.nature.com/articles/s41591-026-04713-y#auth-Yimei-Xu-Aff2)[2](https://www.nature.com/articles/s41591-026-04713-y#Aff2), * [Guo Tang (唐果)](https://www.nature.com/articles/s41591-026-04713-y#auth-Guo-Tang-Aff2) [ORCID: orcid.org/0000-0001-5411-1441](https://orcid.org/0000-0001-5411-1441)[2](https://www.nature.com/articles/s41591-026-04713-y#Aff2), * [Liang Peng (彭亮)](https://www.nature.com/articles/s41591-026-04713-y#auth-Liang-Peng-Aff2) [ORCID: orcid.org/0000-0002-5407-3737](https://orcid.org/0000-0002-5407-3737)[2](https://www.nature.com/articles/s41591-026-04713-y#Aff2), * [Chao Meng (孟超)](https://www.nature.com/articles/s41591-026-04713-y#auth-Chao-Meng-Aff3)[3](https://www.nature.com/articles/s41591-026-04713-y#Aff3), * [Meng Zhao (赵猛)](https://www.nature.com/articles/s41591-026-04713-y#auth-Meng-Zhao-Aff4)[4](https://www.nature.com/articles/s41591-026-04713-y#Aff4), * [Wen Hu (胡文)](https://www.nature.com/articles/s41591-026-04713-y#auth-Wen-Hu-Aff5)[5](https://www.nature.com/articles/s41591-026-04713-y#Aff5), * [Debin Huang (黄德斌)](https://www.nature.com/articles/s41591-026-04713-y#auth-Debin-Huang-Aff6)[6](https://www.nature.com/articles/s41591-026-04713-y#Aff6), * [Chaoyang Zeng (曾朝阳)](https://www.nature.com/articles/s41591-026-04713-y#auth-Chaoyang-Zeng-Aff7)[7](https://www.nature.com/articles/s41591-026-04713-y#Aff7), * [Lei Yu (于磊)](https://www.nature.com/articles/s41591-026-04713-y#auth-Lei-Yu-Aff8)[8](https://www.nature.com/articles/s41591-026-04713-y#Aff8), * [Guangxiu Wu (吴光秀)](https://www.nature.com/articles/s41591-026-04713-y#auth-Guangxiu-Wu-Aff9)[9](https://www.nature.com/articles/s41591-026-04713-y#Aff9), * [Lihui Zhang (张力辉)](https://www.nature.com/articles/s41591-026-04713-y#auth-Lihui-Zhang-Aff10)[10](https://www.nature.com/articles/s41591-026-04713-y#Aff10), * [Yuan Gao (高远)](https://www.nature.com/articles/s41591-026-04713-y#auth-Yuan-Gao-Aff11)[11](https://www.nature.com/articles/s41591-026-04713-y#Aff11), * [Tingyan Zhong (钟庭艳)](https://www.nature.com/articles/s41591-026-04713-y#auth-Tingyan-Zhong-Aff2)[2](https://www.nature.com/articles/s41591-026-04713-y#Aff2) & * [Zi Ye (叶子)](https://www.nature.com/articles/s41591-026-04713-y#auth-Zi-Ye-Aff2) [ORCID: orcid.org/0009-0001-7740-1238](https://orcid.org/0009-0001-7740-1238)[2](https://www.nature.com/articles/s41591-026-04713-y#Aff2) * [on behalf of the OUTSTAND-2 Investigator Group](https://www.nature.com/articles/s41591-026-04713-y#group-1) Show authors [_Nature Medicine_](https://www.nature.com/nm) (2026) [Cite this article](https://www.nature.com/articles/s41591-026-04713-y#citeas) [ Save article ](https://www.nature.com/articles/s41591-026-04713-y/save-research?_csrf=r91vrjTVUtCe1MHo7wVbNbjkUBH8_oHn) [ View saved research ](https://www.nature.com/saved-research) ## Abstract Safiglipron is an oral small-molecule glucagon-like peptide-1 (GLP-1) receptor agonist administered without fasting or dietary restrictions. We evaluated its efficacy and safety versus dapagliflozin in OUTSTAND-2, a phase 3, multicenter, randomized, double-blind, double-dummy, active-comparator-controlled trial conducted at 98 sites in China. We randomized 810 adults (mean hemoglobin A1C (HbA1c) 8.60%, median diabetes duration 5.0 years, 35.7% women) to safiglipron 30 mg (_n_ = 202), safiglipron 60 mg (_n_ = 203), safiglipron 90 mg (_n_ = 203) or dapagliflozin 10 mg (_n_ = 202) for 32 weeks, followed by a 20-week active-treatment extension. For the primary endpoint, treatment differences versus dapagliflozin in change from baseline in HbA1c at week 32 under the primary non-inferiority estimand were −0.30% (95% confidence interval (CI): −0.51 to −0.09), −0.22% (−0.44 to −0.01) and −0.40% (−0.62 to −0.19) for safiglipron 30 mg, 60 mg and 90 mg, respectively, establishing non-inferiority for all three doses (all _P_ < 0.0001; non-inferiority margin 0.4%). Under the treatment policy estimand, 90 mg met the prespecified statistical criterion for superiority (difference −0.25%; 95% CI: −0.45 to −0.05; one-sided _P_ = 0.0067), whereas 60 mg did not (_P_ = 0.0789), after which fixed-sequence testing stopped. HbA1c target attainment rates with safiglipron versus dapagliflozin were 54.9−63.5% versus 36.5% for HbA1c <7.0% and 38.9−48.6% versus 16.1% for HbA1c ≤6.5%. Mean body weight changes were −2.35%, −3.55%, −4.17% and −3.60% for safiglipron 30 mg, safiglipron 60 mg, safiglipron 90 mg and dapagliflozin, respectively. Fasting plasma glucose, seven-point self-monitored blood glucose profiles, waist circumference, HOMA-β, HOMA-IR and changes in treatment satisfaction showed varying degrees of improvement from baseline with both safiglipron and dapagliflozin. Rescue therapy was used by 0.5−1.5% versus 0% of participants, respectively. Gastrointestinal adverse events were more frequent with safiglipron and mostly mild or moderate; adverse events led to treatment discontinuation in 4.0%, 4.0%, 3.9% and 1.5% of participants, respectively. Safiglipron provides an effective oral treatment option for adults with type 2 diabetes inadequately controlled with metformin. ClinicalTrials.gov identifier: [NCT06589765](http://clinicaltrials.gov/study/NCT06589765). ### Explore related subjects Discover the latest articles and news in related subjects. * [Randomized controlled trials](https://www.nature.com/subjects/randomized-controlled-trials) * [Type 2 diabetes](https://www.nature.com/subjects/type-2-diabetes-mellitus) * [Sodium-Glucose Cotransporter 2 Inhibition in Type 2 Diabetes Management](https://www.nature.com/subjects/sodium-glucose-cotransporter-2-inhibition-in-type-2-diabetes-management) ## Main Diabetes affects an estimated 589 million adults worldwide, more than 90% of whom have type 2 diabetes[1](https://www.nature.com/articles/s41591-026-04713-y#ref-CR1 "IDF Diabetes Atlas 11th edn \(eds Magliano, D. J. et al.\) \(International Diabetes Federation, 2025\)."). Progressive β cell dysfunction contributes to deterioration of glycemic control and often necessitates treatment intensification beyond metformin[2](https://www.nature.com/articles/s41591-026-04713-y#ref-CR2 "Lu, X. et al. Type 2 diabetes mellitus in adults: pathogenesis, prevention and therapy. Signal Transduct. Target. Ther. 9, 262 \(2024\)."),[3](https://www.nature.com/articles/s41591-026-04713-y#ref-CR3 "Abdul-Ghani, M., Maffei, P. & DeFronzo, R. A. Managing insulin resistance: the forgotten pathophysiological component of type 2 diabetes. Lancet Diabetes Endocrinol. 12, 674–680 \(2024\)."). GLP-1 receptor agonists and sodium-glucose co-transporter 2 (SGLT2) inhibitors are the preferred pharmacologic additions in this setting, with both providing HbA1c-lowering and cardiorenal benefits, albeit through complementary mechanisms[4](https://www.nature.com/articles/s41591-026-04713-y#ref-CR4 "Preda, A. et al. SGLT2 inhibitors: from glucose-lowering to cardiovascular benefits. Cardiovasc. Res. 120, 443–460 \(2024\)."),[5](https://www.nature.com/articles/s41591-026-04713-y#ref-CR5 "Rosen, C. J. & Ingelfinger, J. R. GLP-1 receptor agonists. N. Engl. J. Med. 394, 1313–1324 \(2026\)."). Current guidelines recommend both classes as preferred therapies for type 2 diabetes, in addition to metformin and, in individuals with established atherosclerotic cardiovascular disease, heart failure or chronic kidney disease, independently of metformin[6](https://www.nature.com/articles/s41591-026-04713-y#ref-CR6 "Bajaj, M. et al. 9. Pharmacologic approaches to glycemic treatment: Standards of Care in Diabetes—2026. Diabetes Care 49, S183–S215 \(2026\)."). Among GLP-1 receptor agonists, conventional peptide-based formulations require subcutaneous injection, which may limit adherence[7](https://www.nature.com/articles/s41591-026-04713-y#ref-CR7 "Horii, T. et al. Adherence and treatment discontinuation of oral semaglutide and once-weekly semaglutide injection at 12 month follow-up: Japanese real-world data. J. Diabetes Investig. 15, 1578–1584 \(2024\)."). Oral semaglutide provides a non-injectable option but requires fasting administration with restricted water intake owing to its peptide-based absorption enhancer co-formulation[8](https://www.nature.com/articles/s41591-026-04713-y#ref-CR8 "Andersen, A., Knop, F. K. & Vilsbøll, T. A pharmacological and clinical overview of oral semaglutide for the treatment of type 2 diabetes. Drugs 81, 1003–1030 \(2021\)."). Oral non-peptide small-molecule GLP-1 receptor agonists may avoid these peptide-related administration requirements. Orforglipron, the first oral non-peptide small-molecule GLP-1 receptor agonist approved by the US Food and Drug Administration, has demonstrated glycemic and body weight benefits across phase 3 trials, including an open-label comparison with dapagliflozin in ACHIEVE-2 (refs. [9](https://www.nature.com/articles/s41591-026-04713-y#ref-CR9 "Welch, M. et al. Orforglipron compared with dapagliflozin in adults with type 2 diabetes and inadequate glycaemic control with metformin \(ACHIEVE-2\): a multicentre, randomised, non-inferiority, open-label, phase 3 trial. Lancet 408, 125–140 \(2026\)."),[10](https://www.nature.com/articles/s41591-026-04713-y#ref-CR10 "Rosenstock, J. et al. Orforglipron, an oral small-molecule GLP-1 receptor agonist, in early type 2 diabetes. N. Engl. J. Med. 393, 1065–1076 \(2025\)."),[11](https://www.nature.com/articles/s41591-026-04713-y#ref-CR11 "Rosenstock, J. et al. Efficacy and safety of once-daily oral orforglipron compared with oral semaglutide in adults with type 2 diabetes \(ACHIEVE-3\): a multinational, multicentre, non-inferiority, open-label, randomised, phase 3 trial. Lancet 407, 1147–1160 \(2026\).")). To our knowledge, however, no double-blind phase 3 trial has directly compared an oral small-molecule GLP-1 receptor agonist to an SGLT2 inhibitor. Safiglipron (proposed International Nonproprietary Name (INN)[12](https://www.nature.com/articles/s41591-026-04713-y#ref-CR12 "INN proposed list 134. World Health Organization https://www.who.int/publications/m/item/inn-pl-134 \(2026\)."); HRS-7535) is an oral non-peptide small-molecule GLP-1 receptor agonist with high oral bioavailability[13](https://www.nature.com/articles/s41591-026-04713-y#ref-CR13 "Wu, J. et al. Safety, pharmacokinetics and pharmacodynamics of HRS-7535, a novel oral small molecule glucagon-like peptide-1 receptor agonist, in healthy participants: a phase 1, randomized, double-blind, placebo-controlled, single- and multiple-ascending dose, and food effect trial. Diabetes Obes. Metab. 26, 901–910 \(2024\)."). In phase 2 trials, safiglipron reduced HbA1c in individuals with type 2 diabetes inadequately controlled with metformin[14](https://www.nature.com/articles/s41591-026-04713-y#ref-CR14 "Guo, L. et al. HRS-7535 for type 2 diabetes inadequately controlled with metformin: a randomized clinical trial. JAMA Netw. Open 9, e2615622 \(2026\)."), body weight in adults with obesity[15](https://www.nature.com/articles/s41591-026-04713-y#ref-CR15 "Gu, W. et al. HRS-7535, an oral small-molecule GLP-1 receptor agonist, in Chinese adults with obesity without diabetes: a randomized, double-blind, placebo-controlled phase 2 trial. Nat. Commun. 17, 7867 \(2026\).") and albuminuria in people with diabetic kidney disease[16](https://www.nature.com/articles/s41591-026-04713-y#ref-CR16 "Lv, R. et al. Efficacy and safety of HRS-7535, an oral small-molecule GLP-1 receptor agonist, in patients with diabetic kidney disease \(SOLID-DKD\): a randomised, double-blind, placebo-controlled, phase 2 trial. EClinicalMedicine 97, 104045 \(2026\)."). We conducted the OUTSTAND-2 trial to evaluate the efficacy and safety of three doses of safiglipron as compared to dapagliflozin in adults with type 2 diabetes inadequately controlled with metformin monotherapy. ## Results ### Trial design and participants OUTSTAND-2 was a multicenter, randomized, double-blind, double-dummy, active-comparator-controlled trial evaluating once-daily oral safiglipron 30 mg, 60 mg and 90 mg versus dapagliflozin 10 mg in adults aged 18−75 years with type 2 diabetes (HbA1c 7.5−11.0%, body mass index (BMI) 19.0−40.0 kg m−2) inadequately controlled with stable metformin monotherapy. The trial comprised a 3-week single-blind run-in, a 32-week core treatment period, a 20-week extension and a 2-week safety follow-up (Extended Data Fig. [1](https://www.nature.com/articles/s41591-026-04713-y#Fig4)). The primary endpoint was the change from baseline in HbA1c at week 32. Prespecified key secondary endpoints were HbA1c target achievement, fasting plasma glucose (FPG) and percentage change in body weight at week 32. Prespecified supportive secondary endpoints included changes in indices of β cell function and insulin sensitivity (HOMA-β and HOMA-IR), post-prandial glucose and insulin responses during a mixed-meal tolerance test (MMTT), waist circumference, seven-point self-monitored blood glucose (SMBG) profiles and the proportion receiving rescue therapy. Prespecified exploratory endpoints included changes in blood pressure, lipid parameters and urinary albumin-to-creatinine ratio (UACR). Patient-reported treatment satisfaction was assessed using Diabetes Treatment Satisfaction Questionnaire, status version (DTSQs). Safety endpoints included adverse events, hypoglycemic episodes, laboratory parameters, electrocardiograms and diabetic retinopathy assessments. Between 27 September 2024 and 30 April 2025, a total of 1,431 participants were screened, of whom 810 underwent randomization; 202 were assigned to receive safiglipron 30 mg, 203 to receive safiglipron 60 mg, 203 to receive safiglipron 90 mg and 202 to receive dapagliflozin (Fig. [1](https://www.nature.com/articles/s41591-026-04713-y#Fig1)). Overall, 809 participants received at least one dose of the assigned study treatment and comprised the safety population. During the 52-week treatment period, 178 (88.1%) participants in the safiglipron 30 mg group, 168 (82.8%) participants in the safiglipron 60 mg group, 167 (82.3%) participants in the safiglipron 90 mg group and 188 (93.1%) participants in the dapagliflozin group completed treatment (Fig. [1](https://www.nature.com/articles/s41591-026-04713-y#Fig1)). Prespecified intercurrent events are reported in Supplementary Table [2](https://www.nature.com/articles/s41591-026-04713-y#MOESM1). **Fig. 1: CONSORT diagram.** ![Fig. 1: CONSORT diagram.](https://media.springernature.com/lw685/springer-static/image/art%3A10.1038%2Fs41591-026-04713-y/MediaObjects/41591_2026_4713_Fig1_HTML.png) [Full size image](https://www.nature.com/articles/s41591-026-04713-y/figures/1) Percentages use the corresponding randomized group size as the denominator. One participant in the safiglipron 60 mg group was found to fail eligibility criteria after randomization, and the investigator determined that no study drug would be administer
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