The headline trial: SUSTAIN-6 and SELECT
SUSTAIN-6 (Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes) and SELECT (Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity)
SUSTAIN-6: Marso et al., NEJM 2016. SELECT: Lincoff et al., NEJM November 2023.
SUSTAIN-6: semaglutide reduced major adverse cardiovascular events (MACE) by 26 percent (hazard ratio 0.74, 95% CI 0.58–0.95) over 2.1 years in T2D patients at high CV risk. SELECT: semaglutide 2.4 mg reduced MACE by 20 percent (hazard ratio 0.80, 95% CI 0.72–0.90) over a median 39.8 months in patients with established CV disease and BMI 27 or higher, without T2D.
Trial enrollment criteria
- Established cardiovascular disease: prior MI, prior stroke, prior TIA or symptomatic peripheral artery disease
- For SUSTAIN-6: T2D with HbA1c at least 7 percent
- For SELECT: BMI greater than or equal to 27 (overweight or obesity), no T2D required
Does this trial apply to you?
If you have T2D plus established CV disease (prior MI, stroke, TIA, PAD or coronary revascularization), Ozempic is FDA-labeled and ADA-preferred for cardiovascular risk reduction. If you have CV disease plus BMI 27+ without T2D, Wegovy is FDA-labeled (SELECT indication) and is a Medicare Part D-eligible pathway.
What to ask your prescriber
- Whether your cardiovascular history is documented with ICD-10 codes (I25.x, I63.x, etc.)
- Most recent HbA1c, lipid panel, blood pressure
- Whether the CV indication (Wegovy SELECT) or T2D indication (Ozempic) is the cleaner path
- Coordination between your PCP, cardiologist and prescribing clinician
Editorial notes
- Medicare Advantage covers GLP-1 under the CV indication (Wegovy SELECT label expansion) and the T2D indication. The obesity-alone pathway is federally excluded.
- Statin and antiplatelet therapy continue alongside GLP-1; the cardiovascular benefit is additive to standard care, not a replacement.
- Blood pressure may drop on GLP-1; coordinate dose adjustments with the cardiologist.
Clinical trials for Type 2 diabetes with established atherosclerotic cardiovascular disease
Or browse the full GLP-1 clinical trials directory, filterable by condition, state and phase.
Take it to your prescriber: PA letter templates
Editable prior-authorization letter templates that cite the registration trial above. Pick the plan your prescriber will submit to, copy the template, fill in the patient-specific findings and have your clinician sign and submit.
Not seeing your plan? The full PA letter librarycovers 20 plans × 10 indications = 200 templates. The appeal letter library handles denials.
Drug profiles
Other GLP-1 conditions
Editorial provenance
Editorial review by John, Editor on 2026-05-23, against SUSTAIN-6 and SELECT (SUSTAIN-6: Marso et al., NEJM 2016. SELECT: Lincoff et al., NEJM November 2023.). We do not yet have a credentialed medical reviewer on staff (actively recruiting). This page summarises public registration-trial data and FDA labeling. It is not clinician-authored medical advice.
Disclaimer
Educational summary of published registration trial data. Not medical advice. Not a substitute for evaluation by a treating clinician. Trial-level results do not guarantee individual outcomes. Discuss eligibility, contraindications, dose adjustments and drug interactions with your prescriber. We do not have a credentialed medical reviewer on staff yet (actively recruiting); the content below is editor-written from public registration-trial publications and FDA labeling, not clinician-authored medical advice.