Research Study Looking at How Well Semaglutide Works in People Suffering From Obesity and Knee Osteoarthritis
- Conditions
- Obesity
- Interventions
- Registration Number
- NCT05064735
- Lead Sponsor
- Novo Nordisk A/S
- Brief Summary
This study will look at participants body weight from the start to the end of the study. It will also look at how much pain participants have in participants knee from the start to the end of the study and how this affects participants daily life. This is to compare the effect on body weight and pain in the knee in people taking semaglutide with people taking "dummy" medicine. Participants will either get semaglutide or "dummy" medicine. Which treatment participants get is decided by chance.
Participants will need to take 1 injection once a week. The study medicine is injected with a thin needle in a skin fold in the stomach, thigh or upper arm. During the study, participants will have talks with study staff about how to eat healthy food and how to be more physically active. The study will last for about 1 ½ years. Participants will have 14 clinic visits with the study staff. At the first clinic visit participants will have a blood sample taken. Participants will have an X-ray of participants knee taken at the first visit. If participants have had an X-ray recently, this may not be needed.
At 6 of the clinic visits participants cannot take pain medications for 3 days before the visit. Participants cannot take part if participants have had a joint replacement surgery in participants knee. Participants cannot take part if participants have or have had diabetes. Women: Women cannot take part if pregnant, breast-feeding or plan to become pregnant during the study period.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 407
- Male or female, age above or equal to 18 years at the time of signing informed consent
- Body Mass Index (BMI) equal to or greater than 30.0 kg/m^2
- Clinical diagnosis of knee OA (American College of Rheumatology (ACR) criteria) with moderate radiographic changes (Kellgren-Lawrence (KL) grades 2 or 3 as per central reading) in target knee. Target knee joint is defined as most symptomatic knee at screening. If pain in knees are equal target knee joint will be in the most dominant leg.
- Pain due to knee OA
- Joint replacement in target knee
- Arthroscopy or injections into target knee within last 3 months prior to enrolment
- Any other joint disease in the target knee
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description semaglutide 2.4 mg (placebo) semaglutide 2.4 mg (placebo) Participants will receive semaglutide subcutaneous (s.c) placebo once-weekly as adjunct to a reduced-calorie diet and increased physical activity semaglutide 2.4 mg semaglutide 2.4 mg Participants will receive semaglutide subcutaneous (s.c) 2.4 mg once-weekly as adjunct to a reduced-calorie diet and increased physical activity
- Primary Outcome Measures
Name Time Method Percentage Change in Body Weight Baseline (week 0), end of treatment (week 68) Percentage change in body weight from baseline (week 0) to end of treatment (week 68) is presented. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
Change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Score Baseline (week 0), end of treatment (week 68) WOMAC is a disease-specific patient-reported outcome measure designed to assess changes in symptoms and lower extremity functioning associated with treatment in patients with osteoarthritis of the hip and/or knee. WOMAC is a 24 item questionnaire which assesses clinically important, participant-relevant symptoms in area of pain, stiffness, and physical function in participants with osteoarthritis (OA). It consists of 3 subscales: pain, stiffness and physical function. The WOMAC raw pain score is derived as the sum of the 5 item scores in the pain domain. It will be normalised and expressed on a 0-100 scale. This is done by dividing raw score by the highest possible value of the raw score for the pain domain (i.e. 50) and multiplying by 100. Higher scores indicate worse outcome. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
- Secondary Outcome Measures
Name Time Method Percentage of Participants Achieving Body Weight Reduction Greater Than or Equal to (≥) 5 Percent (%) (Yes/No) From baseline (week 0) to end of treatment (week 68) Percentage of participants who achieved ≥ 5% body weight reduction (yes/no) from baseline (week 0) to end of treatment (week 68) is presented. In the reported data, 'Yes' infers percentage of participants who have achieved ≥5% weight reduction whereas 'No' infers percentage of participants who have not achieved ≥5% weight reduction. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
Change in WOMAC Physical Function Score Baseline (week 0), end of treatment (week 68) Change in WOMAC physical function score is presented. WOMAC is a 24 item questionnaire which assesses clinically important, participant-relevant symptoms in area of pain, stiffness, and physical function in participants with osteoarthritis (OA). It consists of 3 subscales: pain, stiffness and physical function. WOMAC physical function is 17-item questionnaire used to assess degree of difficulty experienced due to OA in knee. It is calculated as the sum of the 17 item scores in the physical function domain. It is normalized and expressed on a 0-100 scale. This is done by dividing raw score by the highest possible value of the raw score for the physical function domain (i.e. 170) and multiplying by 100. Higher scores indicate worse outcome. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
Percentage of Participants Achieving Body Weight Reduction ≥ 10% (Yes/No) From baseline (week 0) to end of treatment (week 68) Percentage of participants who achieved ≥10% body weight reduction (yes/no) from baseline (week 0) to end of treatment (week 68) is presented. In the reported data, 'Yes' infers percentage of participants who have achieved ≥10% weight reduction whereas 'No' infers percentage of participants who have not achieved ≥10% weight reduction. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
Change in Short Form 36 (SF-36) Physical Functioning Score Baseline (week 0), end of treatment (week 68) SF-36 is self-administered questionnaire that measures each of following 8 health domains: physical functioning, role limitations due to physical problems (role-physical), social functioning, bodily pain, mental health, role limitations due to emotional problems (role-emotional), vitality, and general health perception. There are also 2 component scores derived from the 8 subscale scores: physical component summary (including physical functioning, role-physical, bodily pain and general health) and mental component summary (including vitality, social functioning, role-emotional and mental health). Each SF-36 domain and component summary score ranges from 0 to 100, higher scores reflect better participant health status. A positive change score indicates an improvement since baseline. The outcome measure was evaluated based on data from in-trial period. In-trial period was defined as uninterrupted time interval from date of randomization to date of last contact with trial site.
Change in Waist Circumference Baseline (week 0), end of treatment (week 68) Change in waist circumference from baseline (week 0) to end of the treatment (visit 68) is presented. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
Change in WOMAC Total Score Baseline (week 0), end of treatment (week 68) WOMAC is a disease-specific patient-reported outcome measure designed to assess changes in symptoms and lower extremity functioning associated with treatment in patients with osteoarthritis of the hip and/or knee. WOMAC is a 24 item questionnaire which assesses clinically important, participant-relevant symptoms in area of pain, stiffness, and physical function in participants with OA. The WOMAC raw total score is derived as the sum of the 24 item scores respectively on pain, stiffness and physical function domain. It will be normalized and expressed on a 0-100 scale. This is done by dividing raw score by the highest possible value of the raw score for the total domain (i.e. 240) and multiplying by 100. Higher scores indicate worse outcome. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
Change in WOMAC Stiffness Score Baseline (week 0), end of treatment (week 68) WOMAC is a disease-specific patient-reported outcome measure designed to assess changes in symptoms and lower extremity functioning associated with treatment in patients with osteoarthritis of the hip and/or knee. WOMAC is a 24 item questionnaire which assesses clinically important, participant-relevant symptoms in area of pain, stiffness, and physical function in participants with OA. It consists of 3 subscales: pain, stiffness and physical function. The WOMAC raw stiffness score is derived as the sum of the 2 item scores in the stiffness domain. It will be normalized and expressed on a 0-100 scale. This is done by dividing raw score by the highest possible value of the raw score for the stiffness domain (i.e. 20) and multiplying by 100. Higher scores indicate worse outcome. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
Percentage of Participants Using Allowed Rescue Analgesics During Wash Out (Yes/No) At end of treatment (week 68) Percentage of participants using allowed rescue analgesics during wash out at end of treatment (week 68) is presented. In the reported data, 'Yes' infers percentage of participants who have used allowed rescue analgesics during wash out whereas 'No' infers percentage of participants who have not used allowed rescue analgesics during wash out. Use of allowed rescue analgesics is evaluated based on use of acetaminophen reported in the pain medication diary from one up to 3 days prior to WOMAC assessment. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
Change in SF-36 Bodily Pain Score Baseline (week 0), end of treatment (week 68) Change in SF-36 Bodily Pain Score from baseline (week 0) to end of treatment (week 68) is presented. SF-36 is self-administered questionnaire that measures each of following 8 health domains: physical functioning, role limitations due to physical problems (role-physical), social functioning, bodily pain, mental health, role limitations due to emotional problems (role-emotional), vitality, and general health perception. There are also 2 component scores derived from the 8 subscale scores: physical component summary and mental component summary. Each SF-36 domain and component summary score ranges from 0 to 100, higher scores reflect better participant health status. A positive change score indicates an improvement since baseline. The outcome measure was evaluated based on data from in-trial period. In-trial period was defined as uninterrupted time interval from date of randomization to date of last contact with trial site.
Amount of Allowed Rescue Analgesics Used During Wash Out At end of treatment (week 68) Amount of allowed rescue analgesics used during wash out at end of treatment (week 68) is presented. Allowed rescue analgesic during washout is defined as acetaminophen taken 24-72 hour before the visit. The outcome measure is approximated by a total dose of acetaminophen reported in the pain medication diary from one and up to 3 days prior to WOMAC assessment. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
Percentage of Participants With Use of Pain Medication From baseline (week 0) to end of treatment (week 68) Percentage of participants with use of pain medication from baseline (week 0) to end of treatment (week 68) is presented. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
Percentage of Participants Achieving Body Weight Reduction ≥ 20% (Yes/No) From baseline (week 0) to end of treatment (week 68) Percentage of participants who achieved ≥20% body weight reduction (yes/no) from baseline (week 0) to end of treatment (week 68) is presented. In the reported data, 'Yes' infers percentage of participants who have achieved ≥20% weight reduction whereas 'No' infers percentage of participants who have not achieved ≥20% weight reduction. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
Percentage of Participants Achieving WOMAC Pain Reduction ≥ 50% (Yes/No) From baseline (week 0) to end of treatment (week 68) Percentage of participants who achieved ≥50% WOMAC pain reduction (yes/no) from baseline (week 0) to end of treatment (week 68) is presented. In the reported data, 'Yes' infers percentage of participants who have achieved ≥50% WOMAC pain reduction whereas 'No' infers percentage of participants who have not achieved ≥50% WOMAC pain reduction. WOMAC raw pain score is derived as sum of 5 item scores in pain domain. It will be normalized and expressed on 0-100 scale. This is done by dividing raw score by highest possible value of raw score for pain domain (i.e. 50) and multiplying by 100. Higher scores indicate worse outcome. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
Percentage of Participants Achieving Threshold for Clinically Meaningful Within-participant Change in WOMAC Pain Score (Yes/No) From baseline (week 0) to end of treatment (week 68) Percentage of participants who achieved threshold for clinically meaningful within-participant change in WOMAC pain score from baseline (week 0) to end of treatment (week 68) is presented. The threshold refers to the decrease of at least 37.3 in the WOMAC pain score and it is derived based on 1-category improvement on patient global impression of status (PGI-S) scale. In reported data, 'Yes' infers percentage of participants who have achieved threshold whereas 'No' infers percentage of participants who have not achieved threshold. WOMAC raw pain score is derived as sum of 5 item scores in pain domain. It will be normalized and expressed on 0-100 scale. This is done by dividing raw score by highest possible value of raw score for pain domain (i.e. 50) and multiplying by 100. Higher scores=worse outcome. Outcome measure was evaluated based on data from in-trial period and it was defined as uninterrupted time interval from date of randomization to date of last contact with trial site.
Change in SF-36 Physical Component Summary Baseline (week 0), end of treatment (week 68) Change in SF-36 physical component summary is presented. It is self-administered questionnaire that measures each of following 8 health domains: physical functioning, role limitations due to physical problems (role-physical), social functioning, bodily pain, mental health, role limitations due to emotional problems (role-emotional), vitality, and general health perception. There are also 2 component scores derived from the 8 subscale scores: physical component summary and mental component summary. Physical component summary contains physical functioning, role-physical, bodily pain and general health. Each SF-36 domain and component summary score ranges from 0 to 100, higher scores reflect better participant health status. A positive change score indicates an improvement since baseline. The outcome measure was evaluated based on data from in-trial period. In-trial period was defined as uninterrupted time interval from date of randomization to date of last contact with trial site.
Change in Pain Intensity (Numerical Rating Scale [NRS]) Baseline (week 0), end of treatment (week 68) Pain intensity was assessed on an 11-point NRS over the past 24 hours (before each specified visit), where a score of 0 indicated "no pain" and a score of 10 indicated "worst possible pain", where higher the score, greater the pain intensity. Response at visit was derived from the pain diary data as an average score over 4 days interval leading up to visit-related washout period for pain medication. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
Percentage of Participants Achieving Body Weight Reduction ≥ 15% (Yes/No) From baseline (week 0) to end of treatment (week 68) Percentage of participants who achieved ≥15% body weight reduction (yes/no) from baseline (week 0) to end of treatment (week 68) is presented. In the reported data, 'Yes' infers percentage of participants who have achieved ≥15% weight reduction whereas 'No' infers percentage of participants who have not achieved ≥15% weight reduction. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
Change in SF-36 Mental Component Summary Baseline (week 0), end of treatment (week 68) Change in SF-36 mental component summary is presented. SF-36 is self-administered questionnaire that measures each of following 8 health domains: physical functioning, role limitations due to physical problems (role-physical), social functioning, bodily pain, mental health, role limitations due to emotional problems (role-emotional), vitality, and general health perception. There are also 2 component scores derived from the 8 subscale scores: mental component summary and physical component summary. Mental component summary contain vitality, social functioning, role-emotional and mental health. Each SF-36 domain and component summary score ranges from 0 to 100, higher scores reflect better participant health status. A positive change score indicates an improvement since baseline. The outcome measure was evaluated based on data from in-trial period. In-trial period was defined as uninterrupted time interval from date of randomization to date of last contact with trial site.
Percentage of Participants Achieving WOMAC Pain Reduction ≥ 30% (Yes/No) From baseline (week 0) to end of treatment (week 68) Percentage of participants who achieved ≥30% WOMAC pain reduction (yes/no) is presented. In the reported data, 'Yes' infers percentage of participants who have achieved ≥30% WOMAC pain reduction whereas 'No' infers percentage of participants who have not achieved ≥30% WOMAC pain reduction. WOMAC raw pain score is derived as sum of 5 item scores in pain domain. It will be normalized and expressed on 0-100 scale. This is done by dividing raw score by highest possible value of raw score for pain domain (i.e. 50) and multiplying by 100. Higher scores indicate worse outcome. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
Percentage of Participants Achieving Threshold for Clinically Meaningful Within-participant Change in WOMAC Physical Function Score (Yes/No) From baseline (week 0) to end of treatment (week 68) Percentage of participants who achieved threshold for clinically meaningful within-participant change in WOMAC physical function score from baseline (week 0) to end of treatment (week 68) is presented. The threshold refers to the decrease of at least 41.2 in the WOMAC physical function score and it is derived based on 1-category improvement on PGI-S scale. In reported data, 'Yes' infers percentage of participants who have achieved threshold whereas 'No' infers percentage of participants who have not achieved threshold. WOMAC raw pain score is derived as sum of 5 item scores in pain domain. It will be normalized and expressed on 0-100 scale. This is done by dividing raw score by highest possible value of raw score for pain domain (i.e. 50) and multiplying by 100. Higher scores indicate worse outcome. Outcome measure was evaluated based on data from in-trial period and it was defined as uninterrupted time interval from date of randomization to date of last contact with trial site.
Percentage of Participants Achieving Pain Intensity (Numerical Rating Scale [NRS]) Reduction ≥ 30% (Yes/No) From baseline (week 0) to end of treatment (week 68) Percentage of participants who achieved ≥30% pain intensity reduction (yes/no) from baseline (week 0) to end of treatment (week 68) is presented. In the reported data, 'Yes' infers percentage of participants who have achieved ≥30% pain intensity reduction whereas 'No' infers percentage of participants who have not achieved ≥30% pain intensity reduction. Response at visit was derived from the pain diary data as an average score over 4 days interval leading up to visit-related washout period for pain medication. Pain intensity was assessed on an 11-point NRS over the past 24 hours (before each specified visit), where a score of 0 indicated "no pain" and a score of 10 indicated "worst possible pain", where higher the score, greater the pain intensity. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
Percentage of Participants Achieving Threshold for Clinically Meaningful Within-participant Change in SF-36 Physical Functioning Score (Yes/No) From baseline (week 0) to end of treatment (week 68) Percentage of participants who achieved threshold for clinically meaningful within-participant change in SF-36 physical function score is presented. Threshold refers to increase of at least 11.4 in SF-36 physical functioning score \& it is derived based on 1-category improvement on PGI-S scale. 'Yes' infers percentage of participants who achieved threshold; 'No' infers percentage of participants who have not achieved threshold. SF-36: self-administered questionnaire that measures each of following 8 health domains: physical functioning, role limitations due to physical problems, social functioning, bodily pain, mental health, role limitations due to emotional problems, vitality, \& general health perception. Each SF-36 domain and component summary score ranges from 0-100, higher scores mean better participant health status. Outcome measure was evaluated based on data from in-trial period: uninterrupted time interval from date of randomization to date of last contact with trial site.
Percentage of Participants Achieving Pain Intensity (Numerical Rating Scale [NRS]) Reduction ≥ 50% (Yes/No) From baseline (week 0) to end of treatment (week 68) Percentage of participants who achieved ≥50% pain intensity reduction (yes/no) from baseline (week 0) to end of treatment (week 68) is presented. In the reported data, 'Yes' infers percentage of participants who have achieved ≥50% pain intensity reduction whereas 'No' infers percentage of participants who have not achieved ≥50% pain intensity reduction. Response at visit was derived from the pain diary data as an average score over 4 days interval leading up to visit-related washout period for pain medication. Pain intensity was assessed on an 11-point NRS over the past 24 hours (before each specified visit), where a score of 0 indicated "no pain" and a score of 10 indicated "worst possible pain", where higher the score, greater the pain intensity. The outcome measure was evaluated based on the data from in-trial period. In-trial period was defined as the uninterrupted time interval from date of randomization to date of last contact with trial site.
Trial Locations
- Locations (66)
PrimeCare Medical Group
🇺🇸Houston, Texas, United States
Premier Clinical Trial Research Network (PCTRN)
🇨🇦Hamilton, Ontario, Canada
Baptist Health System
🇺🇸Montgomery, Alabama, United States
Desert Oasis Hlthcr Med Group
🇺🇸Palm Springs, California, United States
Diablo Clinical Research, Inc.
🇺🇸Walnut Creek, California, United States
Westside Center For Clinical Research
🇺🇸Jacksonville, Florida, United States
Renstar Medical Research
🇺🇸Ocala, Florida, United States
East West Medical Research Institute
🇺🇸Honolulu, Hawaii, United States
Clinical Invest Special_Gurnee
🇺🇸Gurnee, Illinois, United States
Evanston Premier Hlthcr Res
🇺🇸Skokie, Illinois, United States
L-MARC Research Center
🇺🇸Louisville, Kentucky, United States
Arcturus Healthcare, PLC.
🇺🇸Troy, Michigan, United States
Sundance Clinical Research LLC
🇺🇸Saint Louis, Missouri, United States
Southgate Medical Group, LLP
🇺🇸West Seneca, New York, United States
Great Lakes Medical Research
🇺🇸Westfield, New York, United States
Accellacare
🇺🇸Wilmington, North Carolina, United States
Cleveland Clinic_Cleveland
🇺🇸Cleveland, Ohio, United States
Prestige Clinical Research
🇺🇸Franklin, Ohio, United States
Coastal Carolina Res Ctr.
🇺🇸North Charleston, South Carolina, United States
Health Res of Hampton Roads
🇺🇸Newport News, Virginia, United States
Ocean West Research Clinic
🇨🇦Surrey, British Columbia, Canada
Wharton Med Clin Trials
🇨🇦Hamilton, Ontario, Canada
Milestone Research
🇨🇦London, Ontario, Canada
Dr. Anil K Gupta Medicine Professional Corporation
🇨🇦Toronto, Ontario, Canada
Centre Medical Acadie
🇨🇦Montreal, Quebec, Canada
Centro de investigación médico asistencial S.A.S
🇨🇴Barranquilla, Colombia
King Khaled University Hospital,King Saud Univ. Med. City
🇸🇦Riyadh, Saudi Arabia
CentrodeInvestigaciónenReumatologíayEspecialidadesMédicas
🇨🇴Bogota, Colombia
Preventive Care S.A.S
🇨🇴Chia, Colombia
Klinik for Led og bindevævssygdomme
🇩🇰Aarhus N, Denmark
Frederiksberg Hospital - Parker Institutet (Artrose)
🇩🇰Frederiksberg, Denmark
Centre Hospitalier de Clermont-Ferrand-Hopital Gabriel Montpied
🇫🇷Clermont-Ferrand, France
Aphp-Hopital La Pitie Salpetriere-3
🇫🇷PARIS cedex 13, France
CHU Pitié-Salpétrière
🇫🇷PARIS cedex 13, France
Ap-Hp-Hopital Europeen Georges Pompidou
🇫🇷Paris, France
Hôpital Européen Georges Pompidou
🇫🇷Paris, France
Hospices Civils de Lyon-Hopital Lyon Sud-1
🇫🇷Pierre Benite, France
Centre Hospitalier Universitaire de Toulouse-Hopital Rangueil-2
🇫🇷Toulouse, France
Akershus Universitetssykehus
🇳🇴Nordbyhagen, Norway
Oslo us HF, Aker sykehus
🇳🇴Oslo, Norway
Senter for sykelig overvekt i Helse Sør-Øst
🇳🇴Tønsberg, Norway
PIH "Clin Hosp "RZD-Medicina" former Kazan OJSC Rus Railways
🇷🇺Kazan, Russian Federation
LLC Medical center "Maksimum Zdorovia"
🇷🇺Kemerovo, Russian Federation
National Medical Research Center of Endocrinology
🇷🇺Moscow, Russian Federation
Setchenov First Moscow State Medical University
🇷🇺Moscow, Russian Federation
Federal Bureau for Medical and Social Expertise
🇷🇺Moscow, Russian Federation
Consultative & Diagnostic Center with a Outpatient Hospital
🇷🇺Saint-Petersburg, Russian Federation
SIH "Saratov Regional Clinical Hospital for War Veterans"
🇷🇺Saratov, Russian Federation
Siberian State Medical University
🇷🇺Tomsk, Russian Federation
Voronezh Regional Clinical Consultive-diagnostic Centre
🇷🇺Voronezh, Russian Federation
SBCI HC Yaroslavl region "Central City Hospital"
🇷🇺Yaroslavl, Russian Federation
King Abdulaziz Hospital-Al Ahsa-National Guard
🇸🇦Al Ahsa, Saudi Arabia
King Faisal Specialist Hospital & Research Centre, Riyadh
🇸🇦Riyadh, Saudi Arabia
King Fahad Medical City
🇸🇦Riyadh, Saudi Arabia
Phoenix Pharma
🇿🇦Port Elizabeth, Eastern Cape, South Africa
Dr J Reddy
🇿🇦Durban, KwaZulu-Natal, South Africa
Complejo Hospitalario Universitario A Coruña
🇪🇸La Coruña, Spain
Hospital Clinico San Carlos
🇪🇸Madrid, Spain
Dr Wilhase's rooms
🇿🇦Boksburg, Gauteng, South Africa
Botho ke Bontle Health Services
🇿🇦Pretoria, Gauteng, South Africa
Clínica Nuevas Tecnologías en Diabetes y Endocrinología
🇪🇸Sevilla, Spain
Maxwell Centre
🇿🇦Durban, KwaZulu-Natal, South Africa
Forskningsmottagning Internmedicin (tidigare KFE)
🇸🇪Malmö, Sweden
S:t Göran Sjukhus
🇸🇪Stockholm, Sweden
Department of Metabolism and Endocrinology
🇸🇪Stockholm, Sweden
Medicinkliniken Överviktsenheten USÖ
🇸🇪Örebro, Sweden
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