Efficacy and Safety of Oral Semaglutide Versus Placebo in Subjects With Type 2 Diabetes and Moderate Renal Impairment

Inclusion Criteria:

• Informed consent obtained before any trial-related activities. Trial-relatedactivities are any procedures that are carried out as part of the trial, includingactivities to determine suitability for the trial

• Male or female, age above or equal to 18 years at the time of signing informed consent

• Diagnosed with type 2 diabetes mellitus for at least 90 days prior to day of screening

• HbA1c (glycosylated haemoglobin) of 7.0-9.5% (53-80 mmol/mol) (both inclusive)

• Moderate renal impairment defined as estimated glomerular filtration rate of 30-59mL/min/1.73 m^2 as per Chronic Kidney Disease Epidemiology Collaboration formula

• Stable daily dose(s) within 90 days prior to the day of screening of any of thefollowing treatment regimens:

• 1-2 of the following oral anti-diabetic drugs:

• Metformin equal or above 1500 mg or maximum tolerated dose documented in the subjectmedical record),

• Sulfonylurea (equal or above half of the maximum approved dose according to locallabel or maximum tolerated dose as documented in subject medical record)

• Basal insulin alone (20% change in total daily dose of insulin glargine, insulindetemir, insulin degludec or NPH insulin) or

• Metformin (equal or above 1500 mg or maximum tolerated dose documented in the subjectmedical record) in combination with basal insulin (20% change in total daily dose ofinsulin glargine, insulin detemir, insulin degludec or NPH insulin)

Exclusion Criteria:

• Female who is pregnant, breast-feeding or intends to become pregnant or is ofchild-bearing potential and not using an adequate contraceptive method (adequatecontraceptive measure as required by local regulation or practice). For certainspecific countries: Additional specific requirements apply

• Any disorder, which in the investigator's opinion might jeopardise subject's safety orcompliance with the protocol

• Family or personal history of Multiple Endocrine Neoplasia Type 2 or Medullary ThyroidCarcinoma

• History of pancreatitis (acute or chronic)

• History of major surgical procedures involving the stomach potentially affectingabsorption of trial product (e.g. subtotal and total gastrectomy, sleeve gastrectomy,gastric bypass surgery)

• Any of the following: myocardial infarction, stroke or hospitalisation for unstableangina or transient ischaemic attack within the past 180 days prior to the day ofscreening and randomisation

• Subjects presently classified as being in New York Heart Association Class IV

• Planned coronary, carotid or peripheral artery revascularisation known on the day ofscreening

• Subjects with alanine aminotransferase above 2.5 x upper normal limit

• Rapidly progressing renal disease (e.g. such as acute glomerulonephritis) as judged bythe investigator or known nephrotic albuminuria (above 2200 mg/24 hours or above 2200mg/g)

• Use of systemic immunosuppressive treatment within 90 days prior to screening

• Treatment with any medication for the indication of diabetes or obesity other thanstated in the inclusion criteria in a period of 90 days before the day of screening.An exception is short-term insulin treatment for acute illness for a total of below orequal to 14 days

• Known hypoglycaemic unawareness and/or recurrent severe hypoglycaemic episodes asjudged by the investigator

• Proliferative retinopathy or maculopathy requiring acute treatment. Verified by fundusphotography or dilated fundoscopy performed within 90 days prior to randomisation

• History or presence of malignant neoplasms within the last 5 years (except basal andsquamous cell skin cancer and carcinoma in situ)