From the Guidelines
Ozempic (semaglutide) is not contraindicated in an 87-year-old female with uncontrolled type 2 diabetes, hypertension, hyperlipidemia, and heart failure with preserved ejection fraction, and it may be beneficial for reducing cardiovascular mortality in this patient profile. According to the most recent and highest quality study, semaglutide has demonstrated cardiovascular benefits and can help reduce cardiovascular mortality in patients with type 2 diabetes who have established cardiovascular disease or are at high risk 1.
The standard starting dose is 0.25 mg once weekly subcutaneously for 4 weeks, then increased to 0.5 mg weekly, with potential further titration to 1 mg weekly if needed for glycemic control. For this elderly patient, careful monitoring is essential, particularly for side effects like nausea, vomiting, and potential hypoglycemia if used with insulin or sulfonylureas. Renal function should be assessed before starting treatment, as dose adjustments may be needed in severe renal impairment.
Some key points to consider when prescribing semaglutide to this patient include:
- Semaglutide works by mimicking GLP-1, which increases insulin secretion, reduces glucagon secretion, slows gastric emptying, and promotes satiety, leading to improved glycemic control and weight loss.
- The anti-inflammatory and anti-atherosclerotic properties of semaglutide likely contribute to its cardiovascular benefits, making it particularly suitable for this patient with multiple cardiovascular risk factors.
- The 2023 guidelines on cardiovascular disease and risk management in diabetes recommend the use of GLP-1 receptor agonists, such as semaglutide, in patients with type 2 diabetes and established atherosclerotic cardiovascular disease or multiple risk factors for atherosclerotic cardiovascular disease 1.
- The European Heart Journal also recommends the use of semaglutide in patients with type 2 diabetes and cardiovascular disease to reduce the risk of cardiovascular events 1.
Overall, the benefits of semaglutide in reducing cardiovascular mortality and improving glycemic control make it a suitable treatment option for this patient, and its use is supported by the most recent and highest quality evidence 1.
From the Research
Contraindications for Ozempic
- The patient's age (87 years old) and medical history, including uncontrolled type 2 diabetes, hypertension, hyperlipidemia, and heart failure with preserved ejection fraction, may increase the risk of adverse effects from Ozempic (semaglutide) 2, 3.
- However, there is no direct evidence to suggest that Ozempic is contraindicated in patients with these conditions 4, 5.
- The patient's high A1c level (10.1) and insulin use may indicate a need for alternative or additional treatments to achieve better glycemic control 6.
Recommendation for Cardiovascular Mortality
- There is evidence to suggest that improving glycemic control and managing cardiovascular risk factors can reduce the risk of cardiovascular mortality in patients with type 2 diabetes 4, 3.
- Ozempic (semaglutide) has been shown to have cardiovascular benefits, including reducing the risk of major adverse cardiovascular events, in patients with type 2 diabetes 5.
- However, the patient's individual characteristics, including their age, medical history, and current medications, should be carefully considered when evaluating the potential benefits and risks of Ozempic for reducing cardiovascular mortality 2, 6.