From the Guidelines
Wegovy (semaglutide) should be considered as an adjunct therapy for individuals with prediabetes who are struggling with weight loss, as it has been shown to improve weight-related complications and potentially prevent progression to type 2 diabetes. The medication, which is primarily approved for chronic weight management in adults with obesity or overweight with at least one weight-related condition, including prediabetes, works by mimicking GLP-1, a hormone that regulates blood sugar and appetite, helping patients lose weight and potentially improving insulin sensitivity 1. For individuals with prediabetes, the resulting weight loss from Wegovy use (typically 15-20% of body weight) may help reduce insulin resistance and improve glucose metabolism.
Key Points to Consider
- The standard Wegovy regimen involves weekly subcutaneous injections, starting at 0.25 mg and gradually increasing to a maintenance dose of 2.4 mg over 16-20 weeks, as suggested by the AGA clinical practice guideline on pharmacological interventions for adults with obesity 1.
- Common side effects include nausea, vomiting, diarrhea, and constipation.
- Lifestyle modifications, including diet and exercise, remain the first-line approach for managing prediabetes, with Wegovy potentially serving as an adjunct therapy for those struggling with weight loss.
- Patients should discuss with their healthcare provider whether Wegovy might be appropriate for their specific situation, as insurance coverage for prediabetes treatment may be limited.
Clinical Decision Making
When deciding whether to use Wegovy for prediabetes management, healthcare providers should consider the individual's overall health status, weight-related complications, and ability to adhere to lifestyle modifications. The AGA suggests using semaglutide 2.4 mg with lifestyle interventions, compared with lifestyle interventions alone, in adults with obesity or overweight with weight-related complications 1. This recommendation is based on moderate certainty evidence and should be taken into consideration when making clinical decisions.
From the Research
Benefits of Wegovy in Prediabetes
- The study 2 analyzed the effects of semaglutide on glucose metabolism and glycemic status in participants with prediabetes, showing that significantly more participants with baseline prediabetes had normoglycemia at week 68 with semaglutide versus placebo.
- Semaglutide resulted in greater improvements in HbA1c, FPG, and HOMA-IR than placebo among participants with baseline prediabetes, indicating its potential benefits in treating prediabetes 2.
- Another study 3 highlighted the benefits of semaglutide on metabolic control, multiple CV risk factors, and renal safety in the real-world, suggesting its potential role in modifying insulin resistance, the pathogenetic basis of prediabetes and T2D.
Role of Semaglutide in Treating Prediabetes
- Semaglutide, a glucagon-like peptide-1 receptor agonist, has been approved as a second-line treatment option for better glycemic control in type 2 diabetes and is currently under scrutiny for anti-obesity purposes 4.
- The study 3 suggested that semaglutide may have a role in modifying insulin resistance (HOMA-IR), the pathogenetic basis of prediabetes and T2D, indicating its potential in treating prediabetes.
- However, most studies focused on the effects of semaglutide in type 2 diabetes, with limited direct evidence on its role in treating prediabetes, emphasizing the need for further research in this area.
Efficacy and Safety of Semaglutide
- The systematic review 5 of real-world evidence on oral semaglutide in type 2 diabetes showed a reasonable reduction in HbA1c and weight, consistent with the findings from PIONEER trials, but highlighted the necessity of long-term investigations to comprehensively assess safety.
- The study 6 demonstrated the efficacy and safety of oral semaglutide in patients with type 2 diabetes, including those considered for injectable GLP-1 receptor agonist therapy or currently on insulin therapy, but its direct application to prediabetes is limited.