From the Guidelines
Ozempic (semaglutide) is not FDA-approved specifically for weight loss in pre-diabetes, but its higher-dose version, Wegovy, can be considered for individuals with pre-diabetes who meet specific criteria, such as a BMI ≥30 kg/m² or BMI ≥27 kg/m² with at least one weight-related comorbidity, as it has been shown to reduce weight and improve weight-related comorbidities significantly 1.
Key Considerations
- The primary goal for individuals with pre-diabetes is to achieve a weight loss of 7-10% to prevent progression to type 2 diabetes, and medication-assisted weight loss can be considered when needed to achieve and sustain this weight loss goal 1.
- Semaglutide, the active ingredient in Ozempic and Wegovy, works by mimicking the hormone GLP-1, which regulates appetite and food intake, leading to reduced hunger and calorie consumption.
- While Ozempic is approved for the treatment of type 2 diabetes, using it specifically for weight loss in pre-diabetes would be considered off-label use.
Recommendations
- For individuals with pre-diabetes who need weight loss, Wegovy (semaglutide) can be considered if they meet the criteria of having a BMI ≥30 kg/m² or BMI ≥27 kg/m² with at least one weight-related comorbidity.
- The typical starting dose for Wegovy is 0.25 mg once weekly for the first month, with gradual increases to the maintenance dose of 2.4 mg weekly.
- Lifestyle interventions, including a reduced-calorie diet and increased physical activity, should be encouraged in conjunction with medication-assisted weight loss to achieve and sustain significant weight loss 1.
Evidence Summary
- The STEP trials demonstrated the efficacy of semaglutide in achieving significant weight loss in individuals with obesity without diabetes, with a mean weight loss of 14.9% and 16.0% at 68 weeks in the STEP 1 and STEP 3 trials, respectively 1.
- A meta-analysis of GLP-1 receptor agonists, including semaglutide, showed that these agents reduced weight and improved weight-related comorbidities significantly more than liraglutide and were associated with lower rates of gastrointestinal adverse events 1.
From the Research
Ozempic Indication for Weight Loss in Pre-Diabetes
- Ozempic (semaglutide) is primarily known for its use in managing type 2 diabetes, but its efficacy in weight loss has also been explored in various studies 2, 3, 4, 5, 6.
- The studies indicate that semaglutide can lead to significant weight loss in adults with overweight or obesity, with or without diabetes 2, 3, 6.
- Specifically, a study published in The New England Journal of Medicine found that once-weekly semaglutide at a dose of 2.4 mg, as an adjunct to lifestyle intervention, resulted in a mean change in body weight from baseline to week 68 of -14.9% in the semaglutide group compared with -2.4% with placebo 2.
- Another study published in Trends in Cardiovascular Medicine noted that semaglutide has demonstrated the largest weight loss of any obesity medication to date, with reductions of approximately 15% of initial weight at 68 weeks, accompanied by improvements in cardiovascular risk factors and physical functioning 3.
- However, the specific indication of Ozempic for weight loss in pre-diabetes is not directly addressed in the provided studies, which focus more on its use in overweight or obese individuals with or without type 2 diabetes.
- Despite this, the mechanism of action of semaglutide, which involves mimicking the action of the glucagon-like peptide-1 hormone to regulate appetite and food intake, suggests it could potentially be beneficial for weight loss in individuals with pre-diabetes 3, 5.
- Further research would be necessary to determine the efficacy and safety of Ozempic specifically for weight loss in pre-diabetic populations.