What are the effects of adding Ozempic (semaglutide) to diabetes patients already on insulin and metformin?

From the Guidelines

Adding Ozempic (semaglutide) to a regimen of insulin and metformin for diabetes patients can be beneficial for improving glycemic control, reducing insulin requirements, and potentially lowering cardiovascular risk. The recommended approach is to start with a low dose of 0.25 mg of Ozempic once weekly for 4 weeks, then increase to 0.5 mg weekly, as supported by the most recent guidelines 1. If needed after at least 4 weeks, the dose can be further increased to 1 mg weekly, with a maximum dose of 2 mg weekly for type 2 diabetes. When adding Ozempic, consider reducing basal insulin doses by 10-20% initially to prevent hypoglycemia, especially in patients with HbA1c below 8%, as suggested by recent studies 1. Some key points to consider when implementing this triple therapy approach include:

• Monitoring blood glucose closely during the first 4 weeks of combination therapy and adjusting insulin as needed
• Advising patients about potential gastrointestinal side effects like nausea and vomiting, which typically improve over time
• Understanding the complementary mechanisms of metformin, insulin, and Ozempic, which work together to improve glycemic control, promote weight loss, and potentially reduce cardiovascular risk in type 2 diabetes patients
• Being aware of the potential benefits of GLP-1 RAs, such as lower risk for hypoglycemia and favorable weight, cardiovascular, and kidney endpoints, as highlighted in recent research 1. Overall, the addition of Ozempic to insulin and metformin can be a valuable treatment strategy for patients with type 2 diabetes, offering improved glycemic control and potentially reduced cardiovascular risk, as demonstrated by recent studies 1.

From the FDA Drug Label

In a 30-week, double-blind trial (NCT02305381), 397 patients with type 2 diabetes mellitus inadequately controlled with basal insulin, with or without metformin, were randomized to OZEMPIC 0.5 mg once weekly, OZEMPIC 1 mg once weekly, or placebo. Treatment with OZEMPIC resulted in a statistically significant reduction in HbA1c after 30 weeks of treatment compared to placebo (see Table 7). Table 7. Results at Week 30 in a Trial of OZEMPIC in Adult Patients with Type 2 Diabetes Mellitus in Combination with Basal Insulin with or without Metformin Placebo OZEMPIC 0. 5 mg OZEMPIC 1 mg Intent-to-Treat (ITT) Population (N)a 133 132 131 HbA1c (%) Baseline (mean) 8.4 8.4 8.3 Change at week 30b -0.2 -1.3 -1.7 Difference from placebob [95% CI] -1.1 [-1.4, -0.8]c -1.6 [-1.8, -1. 3]c

The effects of adding Ozempic (semaglutide) to diabetes patients already on insulin and metformin include:

• A statistically significant reduction in HbA1c compared to placebo
• The mean changes from baseline to week 30 in HbA1c were -1.3% and -1.7% for OZEMPIC 0.5 mg and OZEMPIC 1 mg, respectively
• The percentage of patients achieving HbA1c <7% was 56% and 73% for OZEMPIC 0.5 mg and OZEMPIC 1 mg, respectively
• A reduction in body weight, with mean changes from baseline to week 30 of -3.5 kg and -6.0 kg for OZEMPIC 0.5 mg and OZEMPIC 1 mg, respectively 2

From the Research

Effects of Adding Ozempic (Semaglutide) to Diabetes Patients Already on Insulin and Metformin

There are no research papers provided to directly answer the question about the effects of adding Ozempic (semaglutide) to diabetes patients already on insulin and metformin. However, the available studies provide information on the effects of combining metformin with insulin in patients with type 2 diabetes.

Combination of Metformin and Insulin

• The combination of metformin and insulin has been shown to improve glycemic control and reduce insulin requirements in patients with type 2 diabetes 3, 4, 5.
• Metformin has been associated with significant reductions in mean daily insulin dose requirement, HbA1c level, serum fructosamine level, and total cholesterol level 3.
• Continuing metformin when starting insulin in patients with type 2 diabetes has been shown to decrease weight gain, lower insulin requirement, and improve glycemic control 4.
• The combination of metformin and insulin has also been recommended for obese type 2 diabetes patients on high insulin doses, as it can improve glycemic control and prevent weight gain 5.

Effects of Adding Other Medications to Metformin and Insulin

• The addition of liraglutide to patients with type 2 diabetes receiving metformin and insulin has been shown to be effective and well-tolerated, with significant improvements in glycemic control and reductions in body weight 6.
• However, the effects of adding Ozempic (semaglutide) to diabetes patients already on insulin and metformin are not directly addressed in the provided studies.

Limitations

• The available studies do not provide direct evidence on the effects of adding Ozempic (semaglutide) to diabetes patients already on insulin and metformin.
• Further research is needed to determine the safety and efficacy of combining Ozempic (semaglutide) with insulin and metformin in patients with type 2 diabetes.