From the Guidelines
Semaglutide is a recommended treatment option for type 2 diabetes mellitus (DM2), with a starting dose of 0.25 mg injected subcutaneously once weekly for the first 4 weeks, then increased to 0.5 mg weekly, and potentially up to 1 mg weekly for better glycemic control, as supported by recent studies such as the SUSTAIN-6 trial 1. The treatment of type 2 diabetes mellitus (DM2) with semaglutide involves a comprehensive approach that includes lifestyle modifications and pharmacotherapy.
- The initial therapy for DM2 depends on comorbidities, patient-centered treatment factors, and management needs, but generally includes metformin and comprehensive lifestyle modification, as stated in the standards of medical care in diabetes-2022 1.
- Semaglutide works by mimicking GLP-1 (glucagon-like peptide-1), which stimulates insulin secretion, suppresses glucagon release, slows gastric emptying, and reduces appetite.
- Common side effects of semaglutide include nausea, vomiting, diarrhea, and abdominal pain, which typically improve over time, as reported in various studies, including those on the pharmacologic approaches to glycemic treatment 1 and the clinical pharmacology of GLP-1 receptor agonists 1.
- Patients should be advised to take semaglutide with a small amount of water on an empty stomach and wait 30 minutes before eating, drinking, or taking other medications if using the oral form.
- Regular monitoring of blood glucose levels is essential, and patients should be educated about recognizing and managing hypoglycemia.
- Semaglutide also offers additional benefits, including weight loss and cardiovascular protection, making it particularly valuable for overweight or obese DM2 patients with cardiovascular risk factors, as demonstrated in studies such as the SELECT study 1 and the SUSTAIN-6 trial 1.
- The use of semaglutide has been shown to reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes and established cardiovascular disease, as reported in the SUSTAIN-6 trial 1 and other studies on GLP-1 receptor agonists 1.
From the FDA Drug Label
Semaglutide reduces blood glucose through a mechanism where it stimulates insulin secretion and lowers glucagon secretion, both in a glucose-dependent manner. In patients with type 2 diabetes, treatment with semaglutide 1 mg resulted in reductions in glucose in terms of absolute change from baseline and relative reduction compared to placebo of 29 mg/dL (22%) for fasting glucose, 74 mg/dL (36%) for 2-hour postprandial glucose, and 30 mg/dL (22%) for mean 24-hour glucose concentration.
The treatment for type 2 diabetes mellitus (DM2) in a patient using semaglutide (Ozempic) is semaglutide 1 mg once weekly, which stimulates insulin secretion and lowers glucagon secretion in a glucose-dependent manner, resulting in reductions in fasting and postprandial glucose concentrations 2.
- Key benefits of semaglutide include:
- Reductions in glucose concentrations
- Stimulation of insulin secretion
- Lowering of glucagon secretion
- Dosage: 1 mg once weekly, administered subcutaneously 2.
From the Research
Treatment Overview
The treatment for type 2 diabetes mellitus (DM2) in a patient using semaglutide (Ozempic) involves the administration of semaglutide, a long-acting glucagon-like peptide-1 receptor agonist (GLP-1 RA), to help decrease glycated haemoglobin (HbA1c) and body weight in people with uncontrolled T2D 3.
Efficacy of Semaglutide
- Semaglutide has been shown to be effective in reducing HbA1c levels and body weight in patients with T2D, with a mean reduction in HbA1c of 1.2% to 2.2% and a mean weight loss of 3.17 kg to 6.9 kg 3, 4, 5.
- Semaglutide has been compared to other GLP-1 RAs, such as liraglutide, exenatide, and dulaglutide, and has been found to be non-inferior or superior in reducing HbA1c and body weight 3, 4.
- A higher dose of semaglutide (2.0 mg) has been shown to be more effective than a lower dose (1.0 mg) in reducing HbA1c and body weight 4.
Safety Profile
- The safety profile of semaglutide is comparable to other GLP-1 RAs, with gastrointestinal disorders being the most commonly reported adverse events 3, 4, 6.
- Semaglutide has been found to have a low rate of hypoglycemia, especially when not combined with sulphonylureas or insulin 6.
- A warning has been issued regarding the use of semaglutide in patients with preexisting retinopathy, due to an unexpected increase in diabetes-related retinopathy observed in a cardiovascular outcome trial 6.
Real-World Evidence
- Real-world studies have shown that semaglutide is effective in reducing HbA1c levels in patients with T2D, with a mean reduction of 1.2% to 1.4% 5.
- Patients who are persistent with semaglutide treatment have been found to have greater reductions in HbA1c levels than those who are not persistent 5.