Is it appropriate to discontinue Wegovy (semaglutide) in a patient with normal glycemic control, as indicated by a hemoglobin A1C (HbA1c) level within the normal range?

Discontinuing Wegovy (Semaglutide) with an A1c of 5.4

Wegovy (semaglutide) should not be discontinued solely based on an A1c of 5.4, as this medication provides benefits beyond glycemic control, including weight management and cardiovascular risk reduction. 1

Considerations for Continuing Wegovy with Normal A1c

• GLP-1 receptor agonists like semaglutide are recommended for their multiple benefits independent of A1c levels, particularly for weight management and cardiometabolic risk reduction 1
• Current guidelines from the American Diabetes Association support continuing GLP-1 receptor agonists like semaglutide regardless of A1c values when they provide beneficial effects on weight or cardiovascular outcomes 1
• Semaglutide has demonstrated significant weight reduction benefits that are maintained only with continued therapy 2

When to Consider Dose Adjustment vs. Discontinuation

• For patients with A1c below target (such as 5.4%), consider:

  • Evaluating for hypoglycemia symptoms, which would warrant dose reduction rather than complete discontinuation 1
  • Assessing the patient's weight management goals, as these may justify continued therapy even with normal glycemic control 1
  • Reviewing cardiovascular risk factors that might benefit from continued therapy 1

• Dose reduction may be appropriate if:

  • The patient experiences gastrointestinal side effects that affect quality of life 1
  • There are concerns about hypoglycemia, especially if the patient is on other glucose-lowering medications 1

Special Populations and Considerations

• For older adults or those with multiple comorbidities:

  • Less stringent A1c goals (7-8%) are appropriate, but this doesn't necessarily mean discontinuing GLP-1 RAs 1
  • The medication's benefits on weight management and cardiovascular outcomes may outweigh concerns about tight glycemic control 1

• For patients with established cardiovascular disease:

  • GLP-1 RAs like semaglutide are recommended independent of A1c levels due to their demonstrated cardiovascular benefits 1
  • Discontinuing therapy may remove this protective effect 1

Monitoring Recommendations

• If continuing Wegovy with an A1c of 5.4:
  • Monitor for hypoglycemia symptoms, especially if the patient is on other glucose-lowering medications 1
  • Consider reducing or discontinuing other glucose-lowering agents before reducing the Wegovy dose 1
  • Continue to monitor A1c every 3-6 months 1

Common Pitfalls to Avoid

• Discontinuing GLP-1 RAs based solely on A1c without considering their multifaceted benefits is a common error 1
• Failing to recognize that weight regain typically occurs after discontinuation of GLP-1 RAs 2
• Not considering the patient's cardiovascular risk profile when making decisions about continuing or discontinuing therapy 1

In conclusion, an A1c of 5.4 alone is not a sufficient reason to discontinue Wegovy. The decision should incorporate considerations of weight management goals, cardiovascular risk factors, and the patient's overall clinical picture. If there are concerns about the A1c being too low, consider adjusting other glucose-lowering medications first while maintaining the benefits of Wegovy.