What improvement in Hemoglobin A1c (HbA1c) levels can I expect after increasing Ozempic (semaglutide) to 2 mg and Farxiga (dapagliflozin) to 10 mg while discontinuing Janumet (sitagliptin and metformin)?

Expected A1C Reduction with Ozempic 2 mg and Farxiga 10 mg After Discontinuing Janumet

Increasing Ozempic to 2 mg and adding Farxiga 10 mg while discontinuing Janumet can be expected to reduce your A1C by approximately 1.2-1.7% total, with the greatest benefit coming from the higher dose of semaglutide (Ozempic).

Medication Changes and Expected A1C Impact

Ozempic (Semaglutide) Increase to 2 mg

• Increasing Ozempic to the 2 mg dose can provide significant A1C reduction, with clinical trials showing reductions of 0.7-1.0% beyond what lower doses achieve 1, 2
• GLP-1 receptor agonists like Ozempic are among the most potent glucose-lowering agents, with higher doses providing greater efficacy 1
• The 2 mg dose of semaglutide specifically offers enhanced glycemic control compared to the lower doses, with studies showing A1C reductions of up to 1.0-1.5% from baseline 2

Farxiga (Dapagliflozin) 10 mg Addition

• Adding Farxiga 10 mg can be expected to reduce A1C by approximately 0.5-0.7% 1, 3
• Clinical trials have demonstrated that dapagliflozin 10 mg provides statistically significant improvements in HbA1c when added to existing therapy 3
• Long-term studies (102 weeks) show sustained A1C reductions of 0.58-0.78% with dapagliflozin compared to placebo 4

Discontinuing Janumet (Sitagliptin/Metformin)

• Discontinuing Janumet will result in some loss of glycemic control that needs to be considered 1
• The metformin component typically provides around 1.0-1.5% A1C reduction 1
• The sitagliptin (DPP-4 inhibitor) component typically provides 0.4-0.9% A1C reduction 1
• However, there is significant overlap in the mechanism of action between GLP-1 RAs and DPP-4 inhibitors, so the full additive effect is not lost 1

Net Effect on A1C

• The combined effect of increasing Ozempic to 2 mg and adding Farxiga 10 mg while discontinuing Janumet can be calculated as:

  • Gain from increased Ozempic dose: 0.3-0.5% additional reduction 1, 2
  • Gain from adding Farxiga: 0.5-0.7% reduction 1, 3
  • Loss from discontinuing metformin: 1.0-1.5% increase 1
  • Loss from discontinuing sitagliptin: 0.4-0.9% increase, but largely compensated by the increased Ozempic dose 1

• The net effect is expected to be a reduction of approximately 1.2-1.7% in A1C, assuming the higher dose of semaglutide largely compensates for the loss of sitagliptin and provides additional benefit 1, 2

Important Considerations

• Individual responses may vary based on baseline A1C, duration of diabetes, and individual pathophysiology 5
• Recent research suggests that patients with different diabetes pathophysiologies may respond differently to GLP-1 RAs and SGLT2 inhibitors 5
• The combination of GLP-1 RA and SGLT2 inhibitor provides complementary mechanisms of action that can be particularly effective 1
• Weight loss effects will be enhanced with this combination, which may further improve glycemic control over time 1, 3, 4

Monitoring Recommendations

• Regular blood glucose monitoring is essential during this transition to assess the response 1
• A1C should be checked after 3 months to evaluate the full effect of the medication changes 1
• Watch for potential side effects, including gastrointestinal symptoms from Ozempic and genitourinary infections from Farxiga 1, 3
• Hypoglycemia risk is generally low with this combination but should still be monitored, especially during the transition period 1, 3

This medication change represents a shift toward more potent glucose-lowering agents with additional cardiovascular and renal benefits, which may provide improved outcomes beyond just A1C reduction 1.