When do you consider stopping Ozempic (semaglutide) for a patient with type 2 diabetes mellitus (T2DM)?

When to Consider Stopping Ozempic (Semaglutide) for Patients with Type 2 Diabetes Mellitus

Ozempic (semaglutide) should be discontinued if there are minimal benefits or if harm outweighs any benefit, particularly if the therapy is ineffective or exposes patients to higher risk of side effects such as hypoglycemia, or when glycemic goals have changed due to clinical circumstances. 1

Specific Indications for Discontinuation

Adverse Events and Safety Concerns

• Pancreatitis: Stop Ozempic if pancreatitis is confirmed. After initiation, observe patients carefully for signs and symptoms of pancreatitis (including persistent severe abdominal pain, sometimes radiating to the back, which may or may not be accompanied by vomiting). If pancreatitis is suspected, Ozempic should be discontinued and appropriate management initiated; if confirmed, Ozempic should not be restarted. 2

• Hypersensitivity reactions: Discontinue Ozempic if serious hypersensitivity reactions (e.g., anaphylaxis, angioedema) occur. Treat promptly per standard of care and monitor until signs and symptoms resolve. 2

• Severe or recurrent hypoglycemia: Consider stopping Ozempic in patients experiencing unexplained severe or recurrent hypoglycemia, asymptomatic hypoglycemia, or nocturnal hypoglycemia, especially when used in combination with insulin secretagogues or insulin. 1, 2

• Diabetic retinopathy complications: Monitor patients with a history of diabetic retinopathy closely, as rapid improvement in glucose control with Ozempic has been associated with temporary worsening of diabetic retinopathy. Consider discontinuation if significant progression occurs. 2

• Acute kidney injury: Discontinue Ozempic if acute kidney injury occurs. Monitor renal function when initiating or escalating doses in patients reporting severe adverse gastrointestinal reactions. 2

Glycemic Control Considerations

• Achievement of glycemic targets: Consider reducing or stopping Ozempic when HbA1c levels fall below 48 mmol/mol (6.5%) or substantially below the individualized glycemic target, especially if the patient is also on medications with risk of hypoglycemia. 1

• Change in clinical circumstances: Reassess the need for Ozempic when glycemic goals have changed due to development of comorbidities or healthy aging that warrant less stringent glycemic control. 1

• Ineffective therapy: If there is a lack of substantial response to Ozempic (inadequate HbA1c reduction), consider discontinuation after checking for adherence and ruling out autoimmune (type 1) or pancreatogenic diabetes. 1

Special Populations Requiring Careful Consideration

• Limited life expectancy: Consider less stringent HbA1c goals (such as <8.0%) or discontinuation of Ozempic in patients with limited life expectancy where the risks of treatment may outweigh the benefits. 1

• Advanced complications: Consider stopping Ozempic in patients with advanced microvascular or macrovascular complications where less stringent glycemic control is appropriate. 1

• Extensive comorbidities: Evaluate the benefit-risk profile of continuing Ozempic in patients with extensive comorbid conditions. 1

Monitoring and Assessment

• Regular review: The response to Ozempic should be reviewed at regular intervals, including the impact on efficacy (HbA1c, weight) and safety. 1

• HbA1c monitoring: HbA1c should be tested every 3 months during initial treatment and every 6 months once treatment targets are reached to assess the ongoing need for and efficacy of Ozempic. 1

• Continuous glucose monitoring (CGM): Consider using CGM to identify patterns of hypoglycemia or large blood glucose excursions that might warrant discontinuation of Ozempic. 1

Practical Approach to Discontinuation

1. Evaluate treatment efficacy: Assess if Ozempic is achieving the desired glycemic control (HbA1c reduction) and weight management goals. 1

2. Review side effect profile: Determine if the patient is experiencing adverse effects that outweigh the benefits. 1, 2

3. Consider alternative therapies: If discontinuing Ozempic, consider whether alternative glucose-lowering medications are needed based on the patient's current glycemic control and risk factors. 1

4. Gradual transition: When switching from Ozempic to another therapy, consider a gradual transition to minimize glycemic fluctuations. 1

Common Pitfalls to Avoid

• Failing to recognize euglycemic DKA: Be vigilant for diabetic ketoacidosis even when blood glucose levels are not significantly elevated in patients taking Ozempic. 3

• Overlooking gastrointestinal symptoms: Do not dismiss persistent gastrointestinal symptoms, as they may indicate pancreatitis requiring immediate discontinuation. 2

• Ignoring hypoglycemia risk: When adding new glucose-lowering treatments while on Ozempic, remember to consider reducing or stopping Ozempic to prevent hypoglycemia. 1