From the Guidelines
Semaglutide is a highly effective medication for treating type 2 diabetes and reducing the risk of major adverse cardiovascular events, with a recommended starting dose of 0.25mg weekly, increasing to 0.5-1mg weekly for diabetes management, as supported by the most recent study 1. The medication works by mimicking GLP-1, a hormone that regulates blood sugar and appetite. For diabetes patients, it lowers blood sugar by stimulating insulin release when levels are high, while for weight management, it creates a feeling of fullness and reduces hunger. Some key points to consider when prescribing semaglutide include:
- Common side effects include nausea, vomiting, diarrhea, and constipation, which often improve over time, as noted in the SUSTAIN-6 trial 1.
- Semaglutide requires a prescription and is administered as a weekly subcutaneous injection.
- Patients should store it refrigerated before first use and follow proper injection technique.
- It's not recommended for those with personal or family history of medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2, and should be used cautiously in patients with pancreatitis history or kidney disease, as highlighted in the LEADER trial 1. The most recent study 1 provides the strongest evidence for the use of semaglutide in reducing cardiovascular risk, and its findings should be prioritized in clinical decision-making.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Overview of Semaglutide
- Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist used for the management of type 2 diabetes 2.
- It is available in both subcutaneous and oral dosage forms, with the oral form being the first approved oral GLP-1 receptor agonist 2.
- Semaglutide has been shown to be safe in adults and elderly patients with renal or hepatic disorders, with no dose modification required 2.
Cardiovascular Benefits
- Semaglutide has been proven to reduce various cardiovascular risk factors in patients with established cardiovascular disorders 2.
- A study published in The New England Journal of Medicine found that oral semaglutide was associated with a significantly lower risk of major adverse cardiovascular events than placebo in patients with type 2 diabetes and atherosclerotic cardiovascular disease, chronic kidney disease, or both 3.
- A systematic review and meta-analysis of randomized trials found that long-acting GLP-1 receptor agonists, including semaglutide, reduced the incidence of major adverse cardiovascular events, hospitalization for heart failure, and kidney events, as well as all-cause mortality in patients with type 2 diabetes 4.
Indications and Usage
- Semaglutide is indicated as a second-line treatment option for better glycemic control in type 2 diabetes 2.
- It is also being considered for anti-obesity purposes 2.
- The Lancet review suggests that GLP-1 receptor agonists, including semaglutide, should be considered in patients at high risk of or with established cardiovascular disease, and SGLT2 inhibitors should be considered for patients with heart failure or chronic kidney disease 5.
- A review published in JAMA Cardiology recommends GLP-1RA therapy, including semaglutide, for cardiovascular risk mitigation in patients with type 2 diabetes and established atherosclerotic cardiovascular disease or multiple risk factors, independent of glucose control or background antihyperglycemic therapy 6.
Safety and Tolerability
- Semaglutide is well tolerated, with no risk of hypoglycemia in monotherapy, but it can cause gastrointestinal adverse effects 2.
- The most common adverse effect of GLP-1RA therapy, including semaglutide, is gastrointestinal upset, which typically wanes during the early weeks of therapy 6.
- Semaglutide has a favorable safety profile, with no increased risks of severe hypoglycemia, retinopathy, or pancreatic events 4.