When should I recommend Ozempic (semaglutide) to patients?

From the Guidelines

Ozempic (semaglutide) should be recommended to adult patients with type 2 diabetes mellitus as an adjunct to diet and exercise to improve glycemic control, particularly when other medications have not achieved target glucose levels, as it has demonstrated cardiovascular benefits, as shown in the LEADER trial 1 and SUSTAIN-6 trial 1.

Key Points to Consider

• The typical starting dose is 0.25 mg once weekly by subcutaneous injection for 4 weeks, then increasing to 0.5 mg once weekly.
• If additional glycemic control is needed after at least 4 weeks, the dose can be increased to 1 mg weekly, with a maximum dose of 2 mg weekly.
• Patients should be counseled about common side effects including nausea, vomiting, diarrhea, abdominal pain, and constipation, which often improve over time.
• Ozempic works by mimicking the incretin hormone GLP-1, which stimulates insulin secretion, suppresses glucagon secretion, slows gastric emptying, and reduces appetite, leading to improved glycemic control and often weight loss.
• It should not be used in patients with type 1 diabetes, diabetic ketoacidosis, personal or family history of medullary thyroid carcinoma, or Multiple Endocrine Neoplasia syndrome type 2, and caution is advised in patients with a history of pancreatitis.

Benefits of Ozempic

• Demonstrated cardiovascular benefits, including reduced risk of major adverse cardiovascular events and cardiovascular death, as shown in the LEADER trial 1 and SUSTAIN-6 trial 1.
• Improved glycemic control and weight loss.
• Can be used in combination with other medications, including metformin, sulfonylureas, and insulin.

Important Considerations

• Patients with a history of pancreatitis should be cautioned about the potential increased risk of pancreatitis with Ozempic.
• Patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 should not use Ozempic.
• Ozempic should not be used in patients with type 1 diabetes or diabetic ketoacidosis.

From the FDA Drug Label

OZEMPIC is indicated: • as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus • to reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction or non-fatal stroke) in adults with type 2 diabetes mellitus and established cardiovascular disease

You should recommend Ozempic to patients:

• With type 2 diabetes mellitus as an adjunct to diet and exercise to improve glycemic control.
• With type 2 diabetes mellitus and established cardiovascular disease to reduce the risk of major adverse cardiovascular events. Considerations should be made for patients with a history of pancreatitis, as Ozempic has not been studied in these patients, and other antidiabetic therapies may be more suitable 2.

From the Research

Recommendations for Ozempic (Semaglutide)

• Ozempic (semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist that can be recommended for patients with type 2 diabetes, particularly those with established atherosclerotic cardiovascular disease or at high risk of cardiovascular events 3, 4, 5.
• The medication has been shown to reduce major adverse cardiovascular events, such as non-fatal myocardial infarction, non-fatal stroke, and death from cardiovascular causes 4, 5.
• Ozempic can be used as a first-line injectable glucose-lowering therapy for type 2 diabetes, even before insulin treatment, due to its effectiveness in reducing HbA1c levels and body weight, as well as its cardiovascular benefits 3.
• The medication can also be combined with other glucose-lowering agents, including sodium-glucose cotransporter-2 (SGLT-2) inhibitors, to achieve better glycemic control and cardiovascular outcomes 6.

Patient Selection

• Patients with type 2 diabetes and established atherosclerotic cardiovascular disease or at high risk of cardiovascular events are ideal candidates for Ozempic therapy 3, 4, 5.
• Those with chronic kidney disease or at risk of kidney disease may also benefit from Ozempic, as it has been shown to reduce the risk of major kidney disease events 5.
• Patients who are unable to achieve adequate glycemic control with oral medications or insulin may also be considered for Ozempic therapy 3.

Safety and Efficacy

• Ozempic has been shown to be safe and effective in reducing HbA1c levels, body weight, and major adverse cardiovascular events in patients with type 2 diabetes 3, 4, 5.
• The most common adverse events associated with Ozempic are gastrointestinal disorders, such as nausea, vomiting, and diarrhea 4, 5.
• The medication has been shown to be well-tolerated, with a low risk of serious adverse events, including hypoglycemia 3, 4, 5.