Semaglutide is a new type of injectable medication used to improve blood sugar control in adults with type 2 diabetes. It belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists.
Semaglutide helps lower blood sugar levels by stimulating the release of insulin when blood sugar is high, slowing digestion to reduce the rate at which sugar enters the bloodstream, and decreasing appetite. Some key points about semaglutide:
- Recently approved by the FDA as an addition to diet and exercise to improve blood sugar control in adults with type 2 diabetes
- Brand names Ozempic® and Rybelsus®
- Self-administered once-weekly injection (Ozempic®) or daily pill (Rybelsus®)
- Shown in clinical trials to lower HbA1c levels (a measure of long-term blood sugar control) more than many other diabetes medications
- Also resulted in modest weight loss and reduced blood pressure in clinical trials
Will doctors prescribe semaglutide?
- Most endocrinologists and primary care doctors who treat type 2 diabetes are likely familiar with semaglutide at this point and may prescribe it if appropriate for certain patients
- It can be a good option for patients who have not reached their HbA1c or weight loss goals with other medications like metformin
- Doctors will consider factors like cost/insurance coverage, risk of side effects, patient preferences and needs when deciding whether to prescribe semaglutide
Potential side effects and downsides to consider:
- Gastrointestinal effects like nausea, vomiting, and diarrhea are very common, especially when first starting
- Small risk of thyroid tumors seen in rodent studies (unknown if this occurs in humans)
- Requires injection or daily pill that cannot be skipped
- Expensive - may require prior authorization from insurance, or be prohibitively costly for those with high deductibles/copays
Now that you know the basics about semaglutide, let's dive deeper into some frequently asked questions:
How does semaglutide compare to other GLP-1 drugs, like liraglutide?
- Semaglutide and liraglutide belong to the same class of injectable GLP-1 receptor agonists used for type 2 diabetes and weight management
- In head-to-head clinical trials, semaglutide lowered HbA1c and body weight significantly more than liraglutide
- Other advantages of semaglutide over liraglutide:
- Longer half-life so only needs to be dosed 1x/week vs 1x/day for liraglutide
- Oral formulation (Rybelsus®) available in addition to weekly injections
So semaglutide generally looks like a more potent medication, which may make it preferable for some patients. Of course, individual factors would influence whether it gets prescribed over liraglutide or other GLP-1 drugs.
What side effects can patients expect with semaglutide?
We've touched on the common potential side effects, but here is some more detail:
- The most common side effects involve the gastrointestinal (GI) system:
- Up to 40% experience nausea
- Up to 20% experience diarrhea and vomiting
- Generally worst when first starting and improve over time
- Might also cause indigestion, constipation, abdominal pain
- Small appetite reduction and associated weight loss (not necessarily considered adverse effects)
- There is a black box warning for risk of thyroid tumors observed with rodent studies - unknown significance for humans
We monitor all patients closely and work to minimize side effects. Always let your doctor know if you experience worrisome or persistent side effects while taking any medication.
What about drug interactions?
A few key things to know:
- Semaglutide delays stomach emptying and could impact absorption of oral medications taken at the same time
- Should be taken at least 30 minutes before medications that are particularly dependent on threshold concentrations for efficacy
- No clinically relevant drug interactions observed between semaglutide and common medications like metformin, sulfonylureas, SGLT2 inhibitors, statins
- Has not been studied with insulin - if adding to insulin, close monitoring of blood glucose is recommended
- Tell your doctor and pharmacist about ANY medications you take, including prescription, over-the-counter, vitamins, and herbal supplements
The above covers some of the key questions about whether doctors will prescribe the new type 2 diabetes medication semaglutide. To recap, semaglutide can be a good treatment option for certain patients not meeting control targets on other medications, but may not be appropriate for everyone due to side effects, cost, and other factors. Reach out to an endocrinologist like our experts at Vital Hormones Clinic if you have any other questions! We provide compassionate, cutting-edge diabetes care and will help determine if semaglutide is right for you.