Semaglutide (Ozempic): A new medication for Type 2 diabetes management

As the prevalence of type 2 diabetes increases worldwide, we find that more research is undertaken to help people manage their diabetes well and to prevent complications. A number of new medications have been released in the last 10 years. 90% of the people with Type 2 diabetes are either overweight or obese. We all know that weight loss helps to improve blood sugar control and in some can completely reverse type2 diabetes. In the recent past medications for diabetes are geared to not only reduce blood glucose but also address weight gain.

Here we describe a new medication called Semaglutide, which is GLP-1 (Glucagon Like Peptide-1) analogue.

What is a GLP-1 analogue?

GLP-1 is a natural hormone that has multiple actions in glucose and appetite regulation.  Blood glucose and appetite is mediated by changes happening in the pancreas and the brain. The hormone Glucagon like Peptide or GLP-1 plays a major role.

GLP-1 reduces blood glucose in a glucose dependent manner by stimulating insulin secretion, which means GLP-1 works only when blood glucose is hgh and does not stimulate insulin secretion when blood glucose is low.

GLP-1 also lowers glucagon secretion when blood glucose is high. Glucagon is a hormone which increases blood glucose. The mechanism of blood glucose lowering also involves a minor delay in gastric emptying after consuming food. During hypoglycaemia or low blood glucose, semaglutide reduces insulin secretion. It is also known to reduce body weight and body fat mass through lowered food intake, reduced appetite. In addition, semaglutide reduces the preference for high fat foods.

How is Semaglutide different from the other drugs of the same class?

Semaglutide is a GLP-1 analogue  and administered as an injection once a week.

Research shows that semaglutide was superior at reducing HbA1c (Glycosylated haemoglobin, measure of blood glucose control) from baseline compared with dulaglutide, exenatide OW, sitagliptin and insulin glargine. It was superior and resulted in sustained weight loss from baseline compared with dulaglutide, exenatide (weekly), sitagliptin and insulin glargine for all comparisons. Semaglutide 1 mg demonstrated superior and sustained weight loss of 6.5 kg compared with 3.0 kg with dulaglutide (another GLP-1 analogue).

Treatment with semaglutide resulted in a 26% risk reduction in death from cardiovascular causes, non-fatal heart attack or non-fatal stroke.

Semaglutide like other GLP-1 analogues is known to have a beneficial effect on plasma lipids and lowers systolic blood pressure.

Who can be prescribed Semaglutide or Ozempic?

Semaglutide is a human glucagon-like peptide-1 (GLP-1) analogue produced by recombinant DNA technology. The trade name is Ozempic, manufactured by Novo Nordisk and is available in the following doses: 0.25, 0.5 and 1 milligram prefilled pens.

Ozempic® is indicated for the treatment of adults with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise either on its own when metformin cannot be taken for any reason or in combination with other medications for type 2 diabetes. Ozempic is to be administered once weekly at any time of the day, with or without meals. Ozempic is to be injected subcutaneously in the abdomen, in the thigh or in the upper arm. Ozempic should not be administered intravenously or intramuscularly.

When Ozempic is added to existing therapy of sulfonylurea (like gliclazide, glimepiride) or insulin, a reduction in the dose of sulfonylurea or insulin should be considered to reduce the risk of hypoglycaemia.

The starting dose is 0.25 mg semaglutide once weekly. After 4 weeks the dose should be increased to 0.5 mg once weekly. After at least 4 weeks with a dose of 0.5 mg once weekly, the dose can be increased to 1 mg once weekly to further improve glycaemic control.

Self-monitoring of blood glucose is not needed in order to adjust the dose of Ozempic. However, when initiating treatment with Ozempic in combination with a sulfonylurea or an insulin, blood glucose self-monitoring may become necessary to adjust the dose of the sulfonylurea or the insulin to reduce the risk of hypoglycaemia.

Who cannot be prescribed Semaglutide?

Semaglutide should NOT be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. Semaglutide is not a substitute for insulin. Semaglutide is currently not licenced for management of obesity.

Semaglutide is not recommended in patients with heart failure New York Heart Association class IV.

Acute pancreatitis or inflammation of pancreas has been observed with the use of GLP-1 receptor agonists. Symptoms of acute pancreatitis include

If pancreatitis is suspected, discontinue semaglutide; if confirmed, semaglutide should not be restarted.

Patients treated with semaglutide or any GLP-1 analogue in combination with a sulfonylurea or insulin may have an increased risk of hypoglycaemia (low blood glucose of less than 4mmol/l or 72mg/dl).  The risk can be lowered by reducing the dose of sulfonylurea like gliclazide or insulin when initiating treatment with GLP-1 analogue.

Women of childbearing potential are recommended to use contraception when treated with Semaglutide and therefore, semaglutide should not be used during pregnancy as there is no data on its safety in pregnancy.

Is there a tablet form of Ozempic?

Oral semaglutide is soon to come to the market and will be useful for people with Type 2 diabetes who are averse to injections and are needle phobic. Oral therapy is convenient for patients and also for health care professionals. Staff training cost and training patients to inject can be avoided with oral therapy.