Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) have been attracted attention for various beneficial effects. Among them, oral semaglutide (Rybelsus) was developed using the absorption enhancer sodium N-(8-[2-hydroxybenzoyl] amino) caprylate (SNAC). The relationship between the bioavailability and post-dose fasting time period was analyzed. The results showed that i) its bioavailability with drinking 50mL and 120mL of water together was almost similar, ii) bioavailability for 240mL intake was about 2/3 of 50-120mL, iii) general availability would be about 1.4% for 50-120ml water, and 0.8% for 240mL of water. Tolerability and safety of Rybelsus showed similar results for healthy subjects, patients with renal and/or hepatic impairment. From mentioned above, Rybelsus has been one of the topic agents with characteristic mechanism of SNAC and clinical benefit of GLP-1RA. It will be expected to be applied widely in actual diabetic practice.

Background: Among oral hypoglycemic agents (OHAs), imeglimin (Twymeeg) would be in focus. Case Presentation: The patient in this case is a 58-year-old female with a history of obesity and previous operations for posterior longitudinal ligament ossification. In early September 2022, she developed dizziness and a general feeling of unwellness, leading to a diagnosis of Type 2 Diabetes (T2D) with an HbA1c level of 11.1%. Result: The patient was treated with a low carbohydrate diet (LCD) and Twymeeg, resulting in a significant decrease in HbA1c levels from 11.1% to 9.0%, 6.7%, and 5.9% over the course of three months. Pre-prandial and post-prandial blood glucose levels were measured with great accuracy. Discussion and Conclusion: The administration of Twymeeg was found to be effective in reducing the patient’s HbA1c levels, and the relationship between HbA1c and glucose variability could be further investigated based on these results.

The case is an 82-year-old female patient with Type 2 Diabetes Mellitus (T2DM) for 22 years. She developed right empyema in early January, 2021 and was treated by antibiotics and CT-guided drainage. After improving the status, she was transferred to Hayashi hospital, Tokushima, Japan. Treatment for T2DM was initially multiple daily insulin injection (MDI), but it could not continue because of injection several times a day by the family. Then, Xultophy was started once a day, which brought satisfactory glucose variability with lower doses. Consequently, Xultophy would be effective and useful agent from bio-psycho-social points of view.

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