Meeting the Challenge of Virtual Diabetes Care: A Consensus Viewpoint on the Positioning and Value of Oral Semaglutide in Routine Clinical Practice

Abstract

While glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as semaglutide, are among the most effective drugs for treating people with type 2 diabetes (T2D), they are clinically under-utilised. Until recently, the only route for semaglutide administration was via subcutaneous injection. However, an oral formulation of semaglutide was recently licensed, with the potential to address therapy inertia and increase patient adherence to treatment, which is essential in controlling blood glucose and reducing complications. The availability of oral semaglutide provides a new option for both clinicians and patients who are reluctant to use an injectable agent. This has been of particular importance in addressing the challenge of virtual diabetes care during the COVID-19 pandemic, circumventing the logistical problems that are often associated with subcutaneous medication administration. However, there remains limited awareness of the clinical and economic value of oral semaglutide in routine clinical practice. In this article, we present our consensus opinion on the role of oral semaglutide in routine clinical practice and discuss its value in reducing the burden of delivering diabetes care in the post-COVID-19 pandemic period of chronic disease management.

Retrospective Analysis of the Effectiveness of Oral Semaglutide in Type 2 Diabetes Mellitus and Its Effect on Cardiometabolic Parameters in Japanese Clinical Settings

“…Glucagon-like peptide-1 receptor agonists (GLP-1RA) are widely used for treating type 2 diabetes mellitus (T2DM) as they lower blood glucose more potently than conventional oral drugs and reduce body weight (BW) with less risk of hypoglycemia [1][2][3][4]. Existing GLP-1RA could only be administered by injection, but once-daily oral semaglutide was developed, which is absorbed through the stomach when co-administered with an absorption enhancer, sodium N-[8-(2-hydroxybenzoyl)amino] caprylate) [5].…”

Semaglutide: A Strategic Weapon for Primary Care

“…25 In patients with T2D who have atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), and uncontrolled HbA1c, the Cardiology Renal and Metabolic (CaReMeUK) group recommends GLP-1 RAs as secondline after metformin treatment. 29 The abovementioned recommendations made in favour of semaglutide underscore the multitude of benefits it confers. In both the fasted and post-fed states, semaglutide lowers blood glucose levels by increasing insulin secretion and lowering glucagon secretion, which results in reduced post-hepatic glucose synthesis.…”

“…Although GLP-1RAs are one of the most efficacious medications for managing T2D, poor adoption of GLP-1RAs in primary care can be attributed to certain patients' aversion to needles. 29 The availability of oral semaglutide eradicates one barrier to treatment and offers patients a convenient GLP-1RA option that promotes early adoption and enhances treatment adherence. This is especially important in times of the COVID-19 pandemic, which has made telemedicine services commonplace: PCPs can prescribe a GLP-1RA easily without going through the inconveniences associated with injectable treatments.…”

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“…Tirzepatide is a novel and the first dual association between a GLP-1 and a Glucose-dependent Insulinotropic Peptide (GIP) RA recommended in obese patients, administered subcutaneously once weekly, which provides consistent and persistent reductions in body weight [25]. It is generally known that among patients with DM oral medications tend to have higher rates of therapy adherence than injectable ones, which could represent a limitation of GLP-1 RAs usage [19,68]. The first oral formulation of the GLP-1 analogue, oral semaglutide has been developed for once-daily administration, in which a molecule called SNAC (sodium N-(8-[2-hydroxybenzoyl] amino) caprylate) enhances the absorption of the active ingredient through gastric mucosa [8,21].…”