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What is semaglutide?
Semaglutide is the name of a new drug that is quickly becoming widely popular. According to Dr. Danielle Kelvas, “It is a glucagon-like peptide-1 (GLP-1) analogue that is FDA approved to assist in glycemic control in type 2 diabetes and for weight loss in those with morbid obesity.”
Dr. Kelvas explains, “Semaglutide specifically was developed in 2012 by Novo Nordisk as a longer acting version of the original drug called Liraglutide.” Although liraglutide was efficacious for its indications, skepticism arose when it was associated with thyroid cancer and pancreatitis. Those associations were eventually found to be inconsistent with the drug, but by the time that happened, semaglutide had come into play.
Prior to 2021, semaglutide was only approved by the Food and Drug Administration (FDA) for the treatment of type 2 diabetes. Now, however, it is also approved for the treatment of obesity, thanks to several clinical trials that have shown the drug to be efficacious to treat obesity when taken along with healthy lifestyle changes.
Here’s Dr. Kelvas citing one of these trials, which was performed by Wilding, John, et al: “In the weight loss trial performed to evaluate performance of semaglutide, 1961 patients were enrolled in a double-blind trial (meaning that neither the clinicians nor the patients knew if they were receiving the medication or placebo). ‘The mean change in body weight from baseline to week 68 was −14.9% in the semaglutide group as compared with −2.4% with placebo, for an estimated treatment difference of −12.4 percentage points (95% confidence interval [CI], −13.4 to −11.5; P<0.001).’…Overall, the study concluded that semaglutide combined with consistent lifestyle interventions, such as diet changes and exercise, resulted in clinically significant weight loss reduction.”
Other studies have shown that semaglutide also has beneficial effects on the cardiovascular system, such as reducing blood pressure and fat levels in the blood. That being so, semaglutide is also used to reduce the risk of a stroke, heart attack, or death in adults with type 2 diabetes and heart and blood vessel disease. But semaglutide is not helpful for treating type 1 diabetes or diabetic ketoacidosis.
How does semaglutide work?
As stated above, semaglutide is a GLP-1 analogue drug. GLP-1 is a natural hormone, part of the incretin class of hormones. It is produced in the body after you eat a meal and stimulates insulin releases from the pancreas—semaglutide mimics this hormone to produce the same release of insulin.
Dr. Kelvas gives further explanation: “Insulin is a hormone that allows the cells within the body to absorb glucose (sugar); this fuels a cell’s metabolism.” She says semaglutide also “inhibits the secretion of glucagon, which is a hormone that does the opposite of insulin. While insulin allows cells to uptake glucose, glucagon stimulates cells to release glucose into the bloodstream. GLP-1 drugs slow down digestion in the stomach, which reduces appetite and food intake.” And as you eat less, you lose weight, when combined with a healthy diet and exercise program.
Why should I get semaglutide?
Semaglutide may be right for you if you have type 2 diabetes or if you struggle with obesity. It is important to treat type 2 diabetes, as it can affect many of your major organs, including your heart, blood vessels, nerves, and kidneys. If it is not treated, it can lead to cardiovascular disease, high blood pressure, nerve damage, kidney disease, vision problems, stroke, and dementia, among other complications.
The more recently discovered benefits of semaglutide, though, are for overweight or obese adults. Obesity affects about 70% of Americans and is associated with some of the leading causes of death, including diabetes, stroke, and heart disease. It is also linked to an increased risk of certain types of cancer. But according to the FDA, losing even 5% to 10% of body weight has been associated with a reduced risk of cardiovascular disease for adults who are obese or overweight. That’s where semaglutide comes in. It was approved for the treatment of type 2 diabetes in 2017 and, as of 2021, is the first FDA-approved drug for chronic weight management in overweight adults since 2014. This means that overweight adults or adults with obesity now have an effective new treatment option to help decrease their susceptibility to the severe health issues related to obesity. The FDA has approved once-weekly semaglutide injections for chronic weight management in adults who have obesity or are overweight with at least one weight-related condition (such as type 2 diabetes, high blood pressure, or high cholesterol), when taken alongside a low-calorie diet and increased physical activity.
According to clinical trials involving semaglutide, it appears that a dose of 2.4 mg of semaglutide is effective and safe for a diverse range of diabetic or overweight patients—so no matter your age, exact body mass index, or race/ethnicity, semaglutide may benefit you.
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How do I take semaglutide?
Semaglutide is most commonly administered via injection. But Dr. Kelvas says, “Semaglutide can be taken as an injection in a prefilled pen (this is dosed once weekly) or orally.”
In injection form, semaglutide comes as a liquid in a prefilled pen to be injected under the skin. It is meant to be taken once weekly, on the same day of the week at any time of day. But as long as it has been at least 48 hours since your last dose, you can change the day of the week that you inject the drug.
Semaglutide can be injected into your upper arm, thigh, or stomach area. It is recommended that you rotate the site of injection each week. You should also examine the semaglutide solution before you inject it to make sure it is clear, colorless, and free of any particles. If the liquid is thick, colored, cloudy, or contains solid particles, you should not use it. You should not reuse needles or share pens with anyone else. To dispose of used needles, place them in a puncture-resistant container and ask a medical professional how best to throw away the container.
Semaglutide in oral form is to be taken by mouth with a glass of plain water that is less than 4 ounces. You should not cut, crush, or chew the pills—just swallow them whole. It is best to take them in the morning, 30 minutes before your first food, beverage, or other oral drugs of the day.
For patients taking semaglutide for the treatment of obesity, it should be reiterated that semaglutide is meant to be taken along with a low-calorie, low-fat diet and an exercise program. Otherwise, you will not find it to be effective.
Does semaglutide have any side effects?
While semaglutide is significantly helpful for treating type 2 diabetes and obesity, you may experience some side effects. Dr. Kelvas says, “If too much of the drug is taken…it can cause your blood sugar levels to drop, which is called hypoglycemia. Diabetic patients will recognize hypoglycemic symptoms such as feeling light headed, fatigued, or dizzy. Some studies show that semaglutide can enhance the growth of Beta cells within the pancreas, which are the cells that create insulin. In severe cases of diabetes, or those with poorly controlled blood sugar, the Beta cells eventually stop producing insulin altogether; this is what causes patients to become insulin dependent.” Being insulin dependent is how type 1 diabetes presents, and semaglutide is not indicated for that diabetic condition.
Dr. Kelvas also lists some side effects observed from the aforementioned clinical trial by Wilding, John, et al, and she describes a positive finding regarding those side effects: “The most common side effects were mild to moderate nausea and diarrhea, but most patients found that as they adjusted to the drug, these symptoms abated with time. Other common side effects include mild abdominal pain or constipation.”
Additional clinical trials have confirmed these findings, showing nausea, diarrhea, and constipation to be among potential side effects. Other trials also showed that the side effects tended to show up early in treatment and then improve throughout the course of treatment. Rarely were the side effects severe enough that patients had to stop taking the drug.
