Background:

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Obesity and an increasingly overweight population pose a significant health crisis in the UK, affecting around two-thirds of adults. It is a major contributor to heart disease, type 2 diabetes, and many cancers.

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Recent research shows that semaglutide is an effective medication for weight loss.

Semaglutide however has not yet been licensed for obesity. Semaglutide can be used for weight loss in people with type 2 diabetes and trade name is ozempic. Once the licence for semagalutide for weight loss is available the trade name would be different and would not be called ozempic.

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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.

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Here we describe a new medication called Semaglutide, which is GLP-1(Glucagon Like Peptide-1) analogue. The trade name is Ozempic (Weekly Injection), Wegovy (Weekly Injection) and Rybelsus (Daily Tablet).

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What is a GLP-1 analogue?

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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.

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

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GLP-1 also lowers glucagon secretion when blood glucose is high. Glucagon is a hormone which increases blood glucose. Glucagon is usually produced by the pancreas when blood glucose is low. Glucagon converts the glycogen (sugar stores) in the liver to glucose. 

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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. 

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It is also known to reduce body weight and body fat mass through lowered food intake, reduced appetite. In addition, Ozempic reduces the preference for high fat foods.

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

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

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Research shows that Semaglutide (Ozempic and Wegovy) 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 (Ozempic) 1 mg demonstrated superior and sustained weight loss of 6.5 kg compared with 3.0 kg with dulaglutide (another GLP-1 analogue).

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

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

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Who can be prescribed Semaglutide (Ozempic / Wegovy)?

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Semaglutide is human glucagon-like peptide-1 (GLP-1) analogue produced by recombinant DNA technology. The tradename for weight loss is Wegovy, manufactured by Novo Nordisk and is available in the following doses: 0.25, 0.5, 1mg, 1.7mg and 2.4mg prefilled pens.

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Semaglutide should not be administered intravenously or intramuscularly.

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Who cannot be prescribed Semaglutide?

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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 (not licenced for weight loss).

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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 abdominal pain, loss of appetite, nausea and vomiting. Seek urgent help if pancreatitis is suspected or go to the nearest A&E.

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If pancreatitis is suspected, discontinue semaglutide immediately; 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.

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Women of childbearing potential are recommended to use contraception when treated with

ozempic and therefore, ozempic should not be used during pregnancy as there is no data on its safety in pregnancy.