This article is written by Dr. Gareth Sessel (M.D., E.E.) and provides medical insight into the drug Semaglutide, aka Ozempic. It does not necessarily reflect the views of Ash Wellness staff. Ash Wellness does not offer medical advice and recommends patients consult with their doctor prior to any medical decisions.

Semaglutide, more commonly known as Ozempic, is a medication used for the treatment of type 2 diabetes and obesity (marketed as Wegovy). Semaglutide belongs to the class of glucagon-like peptide-1 receptor agonists (GLP1-RAs). As an MD with experience delivering innovative solutions to patients with chronic conditions, I have insight into the use of Ozempic for diabetes and Wegovy for weight loss. In this blog, I review some notable medical research about Semaglutide, including how it works and the future of similar drugs.

How does Ozempic work? 

Ozempic is one example from a class of drugs called glucagon-like peptide-1 receptor agonists (GLP1-RAs). Glucagon-like peptide-1 (GLP1) is a naturally occurring hormone released by the small intestine in response to food intake. GLP1-RAs, including Ozempic, mimic the action of GLP1 but last longer in the body. While the hype surrounding Ozempic may seem new, the GLP1-RA class of medication has been prescribed by physicians for many years. Early GLP1-RAs were approved by the FDA in 2005, demonstrating improvements in weight loss, reduced hypoglycemia risk compared to some other medications, and excellent HbA1c reductions.

How does Ozempic control type 2 diabetes? 

Blood glucose levels are regulated by multiple hormones, including insulin, glucagon, and GLP-1. Ozempic impacts blood glucose through various mechanisms, such as increasing insulin secretion, slowing gastric emptying, and reducing glucagon release. It is typically not recommended as initial therapy but has shown effectiveness in patients with poor glycemic control, cardiovascular disease, high HbA1c, or obesity. 

Clinical trials, including the SUSTAIN trials, have consistently demonstrated superior HbA1c reductions with Ozempic compared to other second-line diabetes medications. Some of these findings have been reported alongside cautions (such as considerations regarding experimental techniques) but in general, the literature supports the view that Ozempic is a highly effective medication for many patients with type 2 diabetes.

How does Ozempic work for weight loss?

GLP1-RAs, including Ozempic, commonly induce weight loss by reducing average caloric intake through mechanisms like slowed gastric emptying and increased satiety. The STEP trials confirmed significant weight loss with Ozempic in individuals who were overweight or obese, both with and without type 2 diabetes. These trials showcased the medication's effectiveness in achieving substantial weight reductions, benefiting overall and metabolic health. 

How is Ozempic prescribed and administered? 

Ozempic is initiated at a low dose and gradually increased to minimize adverse effects. It is typically prescribed as a weekly subcutaneous injection, using a short and thin needle that is inserted just beneath the skin surface (which is different from injections inserted into a muscle or vein). This is an improvement from earlier drugs in the same class, which were often administered daily.

What are the side effects of Ozempic? 

Common side effects of Ozempic include nausea, vomiting, diarrhea, abdominal pain, and constipation, which usually subside within a few weeks of starting treatment. Adverse events such as acute kidney injury and worsening of chronic renal failure have been reported in some patients, likely associated with dehydration resulting from gastrointestinal symptoms. 

The risk of hypoglycemia while on Ozempic is low when used with metformin alone (the most common first line medication for type 2 diabetes management), but increases when combined with other medications known to cause hypoglycemia. Rapid improvements in blood glucose or hormonal changes may lead to complications like diabetic retinopathy or hair loss. Ozempic is contraindicated in patients with a familial history of certain endocrine tumors and should be discontinued if pancreatitis or a hypersensitivity reaction is suspected.

What's next for this type of medicine?

An oral form of Semaglutide (Rybelsus) is available to be swallowed daily on an empty stomach, offering an alternative administration option to weekly injections. In May 2022, a medication called Tirzepatide (Mounjaro) was approved by the FDA to improve blood sugar control in adults with type 2 diabetes. Tirzepatide stimulates not only GLP1 receptors (like semaglutide), but also other receptors that are involved in blood glucose control (GIP receptors). As a result, tirzepatide has demonstrated higher potency than semaglutide in recent trials for both diabetes management and weight loss (although it does not currently have FDA approval for obesity management). It is important to note that medication choices should be individualized, and patients should consult with their healthcare providers to determine the best treatment options.

Conclusion

Ozempic (Semaglutide) has emerged as a promising medication for managing type 2 diabetes and obesity. With its multifaceted impact on blood glucose regulation and significant weight loss, Ozempic offers an effective treatment option for patients who have poor glycemic control or obesity. Its success in clinical trials, such as the SUSTAIN trials, highlights its superiority in reducing HbA1c compared to other second-line diabetes medications. 

Furthermore, the STEP trials have demonstrated its ability to induce significant weight loss in individuals with obesity or who are overweight. As medical advancements continue, alternative formulations like the oral form of Semaglutide and newer medications such as Tirzepatide (Mounjaro) offer additional options for patients. However, it's essential to consult with healthcare providers to determine the most suitable medication based on individual needs and medical history.

By helping to manage blood glucose levels and promoting weight loss, Ozempic has the potential to improve overall health outcomes and metabolic control in individuals with type 2 diabetes and/or obesity. With ongoing research and development in this field, the future holds promise for further advancements and improvements in medications targeting GLP1 receptors, providing patients with even more effective treatment options.

‍