Semaglutide is a medication used in the treatment of obesity and type 2 diabetes mellitus. It belongs to the class of drugs known as GLP-1 receptor agonists, which act on the GLP-1 receptor in the pancreas to stimulate insulin secretion and reduce glucagon secretion. Semaglutide is similar to the naturally occurring hormone glucagon-like peptide-1 (GLP-1), which is secreted by the small intestine in response to food intake.
Semaglutide was originally approved by the US FDA in 2017 for the treatment of type 2 diabetes mellitus, under the brand name Ozempic. In 2021, the FDA approved a higher dose of semaglutide (2.4 mg) under the brand name Wegovy for chronic weight management in adults with a body mass index (BMI) of 30 kg/m² or greater or adults with a BMI of 27 kg/m² or greater who have at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.
The primary mechanism of action of semaglutide for weight loss is believed to be through the reduction of hunger and increase in feelings of fullness (satiety), leading to reduced caloric intake. Semaglutide also helps to regulate blood sugar levels, which can reduce cravings for high-carbohydrate foods and stabilize energy levels throughout the day.
In clinical trials, semaglutide has demonstrated significant weight loss results. In a 68-week study of over 1,900 patients with obesity or overweight, semaglutide 2.4 mg once weekly led to an average weight loss of 15.3% from baseline, compared to 2.4% in the placebo group. The study also found that more than half of the patients in the semaglutide group achieved a weight loss of 15% or more, which is considered clinically significant.
In addition to weight loss, semaglutide has been shown to have other health benefits. In the SUSTAIN-6 trial, which evaluated the cardiovascular safety of semaglutide in patients with type 2 diabetes, the drug was associated with a significant reduction in major adverse cardiovascular events compared to placebo. Semaglutide has also been shown to improve glycemic control, lower blood pressure, and reduce the risk of diabetic retinopathy, a complication of diabetes that can lead to blindness.
Semaglutide is administered via subcutaneous injection once a week. The medication is available in a pre-filled pen, which makes it easy to use and convenient for patients. The recommended starting dose of semaglutide for weight loss is 0.25 mg once weekly for four weeks, followed by an increase to 0.5 mg once weekly for another four weeks. After that, the dose can be increased to 1 mg once weekly if needed. The maximum recommended dose is 2.4 mg once weekly.
Like all medications, semaglutide may cause side effects. The most common side effects of semaglutide include nausea, diarrhea, vomiting, and constipation. These side effects usually improve over time as the body adjusts to the medication. In rare cases, semaglutide may cause more serious side effects, such as pancreatitis, thyroid cancer, or allergic reactions. Patients should be monitored for these potential side effects, and healthcare providers should be notified immediately if any occur.
Semaglutide is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or in patients with multiple endocrine neoplasia syndrome type 2 (MEN 2). It should also not be used in patients with a history of pancreatitis or a history of diabetic retinopathy complications.
It is important to note that semaglutide is not a standalone solution for weight loss. It should be used in conjunction with a healthy diet and regular exercise to achieve optimal results. Patients who take semaglutide should also undergo regular monitoring to ensure the drug is working effectively and safely.
Semaglutide is a promising medication for the treatment of obesity and weight-related comorbidities such as type 2 diabetes mellitus. It has been shown to be effective in promoting significant weight loss and improving glycemic control, blood pressure, and cardiovascular outcomes. Semaglutide is easy to administer and has a favorable safety profile when used appropriately. As with any medication, patients should consult with their healthcare provider to determine if semaglutide is an appropriate treatment option for their individual needs.