Semaglutide - Diabetes Mellitus
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Status 1
- Subcutaneous injection (sc)
Status 2
- Tablets
Documentation
PAD Profile
Other Indications
Below are listed other indications that Semaglutide is used to treat.
Other Drugs
Below are listed other drugs that are used to treat Diabetes Mellitus.
- Acarbose
- Alogliptin
- Alogliptin/metformin
- Biphasic Insulin Aspart - Novmix 30
- Biphasic Isophane Insulin - Humulin M3
- Biphasic Lispro Insulin - Humalog Mix 25
- Biphasic Lispro Insulin - Humalog Mix 50
- Canagliflozin
- Canagliflozin/metformin
- Dapagliflozin
- Dapagliflozin/metformin
- Dulaglutide
- Empagliflozin
- Empagliflozin/metformin
- Ertugliflozin
- Exenatide
- Glibenclamide
- Gliclazide
- Glimepiride
- Glipizide
- Glyxambi (Linagliptin/empagliflozin)
- Insulin Aspart - Fiasp
- Insulin aspart - NovoRapid
- Insulin Aspart - Trurapi
- Insulin degludec
- Insulin degludec with liraglutide
- Insulin detemir
- Insulin glargine - Abasaglar
- Insulin glargine - Lantus
- Insulin glargine - Semglee
- Insulin Glargine - Toujeo
- Insulin glulisine - Apidra
- Insulin Lispro - Admelog
- Insulin Lispro - Humalog
- Insulin Lispro - Lyumjev
- Insulin pump - non-autoimmune causes
- Insulin pump - Type 1 diabetes
- Isophane (neutral insulin) - hypurin porcine 30/70
- Isophane Insulin - Humulin I
- Isophane Insulin - Hypurin Porcine Isophane
- Isophane Insulin - Insulatard
- Linagliptin
- Linagliptin/metformin
- Liraglutide
- Metformin hydrochloride
- Metformin hydrochloride/pioglitazone
- Metformin hydrochloride/sitagliptin
- Metformin hydrochloride/vildagliptin
- Pioglitazone hydrochloride
- Repaglinide
- Saxagliptin
- Saxagliptin/dapagliflozin
- Sitagliptin
- Soluble insulin - Hypurin porcine neutral
- Soluble insulin - Actrapid
- Soluble insulin - Humulin S
- Sotagliflozin
- Suliqua (Insulin glargine/lixisenatide)
- Tirzepatide
- Tolbutamide
- Vildagliptin
Committee Recommendations (3)
Do not prescribe Ozempic® for the treatment of obesity.
Weight Management Guidelines - for advice see Guidelines : Weight management in adults (res-systems.net)
The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve the use semaglutide (oral formulation) with a GREEN (see narrative) traffic light status.
If a GLP-1 receptor antagonist is clinically indicated,the primary care prescriber after discussion with the patient should strongly recommend initiation of a GLP-1 RA injection because of the evidence for cardiovascular benefit for that formulation.
Semaglutide (oral) is available for patients in a niche group where a GLP-1 RA injection cannot be used (due to clinical reasons or patient preference).
Oral formulation is not the preferred route of administration, due to poor bioavailability and a high incidence of gastrointestinal side effects.
The patient should be advised about the advantages of the injectable form of semaglutide over the oral form because of improved outcomes data and greater certainty that the correct dose will be administered.
Oral semaglutide should be reserved only for those few patients for whom a GLP-1 Receptor Agonist is the treatment of choice and who are:
- unable to tolerate, or unsuitable for an SGLT-2 inhibitor
- unable to tolerate the injectable preparation eg allergy to an ingredient in the injection
- psychologically unable to consider administration of a s.c. injection (even if someone else administers it)
- unable to self-administer the injection, due to physical disability or dexterity problems.
An alternative oral option for ths group of patients for consideration is a SGLT2 inhibitor, In line with current NICE guidance for managing type 2 diabetes, patients should be assessed after 6 months at the maximum tolerated dose. If the patient does not achieve targets of a 1% reduction in HbA1c and 3% reduction in weight, the treatment should be reviewed with a view to discontinuation of treatment and switching to another appropriate therapy.
Dulaglutide continues to be the preferred GLP-1 where weekly injection is indicated (due to it no longer having black triangle status)
Semaglutide is an alternative option for weekly injection. Do not prescribe more than a maximum of 13 Ozempic® pens per year for people with Type II Diabetes
Liraglutide is an alternative 1st-line (for patients who wish to have a daily injection)
Lixisenatide is no longer a preferred treatment but remains an option.
Treatment with GLP-1s should be reviewed at 6 months. If there is no beneficial metabolic response (defined in NICE guidance), then stop treatment, and consider alternative treatment (usually insulin initiation) in line with NICE guidance