Effect of Oral Semaglutide Compared with Placebo and Subcutaneous Semaglutide on Glycemic Control in Patients with Type 2 Diabetes

Julia Lvovich, Mercer University College of Pharmacy

Worldwide, type II diabetes affects 9% of male population and 7.9% of female population. [1] It has been shown that genetics, lifestyle, and environment factors can predispose adults and children to develop insulin resistance that leads to increased glucose levels in the blood. Overtime, prolonged exposure to high blood glucose levels causes damage to blood vessels and increases risk for coronary artery disease, kidney disease, and obstructive sleep apnea. [2] Treatment of type II diabetes can be targeted with lifestyle modifications (e.g. weight and diet management, exercise) and pharmacotherapy. When considering pharmacotherapy agents, the choices depend on the desired lower blood glucose hemoglobin A1C (HbA1C) reduction, weight gain/loss properties, and other comorbidities. [1]

Glucagon-like peptide -1 (GLP-1) receptor agonists are incretin mimetics and lower HbA1C level by 0.5-1.5%. [3] These drugs also possess weight loss property, which provides an added benefit in type II diabetic patients. However, they are only available in injection formulations due to degradation of the peptides by stomach acid. [4] To overcome the pharmacological limitation, an oral GLP-1 receptor agonist was co-formulated with an absorption enhancer, which increases the local pH to prevent the degradation in the stomach. The efficacy and safety of the new drug, semaglutide, has been evaluated in a phase II trial, which is summarized below.

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