Oral GLP-1 Receptor Agonist in Diabetes Management
- Deepti Kumar
- May 13
- 3 min read
Photo Credit : Wix
Diabetes is the ranked the seventh leading cause of death in the United States and a major contributor to cardiovascular disease, the leading cause of death in the United States. According to the latest Center for Disease Control (CDC) report, 40.1 million people in the United States had diabetes in 2023, with a 90%-95% having Type 2 diabetes mellitus (T2DM).
What is T2DM?
T2DM is a chronic metabolic disorder characterized by hyperglycemia, insulin resistance and relative insulin deficiency. People with diabetes have high blood glucose levels and are at risk for various complications including damage to the eyes, kidney, myocardial infarction (MI), stroke, and increased risk of obesity and cardiovascular disease.
Who are at risk for developing T2DM?
High risk factors include age (individuals 45 years or older), certain health conditions such as obesity and physical inactivity. Additionally, individuals with family history of T2DM, certain racial and ethnic groups, and low socio-economic groups are at higher risk for T2DM.
T2DM management and current treatment options
The primary goal of diabetes management is to improve blood glucose control, thereby reducing the risk of complications and improving the quality of life. T2DM treatment should be individualized focusing on lifestyle changes such as nutrition and physical activity. Individuals whose blood glucose levels cannot be controlled by lifestyle changes alone, need anti-hyperglycemic medications to achieve sustained glycemic control. Metformin is the initial medication option for patients with T2DM. When glycemic control cannot be achieved with metformin alone, additional glucose lowering agents such as oral and injectable medications may be required. The choice of these agents depends on factors such as the presence of comorbidities and costs.
Oral GLP-1 receptor agonist semaglutide (Ryblesus) and T2DM management
In September 2019 the Food and Drug Administration (FDA) approved the first oral GLP-1 receptor agonist, semaglutide (Rybelsus, Novo Nordisk) for treatment of adults with T2DM. It is a co-formulation of peptide semaglutide and the absorption enhancer N-(8-[2-hydroxybenzoyl] amino) caprylate (SNAC). SNAC facilitates the uptake of the peptide semaglutide across the stomach wall and protects it from degradation in the acidic environment of the stomach. Thus, overcoming the barriers to oral peptide drug delivery, ensuring effective absorption. Phase III clinical trial studies have shown that treatment with oral GLP-1 significantly reduced HbA1c levels compared to placebo. The PIONEER active-comparator trials show that oral semaglutide significantly reduced HbA1c levels compared to other comparators when used as a second line of treatment in patients with uncontrolled diabetes on metformin. In addition to blood glucose management studies have shown that Rybelsus helps in weight management and protects the heart. Most common adverse effects include nausea, abdominal pain, diarrhea, decreased appetite, vomiting and constipation.
Conclusion:
Rybelsus was initially approved in 2019 with a limitation that it could not be used as an initial therapy for treating people with T2DM. In 2023, the FDA removed this limitation and updated the prescribing information for Rybelsus. In conjunction with diet, exercise and life style changes, Rybelsus could help lower blood glucose and prevent potentially dangerous complications in patients with T2DM.
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Assessed and Endorsed by the MedReport Medical Review Board
