In the current era of type 2 diabetes, we are fortunate to have many different medications to choose from to help people control their blood sugars, choosing the medication(s) that fit each individual’s unique health situation best. In the last decade or so, we have developed diabetes medications that can avoid two unwanted side effects of some of the older diabetes medications: weight gain (with some causing weight loss), and low blood sugars.
Health Canada has just approved a new medication, called semaglutide, which is not only superior to any other medication it has been tested against for blood sugar control, but also causes more weight loss than any other medication on the market.
Semaglutide (trade name Ozempic) is a GLP1 receptor agonist, which works by stimulating the pancreas to increase insulin release and suppress the production of a hormone called glucagon, and also acts as an appetite suppressant in the hunger/fullness centre of the brain. It is a once weekly treatment given by injection under the skin. It reduces hemoglobin A1C (the diabetes report card) by up to 1.8%, and reduces weight in people with diabetes by up to 6.4 kg (14 lb) in the clinical trials that have been conducted.
In terms of side effects, like other GLP1 receptor agonists that are already available (including liraglutide (Victoza), dulaglutide (Trulicity) and exenatide (Bydureon or Byetta), it temporarily slows down stomach emptying, so can cause nausea, constipation, or diarrhea, which usually goes away after a few weeks, if it occurs. Also similar to other GLP1s, there is a low risk of pancreatitis.
Unique to semaglutide, there was an increase in diabetic eye complications seen in the largest clinical trial (in which I was an investigator), which is thought to be due to the power of semaglutide to greatly improve diabetes control (we have seen occasional temporary worsening of diabetic eye disease in studies of other medications, including insulin, when there is a big and rapid drop in blood sugars). This risk is higher in people with existing diabetes eye complications. However, long term improvement in diabetes control decrease the risk of diabetes eye complications overall.
Semaglutide has also been shown to reduce the risk of cardiovascular events in people with type 2 diabetes and cardiovascular disease – now the fourth diabetes medication available in Canada to show this benefit. The full product monograph, with a full description of clinical trials and potential side effects, is available here.
Semaglutide is currently being studied as an obesity treatment as well, in people without diabetes, but is not yet approved for this indication.
Disclaimer: I am involved in research trials of semaglutide for type 2 diabetes and obesity. I receive honoraria as a continuing medical education speaker and consultant from the makers of semaglutide (Novo Nordisk).
