The role of oral semaglutide in managing type 2 diabetes in Indian clinical settings: Addressing the unmet needs. Issue 6 (June 2022)

• Record Type: Journal Article
• Authors: Joshi, Shashank R.; Rajput, Rajesh; Chowdhury, Subhankar; Singh, Awadhesh K.; Bantwal, Ganapathi; Das, Ashok K.; Unnikrishnan, A.G.; Saboo, Banshi D.; Kesavadev, Jothydev; Ghosal, Samit; Mohan, Viswanathan
• Is Part Of: Diabetes & metabolic syndrome. Volume 16:Issue 6(2022)
• Publication Date: 2022-06
• Subjects: Glucagon-like peptide-1 receptor agonists -- Medication adherence -- Oral semaglutide -- Type 2 diabetes mellitus -- Antidiabetic drugs; Diabetes -- Periodicals; Metabolism -- Disorders -- Periodicals; Diabetes Mellitus -- Periodicals; Metabolic Diseases -- Periodicals; Diabète -- Périodiques; Métabolisme, Troubles du -- Périodiques; Endocrinologie -- Périodiques; Diabète -- Physiopathologie -- Périodiques; Diabetes; Metabolism -- Disorders; Electronic journals; Periodicals; 616.462
• DOI: 10.1016/j.dsx.2022.102508
• Languages: English
• ISSNs: 1871-4021

Abstract

Abstract: Aims: Despite their established benefits, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) remain underutilized for type 2 diabetes mellitus (T2DM) management, which indicates that subcutaneous injection is an unfavorable mode of delivery from the patient's perspective. This review summarizes existing challenges related to medication adherence and the use of antihyperglycemia injectables, revisits the established safety and efficacy of oral semaglutide, and explores its features and considerations for use among the Indian T2DM population. Methods: We performed a literature search using MEDLINE and the National Institutes of Health Clinical Trials Registry from July 1, 2016, to July 1, 2021, to identify publications on oral semaglutide approval, T2DM treatment guidelines, and clinical evidence for oral drug formulation. Results: Oral semaglutide is the first oral GLP-1 RA approved for T2DM patients based on phase 3, randomized PIONEER trials. The multitargeted action of this drug offers glycemic control, weight control, and cardiovascular, renal, and additional benefits, including patient convenience and enhanced medication adherence. In addition to achieving glycemic control, the cost of semaglutide is reported to be lower than other GLP-1 RA in the West, thus potentially mitigating the economic burden that appears to be high among the Indian population. Conclusions: Currently, there is no data available on oral semaglutide in Indian clinical settings. However, significant improvements in glycemic control, cardiac and renal benefits, as well as weight loss across clinical trials should encourage clinicians to prioritize oral semaglutide over other antidiabetic agents. Highlights: Effective, safe, and easily accessible antidiabetics with cardiovascular protection are much needed in India. Oral semaglutide has better glycemic and weight control and decreases CV risk, best suited for Indian patients with T2DM. Convenience of oral administration likely to improve medication adherence, subsequently improving T2DM burden in India. Oral semaglutide cost is likely to be the same as current GLP-1RAs and can be a long-term value addition for treating T2DM.