Key Points
• Source: Diabetes Therapy
• Relevance: “This commentary, based on the expert opinion of the authors and suggestions mentioned in other peer-reviewed published papers, shares clinical tips on how to use the drug, in a safe and smart manner, in a wider spectrum of people living with type 2 diabetes. This will ensure rational use of this molecule in a safer and more effective method. Diabetes care is a dynamic field, and oral semaglutide counseling will continue to be updated as research and real-world experience evolve.”
• Escalation of oral semaglutide should be done after 1 month, per the prescribing information. This guidance is to minimize gastrointestinal symptoms and maximizing patient comfort. In certain situations, however, patients may need urgent glucose control to resolve diabetes symptoms, complications, or comorbidities. In other situations, patients may want early control. According to the authors, “If such people demonstrate good gastrointestinal tolerance to the 3 mg or 7 mg dose of semaglutide, one may consider dose up-titration after 10 or 20 days of therapy. Patients must be counseled about the possibility of transient symptoms, and how to mitigate them.
• In patients who have a sudden change in medical status, the continuation of therapy should be a personal decision. Patients who can eat and hydrate, as well as have stable hepatorenal function, should continue, whereas those patients who have vomiting/diarrhea, can’t eat properly, or are in critical conditions should discontinue the drug in lieu of possible insulin therapy.
• “Ramadan fasting is characterized by month-long fasting from dawn to dusk, during which faithful believers abstain from food and water,” wrote the authors. “Oral semaglutide can be taken 30–60 min before the suhur (early morning) meal, but this may be inconvenient for many. Another option is to take the drug before the iftar (evening) meal, but this will extend the fasting period by a half hour to one hour, and will not be welcome.”