High doses of oral semaglutide improve blood sugar control and promote weight loss

Diabetes is a progressive disease that affects one's ability to control blood sugar levels. For many patients, the condition becomes more severe over time and blood sugar levels grow more difficult to manage. Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, have granted patients more control in lowering blood sugar.

The study found that once-daily oral semaglutide taken at 25 milligrams (mg) and 50 mg did a better job in lowering blood sugar levels and promoting weight loss than the lowest dose of 14 mg. The new study is in line with other studies, which are pushing for the use of oral GLP-1 receptor agonists as a treatment for obesity.

In total, 1,606 participants, who were on average male and 58.2 years of age, participated in the phase three program for regulatory approval. The participants were randomized into three groups and were asked to take oral semaglutide once a day. Each group took a different dosage of semaglutide, either a 14 mg dosage, a 25 mg dosage, or a 50 mg dosage, for 52 weeks.

Blood sugar levels are measured through a percentage, called A1C. According to the American Diabetes Association, most adults with diabetes need to have an A1C that is less than 7% to be considered healthy. All of the participants in the trial had an A1C between 8.0% and 10.5%. Researchers found that those who received the 25 mg and 50 mg doses of oral semaglutide were more likely to reach the A1C target of <7.0%, compared with those who took 14 mg.

Semaglutide also causes weight loss by suppressing appetite. At the end of the 52 weeks, the participants who took 50 mg of oral semaglutide had lost, on average, 17.5 pounds. Those who took 25 mg and 14 mg lost about 14.8 pounds and 10 pounds, respectively.

Reference: Efficacy and safety of once-daily oral semaglutide 25 mg and 50 mg compared with 14 mg in adults with type 2 diabetes (PIONEER PLUS): a multicentre, randomized, phase 3b trial, The Lancet, DOI 10.1016/S0140-6736(23)01127-3