Today, I would like to talk about Ozempic
and explain how Ozempic
or Semaglutide works,
what the effect is and what you can likely expect,
the side effects and
essentially how to take it
and get the best and the most out of it.
My name is Dr Sultan Linjawi.
I'm a certified Diabetes Specialist and Endocrinologist
and this is what I do for a living.
I provide education around new diabetes treatments
and old diabetes treatments,
to people around the world.
So let's talk about Ozempic, or Semaglutide.
So Semaglutide is a once weekly injection for people with diabetes.
It is something called a GLP1 analogue
and I'll explain a little bit what a GLP1 is.
But in essence
it looks very similar to a naturally occurring chemical that we all produce
that helps us regulate our appetite
as well as our blood sugar levels.
And this treatment is for people with Type 2 diabetes
where it has been tested and investigated fairly heavily.
It is not approved for people with Type 1 diabetes.
And shouldn't be taken in women who are pregnant or breastfeeding
and it is ill-advised at the moment to be using it in children.
So what is a GLP1?
Well GLP1
is an extremely powerful chemical that is produced
in response to eating by our gut
and it does a number of things,
but there are four main actions.
So the first is that when the chemical is released
it circulates into our system and it gets to our brain
and there it leads to reduced appetite.
It is the thing that people experience
when they have eaten too much
where suddenly they feel they are just overfull.
That sense of sickness, or fullness, that
you might feel if you have gorged yourself
is actually GLP1 hitting the brain
and saying that is enough.
Now, some people seem to produce
fantastic GLP1 responses that are really effective.
Generally, people that are thinner,
they stop eating a lot more quickly.
But we know that in people with Type 2 diabetes
that sense is often impaired
and if you give someone GLP1
you can switch off the appetite to some extent
and achieve some weight reduction.
Now how else does it work in the body?
Well, in the liver, it reduces the amount of glucose,
or sugar, that is released by the liver.
The normal situation for a person would be to release sugar into the circulation
unless you don't need it.
But in Type 2 diabetes,
there is impaired release of glucose out of the liver.
Continually the stores are being released into the circulation
even though the blood sugar level is elevated.
So the third mechanism of action is
around slowing stomach emptying
and slowing what we call gastric emptying.
And that process leaves food in the stomach for longer
therefore there is less necessity to go looking for food.
And finally,
the action is around the effect on the pancreas
where GLP1's both increase the amount
of insulin that is produced
as well as increase the amount that is released.
And the interesting thing about it is
that that is predominantly when the blood sugar is elevated.
In other words GLP1's
and there are a range of these treatments
all have an effect
which is predominantly around high sugars
and if the sugar becomes low, the effect is switched off,
and it is the reason we see very low rates of low blood sugars
so called 'hypos', or hypoglycemic episodes
that occur with GLP1 treatments.
So if you are on Ozempic or Semaglutide
what dose should you use?
Well essentially there are two doses
that are prescribed and talked about.
One is 0.5mg
and the other one is 1mg.
And the way we take it,
well this is how you start taking it.
In the clinical trials,
it was a weekly injection
and they started at 0.25mg a week
and that was for 4 weeks.
And at the end of 4 weeks,
predominantly that was around getting used to the drug,
at the end of 4 weeks,
the dose was increased to 0.5mg weekly.
And for many people that is an extremely effective dose.
In fact for some people,
the lower dose is still going to be highly effective in terms of 0.25mg
and there may not be a need
to increase the dose even though
the clinical trials suggested that was what needed to happen.
We do not know what the actual effect of 0.25mg is.
Now if 0.5mg isn't enough
and you have waited some time
and the blood sugars are still not where they need to be,
then we do have the option of increasing it to the 1mg dose.
So it is a step process,
0.25 initially for 4 weeks to get used to it,
then 0.5mg,
and if that is the dose for you, fantastic.
But if you need escalating further,
then up to 1mg.
But I want to say this, because I think it is important.
Ozempic will take 5 weeks to get going
and get into your system.
It won't reach, what we call steady state, until that time.
Its main effect won't be felt for 12-24 weeks.
So if you think,
I'm going to take this drug
and in 2 or 3 days my sugars are going to be perfect
that's not how it works.
So you have to wait for its effect to have
so you can make those judgments about
when you need to increase the dose
and if you stop it,
it clears the system or the body, in about 4 or 5 weeks.
So how does Ozempic compare to other GLP1 therapies?
Well I think it is just worth mentioning
there are a lot of GLP1 treatments available at the moment
and some of them you will be familiar with,
there are weekly versions and daily versions.
The weekly versions that we are looking at
are things like
Trulicity, which is called Dulaglutide,
or Bydureon,
which is known as Exenetide Extended Release.
And then we have daily versions.
And daily versions would be Liraglutide,
or Byetta
and maybe the only other agent that is used a bit
is Lixisenatide.
So we have quite a bit of options in terms of GLP1 treatments.
And most of those options are being tested and looked at.
So the first study I want to show you,
is this one.
And this was looking at whether or not
Ozempic worked,
and it was comparing Ozempic to a placebo,
so a dummy injection
and across the whole of this image,
the light blue bars
are the low 0.5mg dose of Semaglutide
and the dark blue bars are 1mg.
And you can see that both of the Ozempic doses,
lowered HbA1C by around 1.5-1.6%
compared to placebo.
Incredibly effective.
Compared to Bydureon or Exenetide Extended Release
the 1mg dose
lowered the HbA1C
by about 1.5%
compared to Exenetide at 0.9%
so there was about a 0.6% reduction
but Ozempic was superior.
They compared it to insulin.
And in this case insulin glargine or Lantus.
And you can see whilst Lantus was effective at lowering the blood sugar
by about 0.8% of an HbA1C
again there was superiority in both
the 0.5mg and 1mg dose of Semaglutide.
And the only drug that really got close,
and it really did get very close,
and is a reasonable comparison
is Trulicity, or Dulaglutide.
And there are two different doses of Trulicity
as there are two different doses of Ozempic
but to both ends it looks like Ozempic
was superior by about 0.4mg.
So that is impressive.
Because Trulicity is a very, very effective drug
for many, many people.
What about weight loss?
We talked about the fact that
these drugs are exceptionally impressive
at weight reduction
and in fact out of all the drugs that we have
to date in the GLP1 category
Ozempic seems to be the most effective around weight reduction.
And if you just look at this graph,
anything above the line,
is a weight increase.
So you can see that in the middle there
with the little green mark there
around insulin glargine
which put on a bit of weight.
But across all the other drugs,
and the other trials,
there was weight reduction
and consistently
it looks like there was a
weight loss of between 3.5kg - 6.5kg
favouring Ozempic
with the bigger weight loss
seen in the higher dose.
So what are the side effects of Ozempic?
Well, the common side effects are nausea, diarrhoea,
vomiting, abdominal pain, and decreased appetite.
And that is what was reported,
but in fact if you talk to people who are using it
it is that sense of fullness,
that queasy feeling that you have
if you have eaten too much.
Imagine going to a wedding
and just stuffing your face and then someone saying
"would you like another dessert?"
and just thinking no I can't eat anymore.
That is the sensation that you get with GLP1 therapies
and it is experienced by about 10-20% of people
but the vast majority of these symptoms settle
after around about 8-12 weeks in most people
and if somebody were in a situation
where they felt nauseated
there is no reason
that they need to escalate from 0.25mg up to 0.5mg
until that nausea has settled.
Because it is a very powerful drug
and it would be a shame if we gave up on it
because the side effects were bad in the first week or two
and we didn't find a way to persist.
Now there are a few serious side effects that are noted.
So there was a concern with a GLP1's
around inflammation of the pancreas
that is extremely rare,
low blood sugars are unlikely, but possible,
and of course, there are allergic reactions.
So there is Ozempic.
A new treatment that is being launched all over the world
that is for people with Type 2 diabetes,
that seems to not only lower blood sugars
but also
in lowering blood sugars leads to some weight loss.
There is some good evidence also that in people who have
cardiovascular risk factors,
in other words,
people who are either
susceptible to heart attacks and strokes
or people who have had one in the past,
this reduces the likelihood of having a further event
by around 25-26%.
That is in common with a number of other GLP1 drugs.
So these are really powerful agents
that are really helping us,
as healthcare professionals,
provide great care and outcomes
for people with diabetes
and certainly a great tool
if you have diabetes
to help you moving forward because
with the benefits of weight loss
and the reduction in blood sugars being so powerful
and the potential benefit of reducing heart attacks and strokes
this is part of the future of diabetes.
that is here right now.