Re-imagining Oral Semaglutide in Routine Clinical Practice: Indian Expert Panel Recommendations

Background: The rising prevalence of type 2 diabetes mellitus (T2DM) in India, driven by obesity and lifestyle factors, necessitates innovative treatments like oral Semaglutide, a GLP-1 receptor agonist (GLP-1RA). Its oral formulation enhances patient adherence by overcoming barriers associated with injectables, offering glycaemic control, weight loss, and cardiorenal benefits. Methods: A comprehensive literature review was conducted using PubMed, EMBASE, and Cochrane Library, focusing on oral Semaglutide and GLP-1 RAs. An expert panel convened on November 24, 2023, in Bengaluru, India, to develop guidelines for its use in T2DM management. Live opinion polls and panel discussions provided clinical insights across diverse patient populations. Results: Oral semaglutide demonstrated significant HbA1c reductions of −1.3% to −1.5% at 7 mg and 14 mg doses, and weight loss of up to 5 kg across diverse T2DM profiles, including drug-naïve individuals with normal BMI, obesity, ASCVD, and CKD. In CKD patients, it reduced nephropathy risk by HR 0.64 (95% CI: 0.46–0.88). Cardiovascular safety was supported by a 21% reduction in MACE in PIONEER 6. Additional benefits included improved blood pressure, lipid profiles, and a low risk of hypoglycemia, with consistent efficacy across special populations. Conclusion: Oral semaglutide offers a comprehensive, patient-centric approach to managing type 2 diabetes, with benefits extending beyond glycemic control to address cardiovascular, renal, and metabolic health. Its oral formulation enhances adherence, making it suitable for diverse patient populations. This expert consensus provides practical guidance for its effective use in routine clinical care.