Practical Considerations for the Use of Oral Glucagon-like Peptide-1 Receptor Agonist in India

Despite the established efficacy of glucagon-like peptide-1 receptor agonists, treatment intensification in type 2 diabetes (T2D) remains limited by clinical inertia, nonadherence, and reluctance toward injectables. Oral semaglutide, enabled by permeation enhancer-based gastric absorption, offers a peptide-based oral option with robust glycemic efficacy, meaningful weight reduction, and low hypoglycemia risk. The review integrates evidence from the Peptide Innovation for Early Diabetes Treatment (PIONEER) program, cardiovascular outcomes data, pharmacokinetic studies, and contemporary American Diabetes Association/American Association of Clinical Endocrinology-aligned recommendations, and translates these into practical guidance for Indian physicians. It addresses patient profiles most suited for initiation, dose escalation, administration instructions, gastrointestinal tolerability, nonresponse, Ramadan use, elderly patients, concomitant oral contraceptives and levothyroxine, diabetic retinopathy, gallstone risk, and oral-versus-injectable semaglutide selection. The central message is that oral semaglutide can be positioned as a high-efficacy oral incretin option for Indian patients with T2D, provided that treatment is individualized, dosing instructions are reinforced, and counseling is optimized to improve adherence, tolerability, and long-term outcomes.