Semaglutide (e.g. Ozempic) For adults with type 2 diabetes – The NET Effect

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Background

This subject of semaglutide (e.g. Ozempic) is appearing regularly in my private Facebook group, and I can see there might be some confusion out there. 

But first, I wanted to state that this post is not about me saying semaglutide (or whatever brand names are included in this post) is something you should be taking or not. That is the responsibility of your doctors in conjunction with you the patient.  Nor is this post to be considered in any way a promotion for the drug or the manufacturer, I have no relationship or communications with the manufacturer, nor am I taking this drug. 

I merely wanted to point out some facts about this drug, mainly from the manufacturer’s website and hopefully provide some context for those who may be confused.  That said, clearly you should clarify any concerns with your doctor. 

It’s relevant because many people already have diabetes before being diagnosed and there may be potential overlap issues with NET plus some people may become diabetic through treatment for NET.   I’ve already written about Diabetes and NET – click here to read.

I focused on Ozempic because it is the most common drug mentioned in my group, but my research found that the drug is called generically called semaglutide but there are different brand names with different approvals.  You will see the different approvals below.  e.g. The approval for Type 2 diabetes does not mean it’s prescribed as a weight loss drug, (or an anti-diarrhea drug), it’s only approved for those with Type 2 diabetes. 

What is Semaglutide (e.g. Ozempic®)

A once-weekly injectable prescription medicine for adults with type 2 diabetes used to improve blood sugar, along with diet and exercise, and reduce the risk of major cardiovascular events such as heart attack, stroke, or death in adults with type 2 diabetes and known heart disease.  According to the manufacturer, Ozempic® is proven to lower A1C (HbA1c).

It is not known if Ozempic® can be used in people who have had pancreatitis. Ozempic® is not for use in people with type 1 diabetes. It is not known if Ozempic® is safe and effective for use in children under 18 years of age. Ozempic® may help you lose some weight. But the manufacturer emphasises that Ozempic® is not for weight loss (but see next section) which happens partly due to its effect on reducing your appetite, so you eat less; and slowing down the movement of food in your gut meaning you stay full for longer.

This type of medication works by increasing the levels of hormones called ‘incretins’. These hormones help the body produce more insulin only when needed and reduce the amount of glucose being produced by the liver when it’s not needed. They reduce the rate at which the stomach digests food and empties and can also reduce appetite.  It is known as a “GLP-1 analogue”.  GLP-1 breaks down to glucagon-like peptide-1 receptor agonist. Other GLP-1 analogues approved to treat type 2 diabetes include:

Exenatide (twice-daily injection)Byetta
Exenatide (once-weekly injection)Bydureon
Liraglutide (once-daily injection)Victoza
Lixisenatide (once-daily injection)Lixumia
Dulaglutide (once-weekly injection)Trulicity

There is a tablet form of semaglutide for those unable to tolerate injections. This is branded as “Rybelsus“.

The confusing bit about weight loss and semaglutide

The situation regarding weight loss has been in the media in UK this year (2023) because the National Institute for Health and Care Excellence (NICE) has recommended the use of semaglutide (Wegovy), alongside a reduced-calorie diet and increased physical activity to adults who have at least 1 weight-related comorbidity and a body mass index (BMI) of at least 35kg/m2.  People with an BMI of between 30-34.9 kg/m2, with 1 weight-related comorbidity who are eligible for referral to specialist weight management services could also be prescribed the drug. A weight-related comorbidity could be one of: dysglycaemia (prediabetes or type 2 diabetes mellitus), hypertension, dyslipidaemia (in which disturbances in fat metabolism lead to changes in the concentrations of lipids in the blood), obstructive sleep apnoea or cardiovascular disease.  NICE stipulated “Semaglutide won’t be available to everyone. Their committee has made specific recommendations to ensure it remains value for money for the taxpayer, and it can only be used for a maximum of two years”.

A similar announcement was made in US in June 2021 – i.e. Wegovy was approved by US FDA for chronic weight management in adults with obesity or overweight with at least one weight-related condition (such as high blood pressure, type 2 diabetes, or high cholesterol), for use in addition to a reduced calorie diet and increased physical activity. There doesn’t appear to be a two-year restriction as per UK above but will update if found to be the case. 

Something similar probably happened in many countries where these announcements made the headlines in many national newspapers and other media sources. 

Although Ozempic and Wegovy are made by the same company (Danish pharmaceutical company Novo Nordisk), there are differences between the different semaglutide brand names in terms of what they are recommended for:

    • Ozempic and Rybelsus (tablet version – also Novo Nordisk) are recommended to manage blood glucose in people with type 2 diabetes.
    • Wegovy is recommended for weight management in people with or without type 2 diabetes.

Note – Ozempic, Wegovy and Rybelsus are all GLP-1 analogue brand names based on the Semaglutide product. The approvals are different, but the patient insert leaflets containing warnings/contraindications etc, appear to be the same as Ozempic but always check the information with your doctor. 

What is the most important information I should know about Ozempic® (semaglutide)?

I wanted to ensure this bit is clear after one misleading comment was made in my group.  There is a potential overlap with certain types of NET. 

Ozempic® may cause serious side effects, including:

  • Possible thyroid tumors, including cancer. Tell your health care provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, Ozempic® and medicines that work like Ozempic® caused thyroid tumors, including thyroid cancer. It is not known if Ozempic® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people. 
  • Do not use Ozempic® if you or any of your family have ever had MTC, or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

    (author’s note:  Familial MTC (FMTC) and MEN2 are both heavily associated with Neuroendocrine Tumours such as Pheochromocytoma and Paraganglioma)

Do not use Ozempic® if:

  • you or any of your family have ever had MTC or if you have MEN 2.
  • you are allergic to semaglutide or any of the ingredients in Ozempic®

Before using Ozempic®, tell your health care provider if you have any other medical conditions, including if you:

  • have or have had problems with your pancreas or kidneys. 
  • have a history of diabetic retinopathy.
  • are pregnant or breastfeeding or plan to become pregnant or breastfeed. It is not known if Ozempic® will harm your unborn baby or passes into your breast milk. You should stop using Ozempic® 2 months before you plan to become pregnant.

Tell your health care provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, herbal supplements, and other medicines to treat diabetes, including insulin or sulfonylureas.

Note – Ozempic, Wegovy and Rybelsus are all GLP-1 analogue brand names based on the Semaglutide product. The approvals are different, but the patient insert leaflets containing warnings/contraindications etc, appear to be the same as Ozempic but always check the information with your doctor. 

Beware of Compounded Versions of semaglutide

I was concerned (but not surprised) to read that supply shortages of Semaglutide have been exploited by companies producing “compounded products” (complicated but essentially something that has not gone through the formal clinical trial processes)

MedPage Today stated that obesity specialists warn against using compounded semaglutide since its quality and safety cannot be guaranteed (their headline used the term “bootlegged”. 

Please ensure you’re getting the right drug. 

Disclaimer

I am not a doctor or any form of medical professional, practitioner or counsellor. None of the information on my website, or linked to my website(s), or conveyed by me on any social media or presentation, should be interpreted as medical advice given or advised by me. 

Neither should any post or comment made by a follower or member of my private group be assumed to be medical advice, even if that person is a healthcare professional.   

Please also note that mention of a clinical service, trial/study or therapy does not constitute an endorsement of that service, trial/study or therapy by Ronny Allan, the information is provided for education and awareness purposes and/or related to Ronny Allan’s own patient experience. This element of the disclaimer includes any complementary medicine, non-prescription over the counter drugs and supplements such as vitamins and minerals.

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Thanks for reading.

Ronny

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