Improved Glycemic Control using Oral Semaglutide in a Patient with Type 2 Diabetes with Insulin Allergy

Abstract We present a unique clinical scenario of a patient with type 2 diabetes mellitus (T2DM) who exhibited an allergic reaction to all forms of insulin. The patient had previously maintained good glycemic control with maximum-dose metformin. However, her glycemic control deteriorated once she became pregnant. Trials with various types of insulin resulted in allergic reactions, but this was managed successfully using insulin pump therapy, which was discontinued postpartum. Upon reassessment, her HbA1c had deteriorated to 80 mmol/mol. After re-attempting various insulin formulations without success, she was trialed again using the closed-loop Omnipod system. Initial management with the closed-loop system failed to achieve optimal glycemic control. Therefore, oral semaglutide was added. The introduction of oral semaglutide to her treatment regimen led to a significant improvement in her glycemic status. This report compares the patient's glycemic control while on the closed-loop Omnipod system alone versus in combination with oral semaglutide. The findings suggest that oral semaglutide, in conjunction with a closed-loop system, may offer a viable alternative for patients with insulin-dependent type 2 diabetes who cannot tolerate insulin.