Expert Opinion on Cardio-Renal-Metabolic Approach to Management of Adults with Type 2 Diabetes Mellitus Using Oral Semaglutide: An Indian Perspective

Objective: This study aims to evaluate the efficacy and safety of oral semaglutide in managing type 2 diabetes (T2D) through a cardio-renal-metabolic approach tailored for the Indian context. Materials and methods: A literature review was conducted using PubMed and Google Scholar, focusing on systematic reviews, meta-analyses, and randomized controlled trials related to oral semaglutide. Findings were discussed at the 16th National Insulin and Incretin Summit (NIIS) on November 19, 2022, where an expert panel developed guidelines based on collective insights and live opinion polls. Results/Key findings: The expert committee recommends oral semaglutide for adults with T2D due to its effectiveness in lowering blood glucose and promoting weight loss. It can be used alone or with other oral anti-diabetic agents, except dipeptidyl peptidase 4 inhibitors (DPP-4i). The drug is safe for those with cardiovascular disease or chronic kidney disease (CKD). Common gastrointestinal side effects are typically mild. Administration requires fasting for 30 min after dosing. Gradual dose escalation is advised to minimize side effects, and patients should be counseled on potential interactions with other medications and pregnancy considerations.