Practical application of semaglutide: From evidence-based research to expert decisions

The rapid progress in the development of highly effective weekly incretin-based medications offers increasingly broad opportunities for comprehensive correction of cardiometabolic disorders in patients with type 2 diabetes and/or obesity. This article aims to summarize existing research that confirms the efficacy and safety of one of the most prescribed medications from the class of glucagon-like peptide-1 receptor agonists – weekly semaglutide. In addition to presenting the main results of randomized clinical trials involving semaglutide, special emphasis is placed on experimental and clinical studies related to the drug’s effectiveness in real-world conditions and during specific life periods for patients with type 2 diabetes and/or obesity, such as surgical and endoscopic interventions, bariatric surgery, intermittent fasting, and religious dietary restrictions. Based on this evidence base and their own clinical experience, the interdisciplinary author team proposes practical approaches to adjusting hypoglycemic therapy in patients with type 2 diabetes when combined with semaglutide and switching to other therapies. Practical recommendations for the use of the drug in patients with obesity during the active weight loss phase and the weight maintenance phase are also formulated. Key considerations supporting long-term obesity treatment are presented; however, trial de-escalation therapy schemes are also provided for patients who have successfully modified their lifestyle while achieving target weight outcomes. The reasons and mechanisms behind the most common adverse events associated with semaglutide use, which represent a potential barrier to its utilization, are separately discussed. The most effective measures for their prevention and correction are outlined, which will enable the realization of the therapeutic potential of weekly semaglutide and thus improve patient outcomes in the long-term management of obesity and type 2 diabetes.