Type 2 diabetes

Semaglutide on the PBS for type 2 diabetes

Another GLP-1 receptor agonist semaglutide (Ozempic) is now on the PBS as a treatment option for patients with insufficiently controlled type 2 diabetes.

The once-weekly glucose-lowering treatment is preferentially used as second and third line treatment in type 2 diabetes, particularly for patients at high risk of cardiovascular disease and in patients who are overweight or obese.

Associate Professor Neale Cohen, from the Baker Heart and Diabetes Institute, told the limbic it was a very effective new medication for managing type 2 diabetes. 

“So its indication is really for glucose lowering as an add on after metformin or sulfonlyurea or both ….but you certainly can add it on after any glucose lowering medication including insulin although the PBS restricts us a little bit in terms of what we are allowed to do in Australia.”

He said evidence for the drug included the findings of the SUSTAIN-6 cardiovascular outcomes trial. 

“All diabetes drugs now need cardiovascular safety trials. It didn’t just show safety it showed cardiovascular benefit and this is similar to the other GLP-1 studies.” 

“We don’t know why exactly, we are a bit surprised. We don’t think it’s just the weight loss, we don’t think it’s just the blood pressure lowering…. but it is a consistent finding and for some reason these are cardioprotective drugs.”

He said choosing between an SGLT2 inhibitor and a GLP-1 receptor agonist depended very much on the patient.

“Honestly you could choose either way – there are pluses and minuses for both of these classes. For example, people will often prefer a tablet so you might go for an SGLT2 inhibitor in that group but people may prefer marked weight loss in which case you’d probably prefer the GLP-1 agonists as they are probably better at weight loss.”

“It’s a good therapeutic option really; this is a good medication.”

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