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Publications

Journal Article Ppublish

PubMed: 40542226 DOI: 10.1007/s13300-025-01762-3

Oral Semaglutide as an Opportunity for an Appropriate Therapeutic Switch in People with Type 2 Diabetes: A Delphi Consensus.

Diabetes Ther 16(8):1707-1725

Authors: Matteo Bruglia, Francesca Cardini, Raffaella Di Luzio, Stefania Fiorini, Antonella Guberti, Silvia Haddoub, Valentina Lo Preiato, Alessandra Luberto, Francesca Lugli, Massimiliano Maiello, Elisa Manicardi, Marco Marcello Marcellini, Marcello Monesi, Francesca Pellicano, Daniela Piani, Rosa Maria Trianni, Anna Vacirca, Antonio Nicolucci, Paolo Di Bartolo

Affiliations

  • AUSL della Romagna-Rimini Diabetes Center, Rimini, Italy.
  • AUSL della Romagna-Riccione Diabetes Center, Riccione, Italy.
  • AUSL di Modena-Modena Diabetes Center, Modena, Italy.
  • AUSL della Romagna-Forlì/Cesena Diabetes Center, Cesena, Italy.
  • AUSL Parma-Distretto di Fidenza Diabetes Center (PR), Fidenza, Italy.
  • Azienda Ospedaliera Parma-University of Parma Endocrinology and Diabetes Center, Parma, Italy.
  • Azienda Policlinico Sant'Orsola-University of Bologna Endocrinology and Diabetes Center, Bologna, Italy.
  • AUSL della Romagna-Ravenna Diabetes Center, Diabetes Unit, Local Healthcare Authority of Romagna, 48100, Ravenna, Italy.
  • AUSL Ferrara-Ferrara Diabetes Center, Ferrara, Italy.
  • AUSL Reggio Emilia-Reggio Emilia Diabetes Center, Reggio Emilia, Italy.
  • AUSL Reggio Emilia-Montecchio Diabetes Center, Reggio Emilia, Italy.
  • AUSL Imola-Imola Diabetes Center, Imola, Italy.
  • Center for Outcomes Research and Clinical Epidemiology-CORESEARCH, Pescara, Italy.
  • AUSL della Romagna-Ravenna Diabetes Center, Diabetes Unit, Local Healthcare Authority of Romagna, 48100, Ravenna, Italy.

Abstract

INTRODUCTION

The expanding range of therapeutic options for type 2 diabetes (T2D) calls for a reassessment of clinical scenarios in which existing glucose-lowering therapies might be substituted with the oral glucagon-like peptide 1 receptor agonist (GLP-1 RA) semaglutide (OS). In light of the numerous unresolved questions, a panel of experts was convened to develop practical guidance for clinicians using the Delphi consensus method.

METHODS

A panel of 13 experts formulated 31 statements addressing the following clinical scenarios: switch from injectable GLP-1 RA to OS; switch from sodium-glucose cotransporter 2 inhibitor to OS; switch from insulin to OS; switch from dipeptidyl peptidase 4 inhibitor (DPP4i) to OS; switch from "old" oral therapies (i.e., sulfonylureas, glinides, pioglitazone, acarbose) to OS. A panel of 28 diabetologists from the Emilia-Romagna region evaluated each statement by assigning a relevance score on a 9-point scale via a dedicated online platform. The RAND/UCLA Appropriateness Method was employed to determine the presence of disagreement among panelists.

RESULTS

Panelists showed agreement for all 31 statements, all considered relevant. Panelists agreed that in many circumstances OS can represent a valuable alternative to injectable GLP-1 RAs, other oral glucose-lowering drugs, and insulin. The selection of OS is justified by its proven effectiveness in reducing glycated hemoglobin and body weight, as well as its positive impact on cardiovascular outcomes and all-cause mortality. Furthermore, OS can allow a simplification of therapy in patients treated with insulin.

CONCLUSION

In an ever-evolving therapeutic landscape, OS therapy stands as a valuable option in the management of patients with T2D.

MeSH

Diabetes Mellitus, Glucagon-Like Peptide 1, Insulin, Therapeutics, Diabetes Mellitus, Type 2, Semaglutide