A prescription that doctors don't want to prescribe: the double-edged "weight loss drug" semaglutide

Summer is here, and many endocrinologists have probably encountered the same problem: girls who are obviously healthy ask doctors to prescribe semaglutide. A closer look reveals that their purpose is to lose weight. This drug is praised as a "weight loss magic" on the Internet, and it is said that "one injection can make you lose 8kg", so it has attracted the attention of many people who need to lose weight.

However, this so-called "magic weight-loss tool" is a prescription drug used to treat type 2 diabetes (T2DM). Whether at home or abroad, the use of semaglutide is subject to many precautions and conditional restrictions. It is not a "magic weight-loss tool" that everyone can use.

01 Indications for semaglutide

Semaglutide is suitable for the control of blood sugar in adult patients with T2DM, and for adult patients with T2DM whose blood sugar is still poorly controlled after treatment with metformin and/or sulfonylurea drugs on the basis of diet control and exercise. At the same time, it is suitable for reducing the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction or non-fatal stroke) in adult patients with T2DM and cardiovascular disease.

Its mechanism of action is to stimulate insulin secretion and inhibit glucagon secretion in a glucose concentration-dependent manner, thereby exerting a hypoglycemic effect, but it does not change the reverse regulatory response of elevated glucagon in T2DM patients, and will not reduce C-peptide levels. At the same time, it can act on the liver, adipose tissue, and skeletal muscle, increasing the uptake of glucose by adipose tissue and muscle, inhibiting the production of glucose in the liver, and thus exerting a hypoglycemic effect.

In addition, semaglutide can also induce appetite suppression of fasting blood sugar and postprandial blood sugar, reduce the desire for food, reduce the patient's preference for high-fat food, improve the first and second phase insulin secretion of T2DM patients, and increase the maximum secretion capacity of pancreatic B cells in T2DM patients. Sensory information is transmitted to the hypothalamic feeding center through the vagus nerve afferent center, stimulating the neurons that regulate appetite intake to inactivate them and reduce food intake. At the same time, it plays a protective role by increasing satiety, inhibiting gastric emptying, reducing gastrointestinal motility, reducing the secretion of gastric acid by parietal cells, and increasing the secretion of gastrointestinal mucus.

02 People who should not take semaglutide

The following people are contraindicated in taking semaglutide:

1. Those who are allergic to the active ingredients of this product or any excipients in this product;

2. Patients with a personal or family history of medullary thyroid cancer, or multiple endocrine neoplasia syndrome type 2;

3. It is not a substitute for insulin, so it is not recommended for patients with type 1 diabetes, pregnant women or patients with diabetic ketoacidosis;

4. Since there is no experience in using it in patients with New York Heart Association grade IV congestive heart failure, it is not recommended for use in such patients;

5. People with a history of acute pancreatitis and a family history of multiple endocrine neoplasia should not use this product.

03 Common adverse reactions of semaglutide

The most common adverse reactions listed in the instructions for semaglutide injection/tablets include nausea, diarrhea and hypoglycemia (when used in combination with insulin or sulfonylurea); common adverse reactions include dizziness, fatigue, vomiting, abdominal pain, abdominal distension, indigestion, belching, etc.; occasional adverse reactions include allergies, injection site reactions, increased heart rate, taste disorders, etc.

The latest version of the instructions for 2021 shows that semaglutide can increase the risk of thyroid C-cell tumors in rats, but this has not been confirmed in humans. At the same time, it is still unclear whether it can cause other adverse drug reactions such as pancreatitis and diabetic retinopathy. Therefore, when prescribing such drugs, clinicians should carefully warn patients to pay attention to the occurrence of adverse reactions.

In my country, semaglutide is only approved for the treatment of adult T2DM and reducing the risk of adverse cardiovascular events in patients with T2DM and cardiovascular disease, but its weight loss indication has not yet been approved. In addition, there are many adverse reactions and contraindications to the use of semaglutide, so patients need to obtain the drug through regular hospital channels and use it under the guidance of a doctor.

References:

[1] Sun Qian, Tan Wei. Research progress of semaglutide in the treatment of obese type 2 diabetes[J]. Chinese Modern Doctor, 2022, 60(29): 117-120.

[2] Qu Han, Wu Zhenghua, Shi Chenyang, et al. Detection and analysis of adverse reaction signals of semaglutide[J]. Chinese Journal of Clinical Pharmacy, 2022, 31(20): 88-93.