The prevalence of type 2 diabetes is on an increase worldwide and is tightly linked with an increase in overweight and obesity. The burden of the disease has increased each year and appears to be more as individuals age. In the United States, about 11.3% of the total population have diabetes and this includes 28.5 million adults (Davies et al., 2021). The effects of this disease are long-term and include vascular complications, heart disease, and increased healthcare costs. To effectively manage the disease, pharmacological and lifestyle changes are used. Among the recently approved pharmacological management of type 2 diabetes is semaglutide, a glucagon-like peptide 1 receptor agonist. This drug is available s a once-weekly dose and is thought to be more effective than the daily insulin doses in managing HbA1c levels. This discussion compares the effectiveness of semaglutide to other antidiabetic agents in managing type 2 diabetes.
Pharmacotherapy for type 2 diabetes management usually aims at reducing A1c levels using different classes of drugs. The purpose of this review is to determine the effectiveness of the weekly injectable semaglutide compared to daily insulin doses in managing type 2 diabetes.
Practice Problem and PICO Question
Type 2 diabetes mellitus is a chronic problem characterized by defects in glucose metabolism. During the management of the disease, oral medication like metformin is usually recommended but sometimes can fail to achieve the desired glucose levels. The alternative is to use injectable insulin that is administered daily with dosage depending on the blood sugar levels of the patient. However, the majority of the patients develop insulin resistance making it ineffective in managing diabetes. For instance, about 3% of patients diagnosed with the disease develop resistance (Pearson et al., 2019). Additionally, the use of injectable insulin is observed to cause weight gain and hypoglycemia is not well monitored. Administering daily doses of insulin puts individuals at risk for hypoglycemia and weight gain can predispose individuals to hypertension and obesity (Andreadis et al., 2018). To address this challenge, Semaglutide is an alternative drug available to reduce HbA1c levels for diabetic patients while addressing the challenges of weight gain and hypoglycemia.
PICO question: Do Type II diabetes patients (P) who received insulin injections (Semaglutide) once a week (I) have improved blood glucose levels (O) than those who receive daily insulin injections (C)?
The PICO question focuses on patients with type 2 diabetes mellitus receiving daily insulin injections. The effectiveness of this injection is questionable because of the risks observed including weight gain and hypoglycemia. To address this problem, this question compares the use of semaglutide, a glucagon-like peptide 1 receptor agonist administered once weekly, in reducing blood glucose levels.
Role of Appraisal of Evidence
Evidence appraisal during research is the process of examining research to judge its value and relevance in a particular context. Appraisal of evidence helps to reduce the burden of finding research that is relevant to the topic of discussion. It helps in finding high-quality evidence that can be used to inform changes in healthcare practices. Type 2 diabetes is a chronic condition that requires long-term management and effective treatment should be supported by evidence. Semaglutide is a new treatment approach that requires enough evidence to support its use in addressing blood glucose levels compared to current treatment measures. Appraisal of evidence could be an important step to identify high-level evidence available to support its effectiveness in clinical practice.
Practice Problem and Question
Diabetes is a chronic condition that can cause individuals to become fatigued, feel extreme hunger, and experience more serious complications (Zhong et al., 2021). It makes it difficult to perform activities of daily living and healthcare costs associated with the disease make life difficult for patients and families. Diabetes can cause complications like vision loss, the risk of developing dementia, and vascular complications that can be fatal (Shi et al., 2018). During routine care, patients are subjected to daily oral and injectable doses of drugs to manage their blood sugar levels. This exercise can be tedious to healthcare providers and patients and can also cause harm or risk for infection. Changing management approaches to type 2 diabetes using weekly doses of semaglutide can be an important step towards reducing associated risks. This drug is thought to effectively control HbA1c levels within the required limits and helps in reducing the weight that is associated with diabetes.
Population (P)- Do type 2 diabetes patients
Intervention (I)- who receive weekly semaglutide insulin injection
Comparison (C)- compared to those receiving daily insulin injections
Outcome (O)- improve blood glucose levels
Time (T)- over three months implementation period?
To assess the effectiveness of the semaglutide weekly injections for type 2 diabetes management, a literature review was done. The articles selected for the evidence synthesis were obtained following an electronic search with key terms including type 2 diabetes, semaglutide, injectable insulin, and diabetes management. Five articles are selected for this review and all focus on the effectiveness of semaglutide drug in managing type 2 diabetes.
Main Points From Evidence and Comparison
The first article selected for appraisal aimed at assessing the efficacy of semaglutide in managing type 2 diabetes. The systematic review analyzed various RCTs that used semaglutide to manage diabetes across different populations. It was observed that subcutaneous semaglutide reduced HbA1c levels and demonstrated superior efficacy compared to other antidiabetic agents (Andreadis et al., 2018). The researchers concluded that weekly doses of semaglutide can be effective in reducing HbA1c, body weight, and systolic blood pressure in diabetic patients. In another review, it was observed that oral semaglutide has proven its efficacy in lowering glucose levels and is highly well-tolerated (Pearson et al., 2019). It was found that semaglutide can be considered as second-line therapy after metformin for control of blood glucose levels (Pearson et al., 2019). To improve adherence to the drug, oral doses should be considered, particularly in those requiring assistance from caregivers.
A randomized controlled trial was conducted to assess the efficacy and safety of subcutaneous 2.4 mg of semaglutide in managing type 2 diabetes (Davies et al., 2021). After 68 weeks of treatment, it was observed that the drug helped in the reduction of body weight by at least 5%. Overall, semaglutide 2.4 mg once weekly helped in weight reduction that could eventually contribute to diabetes management (Davies et al., 2021). In another systematic review and meta-analysis, semaglutide had significant effects in reducing HbA1c levels, fasting plasma glucose, and bodyweight of patients (Shi et al., 2018). A similar approach was used to determine the effectiveness of oral and subcutaneous semaglutide in patients with type 2 diabetes. After analyzing 24 randomized trials, the researchers found semaglutide to be effective in glycemic control and weight management without increasing the risk of hypoglycemia (Zhong et al., 2021). This evidence appraisal supports the use of semaglutide to manage both glucose levels and weight in patients with diabetes.
Diabetes imposes a substantial economic burden on patients and society. Patients with the disease spend twice as much compared to healthy individuals and have long-term effects that reduce the quality of life of patients. Complications like retinopathy and vascular complications can be fatal to patients leading to morbidity that reduces the normal functioning of patients. To address the challenge of diabetes, and evidence appraisal using recent studies was done. All the articles were relevant because they discussed the use of semaglutide to manage type 2 diabetes. The majority of the evidence selected was level 1 and utilized RCTs making the findings generalizable. The findings indicate that semaglutide can be superior in reducing glucose levels and addressing weight issues in patients with type 2 diabetes compared to daily insulin doses. However, more research is required to test the long-term effects of the drug to fully understand its efficacy in blood sugar control.
Andreadis, P., Karagiannis, T., Malandris, K., Avgerinos, I., Liakos, A., Manolopoulos, A., … & Tsapas, A. (2018). Semaglutide for type 2 diabetes mellitus: A systematic review and meta‐analysis. Diabetes, Obesity and Metabolism, 20(9), 2255-2263. https://doi.org/10.1111/dom.13361
Davies, M., Færch, L., Jeppesen, O. K., Pakseresht, A., Pedersen, S. D., Perreault, L., … & STEP 2 Study Group. (2021). Semaglutide 2· 4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): A randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial. The Lancet, 397(10278), 971-984. https://doi.org/10.1016/S0140-6736(21)00213-0
Pearson, S., Kietsiriroje, N., & Ajjan, R. A. (2019). Oral semaglutide in the management of type 2 diabetes: A report on the evidence to date. Diabetes, Metabolic Syndrome and Obesity : Targets and Therapy, 12, 2515–2529. https://doi.org/10.2147/DMSO.S229802
Shi, F. H., Li, H., Cui, M., Zhang, Z. L., Gu, Z. C., & Liu, X. Y. (2018). Efficacy and safety of once-weekly semaglutide for the treatment of type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Frontiers in Pharmacology, 9, 576. https://doi.org/10.3389/fphar.2018.00576
Zhong, P., Zeng, H., Huang, M., He, G., & Chen, Z. (2021). Efficacy and safety of subcutaneous and oral semaglutide administration in patients with type 2 diabetes: A meta-analysis. Frontiers in Pharmacology, 12, 695182. https://doi.org/10.3389/fphar.2021.695182
Table 1. Evidence Summary Table
|Author & Date||Evidence Type||Sample, Sample Size & Setting||Study findings that help answer the EBP question||
|Evidence Level & Quality|
|1||Shi et al., 2018||Systematic Review and Meta-Analysis
|Comprehensive search for phase III RCTs. 9 RCTs including 9773 subjects were included.
|Semaglutide resulted in a significant reduction of glycosated hemoglobin, fasting plasma glucose, and body mass index. Semaglutide was effective and acceptable in type 2 diabetes patients when administered once-weekly||The study is limited in the number of RCTs (9) used to establish conclusions.||Level I, Grade A|
|2||Andreadis et al., 2018||Systematic review and Meta-Analysis||Materials were searched electronically for RCTs comparing Semaglutide with placebo and other antidiabetics. 6 placebo-controlled and 7 active-controlled studies were included.
|Semaglutide doses demonstrated superior glycemic efficacy compared to other antidiabetic agents like insulin glargine, sitagliptin, and exanatide. The drug is potent once-weekly and significantly reduces HbA1c levels, body weight, and systolic blood pressure.||The study population used was small and this requires more evidence from RCTs to support this research.||Level I, Grade A|
|3||Davies et al., 2021||Randomized controlled trial (RCT).||Patients were recruited from 149 outpatient clinics in 12 countries. A total of 1595 patients were screened and 1210 randomly assigned to Semaglutide.
|Semaglutide 2.4 mg administered once-weekly was effective in managing type 2 diabetes through weight reduction compared to placebo.||The study did not provide adequate evidence on the effectiveness of Semaglutide in managing HbA1c levels that is the target of other antidiabetic agents.||Level II, Grade A|
|4||Pearson et al., 2019||Qualitative study||The authors discussed evidence on the effectiveness of oral Semaglutide and other antidiabetic agents in the management of type 2 diabetes.
|Oral semaglutide is well-tolerated and has proven to be effective in lowering HbA1c levels. The study found out that oral semaglutide can be used as a second-line therapy after metformin, especially when weight is an issue among patients.||The study findings cannot be verified because the RCTs and systematic reviews used were not fully described.||Level VI, Grade B|
|5||Zhong et al., 2019||Meta-Analysis||The authors searched for phase 3 RCTs and found 24 trials. A total of 2215 patients were included in these trials.
|The efficacy of semaglutide was superior to other antidiabetic drugs in reducing HbA1c levels. Both subcutaneous and oral drugs proved effective in managing type 2 diabetes and weight reduction without increasing the risk for hypoglycemia.||Some studies used in the meta-analysis were done in a short duration. Longer duration for these studies might be needed to validate the promising superiority of semaglutide.||Level I, Group A|
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