Department of Medicine, Donald and Barbara Zucker School of Medicine, Hofstra/Northwell University , New York, NY, USA.
Primary Care Department, College of Osteopathic Medicine, Touro University California , Vallejo, CA, USA.
Postgrad Med. 2020 Nov;132(8):687-696. doi: 10.1080/00325481.2020.1788340. Epub 2020 Jul 9.
As the cornerstone of type 2 diabetes (T2D) management within the community, primary care providers are now faced with the challenge of not only managing diabetes itself, but also preventing hypoglycemia and weight gain associated with intensive disease management, and reducing cardiovascular risk. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are well established as efficacious treatments for T2D, and the safety/tolerability profile of this drug class is well defined. However, despite their beneficial effects, GLP-1RAs are under-utilized, highlighting the need for novel approaches to increase their use in primary care. Oral semaglutide is the first oral GLP-1RA approved for the treatment of T2D, offering glucose lowering and body weight loss, a low risk of hypoglycemia, and no increase in cardiovascular risk. Oral semaglutide represents an additional treatment option for patients not achieving their glycemic goal despite treatment with metformin, either alone or with other hypoglycemic agents. Oral semaglutide has the potential to increase usage of GLP-1RAs in the primary care setting by addressing clinician and patient concerns about injections, and may facilitate earlier initiation of GLP-1RA therapy in T2D. Due to the formulation of oral semaglutide, clinicians need to be aware of specific considerations in order to ensure optimal use. Such considerations include dosing conditions and use of concomitant medications. This article provides practical guidance on the use of oral semaglutide in the primary care setting, based on evidence from clinical studies, including the phase 3a PIONEER program, and the authors' clinical experience.
作为社区 2 型糖尿病（T2D）管理的基石，初级保健提供者现在不仅面临着管理糖尿病本身的挑战，还面临着预防与强化疾病管理相关的低血糖和体重增加以及降低心血管风险的挑战。胰高血糖素样肽-1 受体激动剂（GLP-1RAs）已被证明是治疗 T2D 的有效药物，并且该药物类别的安全性/耐受性特征已得到很好的定义。然而，尽管它们具有有益的作用，但 GLP-1RAs 的应用不足，这凸显了需要采用新方法来增加它们在初级保健中的应用。口服司美格鲁肽是第一种获批用于治疗 T2D 的口服 GLP-1RA，可降低血糖和体重，低血糖风险低，且不增加心血管风险。对于尽管使用二甲双胍单独或与其他降糖药物治疗仍未达到血糖目标的患者，口服司美格鲁肽代表了另一种治疗选择。口服司美格鲁肽通过解决临床医生和患者对注射的担忧，有可能增加 GLP-1RA 在初级保健环境中的使用，并可能促进 T2D 中 GLP-1RA 治疗的更早开始。由于口服司美格鲁肽的配方，临床医生需要了解特定的注意事项，以确保最佳使用。这些注意事项包括剂量条件和同时使用其他药物。本文根据来自临床研究的证据，包括 3a 期 PIONEER 计划和作者的临床经验，提供了在初级保健环境中使用口服司美格鲁肽的实用指南。
