What Happens to Patients With Diabetes When Semaglutide Dosing Is Disrupted? Dr Ian Neeland Explains

The potential long-term consequences for patients with diabetes forced to switch to alternative medications during the semaglutide shortage include the risk of losing ground in glycemic control, having uncontrolled diabetes with associated symptoms, and other adverse events, according to Ian Neeland, MD. Neeland is the director of cardiovascular prevention and co-director of the Center for Integrated and Novel Approaches in Vascular-Metabolic Disease at the University Hospitals Harrington Heart & Vascular Institute, as well as associate professor of medicine at Case Western Reserve University School of Medicine.

Transcript

Can you elaborate on the potential long-term consequences for patients with diabetes who are forced to switch to alternative medications amid the shortage?

Switching for these medications, as I mentioned, requires starting at lower doses and escalating those doses over time. So, you may lose ground when you're switching from one to the other in terms of your glycemic control, and you can have poor control for that during that period of time, whereas previously things were stable. And obviously, when you create an unstable situation of diabetes control, that can lead to symptoms or adverse consequences that you would see with uncontrolled diabetes, so that is certainly a concern over that. There are definitely plenty of options for diabetes management, though, so if one drug has to be stopped for a while, there are others that can be substituted, although many of the others don't have the same cardiovascular or kidney benefits as things like the GLP-1 receptor agonists or the GIP receptor agonist.

It's important to try to maintain glycemic control in the context of guideline-based, evidence-based therapies that have benefits for cardiometabolic kidney in general, as opposed to something like a sulfonylurea instead, which really can control blood sugar but has no other positive cardiovascular benefit. I think that creates an issue, and switching from one drug to the other, you can create adverse issues like side effects that can occur. Often when patients will stop a medication because of a drug shortage, one of these injectable medications, what they do is they start back at the dose they were previously on, and that's usually a bad idea because the side effects can be very severe. For example, I had a patient who was on 2 milligrams of semaglutide and had to stop for whatever reason for several weeks, and they started again, but they start at the 2 milligram dose and they got pretty ill. That's an issue and a concern which obviously can be mitigated with education, counseling, appropriate information for the patients, but anytime you're kind of switching things up and moving things around, things get lost in translation and you may have issues, controlling blood sugar and controlling risk factors.