GUEST BLOG by Dr. Mansur Shomali, Endocrinologist and co-author of the Health & Wellness Series
For those of you who have followed my blogs or read our books, you know how big a fan I am of the class of diabetes medications known as glucagon-like peptide 1 receptor agonists, affectionately known as the GLP-1s. These medications lower glucose (blood sugar) and they don’t usually cause hypoglycemia, plus they help with weight loss. And most of them have been proven to reduce the risk of bad cardiovascular events like heart attacks and strokes. Until now, all have been injectable drugs, and some of them (Trulicity, Ozempic, and Bydureon) can be conveniently dosed once a week.
Rybelsus, the newest member of the GLP-1 class to be approved in the U.S. and Canada, differs from the others in that it comes as a pill, not an injectable medication. Rybelsus actually contains the same active ingredient of Ozempic, which is semaglutide. Therefore, Rybelsus and Ozempic are expected to have similar effects on the human body.
The manufacturer of Rybelsus did not carry out a head-to-head study against Ozempic to compare their effects. There is a cardiovascular study for Ozempic that shows it lowers cardiovascular risk. Rybelsus hasn’t been studied exactly that way. We do know that Rybelsus does not increase cardiovascular risk, and people with diabetes who take it have a good chance of getting their A1C down to less than 7% with a significant amount of weight loss.
Rybelsus is not usually the first medication prescribed when someone is diagnosed with type 2 diabetes. In most cases, metformin is the first medication. Most people with type 2 diabetes need more than one medication to control the glucose. In that case, your health care professional (HCP) has lots of choices, Rybelsus among them.
Rybelsus comes in three doses: 3 mg, 7 mg, and 14 mg tablets. Most people start off with the 3 mg dose. It must be taken 30 minutes before eating breakfast and with no more than 4 oz of plain water. It is important to take it correctly so that the dose can be absorbed into your body properly. After 30 days, your HCP should increase your dose to 7 mg. 3 mg is only a starting dose. After 30 more days, if your glucose levels aren’t where they need to be, your HCP may increase the dose to 14 mg.
There are no perfect medications. Some people get side effects when starting Rybelsus. The most common ones are mild nausea, vomiting, and diarrhea. These side effects get less with use. There are more serious warnings on the product label. There is a safety warning about Rybelsus causing thyroid tumors. This warning is present for all the GLP-1 medications. Thyroid tumors have been seen in studies with rodents. They don’t seem to be a problem for people, but, in order to remain cautious, the US FDA and Health Canada have kept this warning.
In summary, Rybelsus is a good option for someone with type 2 diabetes who needs more help than metformin can give by itself. It is especially useful for someone who strongly prefers pills over injections. In someone with heart disease, using one of the once-weekly injectable GLP-1 medications may be a better choice since they are shown to reduce the risk of future cardiovascular events. Most of my patients find the once-weekly injections really easy and convenient. As always, discuss your diabetes treatment options with your health care team.