When it comes to managing weight loss and diabetes, the right medication can make all the difference. At Genesis Lifestyle Medicine, we understand that the choice between oral Semaglutide and injections can be difficult. This article sheds light on the key differences between these two forms of GLP-1 receptor agonists.

Background: what are GLP-1 receptor agonists?

Before diving into the specifics of oral Semaglutide and injections, it's important to understand what GLP-1 receptor agonists are and how they work. GLP-1, or glucagon-like peptide-1, is a hormone that plays a crucial role in regulating blood sugar levels and appetite.

When you eat, GLP-1 is released from the intestines, stimulating insulin secretion, which helps lower blood sugar levels. Additionally, GLP-1 slows down the emptying of the stomach, leading to a feeling of fullness, which can reduce food intake and support weight loss. GLP-1 receptor agonists like Semaglutide mimic the effects of this hormone to manage type 2 diabetes and support weight loss. These medications improve blood sugar control and promote weight loss by reducing appetite and food intake. 

Oral Semaglutide

Marketed under the brand name Rybelsus, oral Semaglutide offers a convenient alternative to injections. The unique challenge with oral administration is ensuring the medication survives the harsh environment of the stomach and is absorbed effectively into the bloodstream. It uses an absorption enhancer called SNAC (sodium N-(8-(2-hydroxybenzoyl)amino)caprylate) to overcome this issue. This enhancer helps the medication pass through the stomach lining and into the bloodstream, where it can exert its effects on the GLP-1 receptors.

Benefits of oral Semaglutide:

• Convenience: One of the main advantages of oral Semaglutide is its ease of use. Many people find taking a pill once a day more convenient than administering injections. This can be particularly beneficial for individuals with busy lifestyles or those who travel frequently.
• Reduced discomfort: For those who have a fear of needles or experience discomfort with injections, oral Semaglutide offers a pain-free alternative. This can make a significant difference in adherence to the medication regimen.
• Improved adherence: The simplicity of taking a daily pill can lead to better adherence to the medication regimen, potentially improving outcomes. Adherence is crucial for achieving the desired therapeutic effects and maintaining long-term health benefits.

Potential drawbacks of oral Semaglutide:

• Absorption issues: Oral medications can have variable absorption rates due to stomach acidity and the presence of food. This can affect the consistency of the drug’s effectiveness. It is recommended to take oral Semaglutide on an empty stomach with a small amount of water and to avoid eating or drinking anything else for at least 30 minutes afterward.
• Daily dosing: Unlike injectable GLP-1 receptor agonists, which are administered weekly, oral Semaglutide requires daily dosing, which might be less convenient for some individuals. Daily dosing increases the patient's responsibility to remember to take their medication consistently.

Injectable Semaglutide

Injectable Semaglutide, marketed under the brand name Ozempic and Wegovy, has been available for longer and has a robust track record of efficacy and safety. It is administered subcutaneously (under the skin) and works by mimicking the GLP-1 hormone. Once injected, Semaglutide is absorbed directly into the bloodstream, bypassing the digestive system. This ensures consistent absorption and effectiveness, as the medication reaches the GLP-1 receptors without being affected by factors like stomach acidity.

Benefits of Semaglutide injections:

• Consistent absorption: Semaglutide Injections provide more consistent and reliable absorption of the medication compared to oral forms. This can lead to more stable blood sugar control and weight management. The medication's direct entry into the bloodstream ensures that it can exert its effects efficiently.
• Longer dosing intervals: Injectable Semaglutide is administered once weekly, which can be more convenient and lead to better adherence for some individuals. The longer dosing interval reduces the frequency of medication administration, which can be more manageable.
• Proven results: Injectable Semaglutide has been extensively studied and has demonstrated significant benefits in managing type 2 diabetes and promoting weight loss. Clinical trials have shown their efficacy in helping patients lose up to 14.9% of their initial weight in a few months.

Potential drawbacks of Semaglutide injections:

• Discomfort and fear of needles: The need for injections can be a barrier for individuals who have a fear of needles or experience discomfort with injections. This can impact their willingness to start or continue the medication.
• Storage requirements: Injectable medications often require refrigeration, which can be less convenient for travel and storage. Patients need to be mindful of storing their medication properly to maintain its efficacy.

Oral Semaglutide vs. injectable Semaglutide

Blood sugar control

Both oral and injectable GLP-1 receptor agonists are effective at lowering blood sugar levels. A study published in Diabetes Therapy found that oral Semaglutide at a dose of 14 mg was as effective, if not more so, at lowering blood sugar levels compared to its injectable counterparts. This challenges the previous notion that injectable forms, particularly Semaglutide (Ozempic), have superior efficacy. The study highlights that oral semaglutide can achieve significant reductions in HbA1c levels, making it a viable alternative for effective glycemic control.

Weight loss

Both oral Semaglutide (Rybelsus) and injectable Semaglutide (Ozempic) have been shown to promote weight loss effectively. The same meta-analysis mentioned above also indicated that oral Semaglutide at 14 mg is comparable to injectable Semaglutide in promoting weight loss. However, patients with gastrointestinal issues may benefit more from injectable Semaglutide because they may have trouble absorbing oral medications. This can also be attributed to the higher and more consistent drug levels achieved with injections, which enhance the appetite-suppressing and metabolic effects of the medication.

Safety and side effects

Both forms of GLP-1 receptor agonists have similar safety profiles, with common side effects including nausea, vomiting, and diarrhea. These side effects are generally mild and tend to decrease over time as your body adjusts to the medication. However, because oral Semaglutide requires daily dosing, some individuals may experience more frequent gastrointestinal side effects initially. Injectable forms, with their longer dosing intervals, may lead to less frequent occurrences of these side effects.

At Genesis Lifestyle Medicine, we are committed to helping you achieve your health goals with personalized care and expert guidance. Both oral and injectable Semaglutide have their unique advantages and potential drawbacks. By understanding your preferences, lifestyle, and health needs, we can help you make the best choice for your weight loss goals.