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Written by: Dr Jay Narainsamy, MBChB (Natal), FRCP (SA), MMed (UKZN), Cert Endocrinology (SA) Specialist Physician/Endocrinologist
Published: 02 August 2023

Type 2 diabetes mellitus is a largely unseen pandemic. The International Diabetes Federation estimates that 537 million people were living with diabetes worldwide in 2021 and around 4.2 million of these were in South Africa.1 The economic burden of diabetes-related complications on health care sectors and society is profound. The physical, psycho-social and emotional toll on people with diabetes is even more concerning. As health care practitioners, we need to focus on achieving glycaemic and other risk factor targets quickly and safely…

Pharmacological agents used for diabetes have evolved over the years to address more of the 11 pathophysiological pathways causing type 2 diabetes.2 The advent of sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists now allows us to address more than just glycaemic control and this sets them apart from older agents. Thus, health care practitioners can now look at using these agents with enthusiasm.

Ozempic® (semaglutide), a once weekly subcutaneous injection of the acylated peptide called semaglutide, is a newer addition the GLP-1 receptor agonist class of agents.3 GLP-1 is naturally secreted by our gastro-intestinal tract in response to food intake. Unfortunately, this hormone is rapidly destroyed by the dipeptidyl peptidase-4 inhibitor enzyme in the body. Injected analogues of GLP-1 promote satiety, slow gastric emptying, reduce glucagon secretion by alpha cells and promote glucose dependent insulin secretion.4 Through these multiple actions, this molecule goes beyond just glycaemic management.

The SUSTAIN-6 study was designed to assess cardiovascular safety of semaglutide in high-risk people with type 2 diabetes. HbA1c reductions of 0.7 and 1 percent were noted with doses of 0.5 and 1 mg of Ozempic® respectively. This finding did not make this the most potent glycaemic agent available, but there were other exciting findings which proved just as important…

A 3.6 kg weight loss was achieved with the 0.5 mg dose and a 4.9 kg loss with the 1 mg dose.5 This is an attractive ‘side effect’ when managing clients who are struggling with issues of weight (excess adiposity) and the consequences thereof. I must state emphatically that Ozempic® is NOT registered for weight loss in South Africa. Unfortunately, the off-label prescription of this agent for weight loss by unscrupulous health care providers has led to a global shortage of Ozempic®, leaving truly deserving clients unable to source the agent.

The SUSTAIN-6 trial also demonstrated a 26% lower risk of the primary composite outcome of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. So Ozempic® was not only safe but beneficial in certain clients, making Ozempic® an attractive agent for clients with high cardiovascular risk. Healthcare practitioners can now offer glucose management and cardiovascular risk reduction with a single agent.

Public figures like Elon Musk have created so much media buzz around semaglutide that the true value of this agent has been lost in all the chaos. It is being abused and over-prescribed with no thought of the consequences. Ozempic®, like any other agent, can have issues and this has been underplayed in the media frenzy. Side effects of Ozempic® include pancreatitis and other gastro-intestinal issues, and clients need to be counselled fully before starting treatment.

I am as excited about Ozempic® as any other health care practitioner. In the right person, it can be a game changer. However, the ongoing abuse and over-prescription of this agent is clouding its proper use and potential benefits. I hope that this quick overview of Ozempic® highlights is actions, correct use, and benefits. I also hope that the insights provided inspire health care professionals to take the time to choose the correct person who may reap the benefits of this exciting agent.


  1. International Diabetes Federation (2021). IDF Diabetes Atlas, 10th Brussels, Belgium. Available at:
  2. Schwartz SS, et al. (2016). The Time Is Right for a New Classification System for Diabetes: Rationale and Implications of the β-Cell-Centric Classification Schema. Diabetes Care. 39(2):179-86. DOI: 10.2337/dc15-1585.
  3. Drucker DJ (2018). Mechanisms of Action and Therapeutic Application of Glucagon-like Peptide-1. Cell Metabolism. Apr 3;27(4):740-756. DOI: 10.1016/j.cmet.2018.03.001.
  4. Nauck MA et al. Diabetologia 1986; 29: 46‒52. 2. Drucker DJ. Diabetes 1998; 47: 159‒169. 3. Flint A et al. J Clin Invest 1998; 101: 515‒520. 4. Larsson H et al. Acta Physiol Scand 1997; 160: 413‒422. 5. Nauck MA et al. Diabetologia 1996; 39: 1546‒1553.
  5. Marso et al. (2016) Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 375:1834-1844
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