How the new GLP-1 option works for difficult-to-control diabetes

Semaglutide offers a therapeutic approach that not only lowers blood sugar but also addresses excess weight and the cardio-renal risks that often shape long-term outcomes for people with type 2 diabetes.

“Going by the available evidence on once-weekly semaglutide, it has shown strong and consistent performance across global clinical trials. Patients on this therapy have experienced substantial reductions in HbA1c, often beyond what is achieved with traditional oral medications,” says noted internist Dr. K. K. Vijay.

“The drug also supports weight loss by acting on appetite-regulation centres in the brain,” he adds.

For many people with type 2 diabetes, weight reduction is not just beneficial for overall metabolic health but is closely linked to durable glycaemic control. Large outcome trials have also demonstrated cardiovascular and kidney benefits, with semaglutide reducing the risk of major adverse cardiovascular events and slowing the progression of chronic kidney disease in at-risk individuals.

GLP-1 receptor agonists are now among the most recommended therapeutic classes in international diabetes guidelines, particularly for patients with elevated cardiovascular risk. Ozempic works by mimicking the GLP-1 hormone, enhancing glucose-dependent insulin secretion, slowing gastric emptying, reducing appetite and regulating food intake. Because it targets multiple metabolic pathways, it improves blood sugar control, aids weight loss and provides organ-protective effects. Its once-weekly FlexTouch pen delivery adds convenience for patients who struggle with multi-drug regimens, as widely reported in leading medical journals.

According to Novo Nordisk, Ozempic has completed nearly a decade of global clinical use and arrives as an important addition to India’s limited pool of advanced diabetes therapies.

The company said on Friday that Ozempic will be available in India in 0.25 mg, 0.5 mg and 1 mg strengths, allowing physicians to escalate doses gradually and minimise early gastrointestinal side effects.

However, the therapy’s overall impact in India will depend heavily on accessibility and affordability. Since most patients pay out of pocket, cost may limit early adoption. The initial 0.25 mg pen is priced at Rs 8,800, followed by Rs 10,170 for the 0.5 mg strength and Rs 11,175 for 1 mg. Each pen contains four weekly doses. While the company maintains that prices have been localised for India, patient groups argue that the therapy remains considerably more expensive than most conventional diabetes medications.

As a result, insurance coverage, public procurement policies and patient-assistance programmes will play a decisive role in determining who can benefit from the drug. India’s pharmaceutical landscape is also expected to evolve over the next few years as patents expire and domestic manufacturers prepare semaglutide formulations, which may improve affordability but will require stringent regulatory oversight to ensure quality and safety.

For clinicians, Ozempic presents a strong option for adults with type 2 diabetes who need both glycaemic control and weight management, as well as for those with high cardiovascular risk. Careful patient selection, however, remains essential. Physicians must monitor for gastrointestinal discomfort, pancreatitis, gallbladder disorders and adherence to dose-escalation protocols.

Medical experts emphasise that the drug is not suitable for individuals with a history of medullary thyroid carcinoma or certain endocrine conditions and should not be used during pregnancy. They also warn against off-label or cosmetic use, especially amid growing global interest in semaglutide for weight loss among people without diabetes.