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"There's nothing in the current evidence that raises unique safety red flags" beyond the known GLP-1 side effects and risks, says Srivastava
The standard protocol from the SUSTAIN trials (Marso et al., New England Journal of Medicine , 2016): Reduce basal insulin dose by 20% on the day you start semaglutide Monitor fasting blood glucose daily for the first 2 weeks Further reduce basal insulin by 10 to 20% if fasting glucose drops below 80 mg/dL or if hypoglycemia occurs Reduce mealtime (bolus) insulin by 20 to 30% during semaglutide titration, adjusting based on post-meal glucose readings Most patients on basal insulin end up reducing total daily insulin dose by 30 to 50% by the time they reach maintenance semaglutide dose
Notably, trials involving type 2 diabetes populations exhibited a higher odds ratio for NAION compared to obesity trials, reinforcing existing literature indicating that metabolic syndrome and type 2 diabetes may be significant risk factors for NAION, the authors noted
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