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For type 2 diabetes management , NICE guideline NG28 recommends considering GLP-1 receptor agonists when: Triple therapy with metformin and two other oral medications is ineffective, not tolerated or contraindicated The patient has a body mass index (BMI) of 35 kg/m or higher (with lower thresholds for people from certain ethnic backgrounds), or lower BMI with specific clinical circumstances where weight loss would benefit other obesity-related comorbidities Insulin would have significant occupational implications GLP-1 therapy should only be continued beyond six months if there has been a beneficial metabolic response, defined as a reduction in HbA1c of at least 11 mmol/mol (1.0 percentage point) and weight loss of at least 3% of initial body weight
The primary endpoints were A1C reduction and safety, not weight loss
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It is studied as a receptor-mediated signaling model rather than as an external hormone administration system
The FDA has documented dosing-error harms with compounded injectable semaglutide and warns specifically against salt forms (semaglutide sodium, semaglutide acetate) different active ingredients than the base form used in approved drugs
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