Semaglutide in Diabetes Therapy: Analysis of Benefits and Risks
Semaglutide has become one of the most discussed treatments for managing type 2 diabetes and controlling body weight. However, along with its high efficacy in glycemic regulation, this drug has several physiological characteristics and potential adverse reactions. Before starting therapy, it is important to understand exactly how this substance affects the body and what risks a patient might face.
How semaglutide affects the human body
Semaglutide belongs to the class of glucagon-like peptide-1 (GLP-1) receptor agonists, which mimic the physiological action of the natural incretin hormone produced in the intestine in response to food intake. Unlike the natural hormone, which is degraded by the DPP-4 enzyme within minutes, the molecular structure of semaglutide is resistant to cleavage, allowing the drug to circulate in the bloodstream for a long time. The primary mechanism of action lies in the glucose-dependent stimulation of insulin secretion by pancreatic beta cells. This means that the drug activates insulin release only when glucose levels exceed the physiological norm, substantially minimizing the risk of dangerous hypoglycemic states. Simultaneously, the substance suppresses excessive glucagon secretion by alpha cells, reducing glucose production by the liver. An additional important aspect of its action is the slowing of gastric emptying and a direct effect on satiety centers in the hypothalamus. Thanks to this, the patient experiences a long-lasting feeling of fullness after consuming a small amount of food, which facilitates adherence to dietary recommendations and prevents overeating.
Key health benefits of therapy
Modern clinical trials demonstrate a comprehensive positive impact of semaglutide on various organ systems. The American Diabetes Association (ADA) notes that the drug is highly effective in reducing cardiovascular risks in adults with type 2 diabetes and concomitant cardiac pathologies. In particular, the SOUL study, the results of which were presented at the ADA Scientific Sessions, confirmed that the use of oral semaglutide reduces the risk of major adverse cardiovascular events (MACE) by 14%. Another significant study, STRIDE, revealed a major vascular effect in patients with type 2 diabetes and peripheral artery disease: the therapy helped improve walking capacity and reduced the risk of vascular disease progression by 54%. In older patients with uncontrolled diabetes, adding semaglutide to basic therapy led to a reduction in the average glycated hemoglobin (HbA1c) level by 1.5% and shortened the daily insulin dose by an average of 22.5%, according to scientific reports from 2026. Also, a significant meta-analysis by the Cochrane Collaboration, which covered 18 randomized controlled trials involving more than 27,900 adults, confirmed the high and stable efficacy of the substance in reducing excess body weight. Furthermore, clinical observations prove a significant nephroprotective effect of the drug, expressed in slowing the rate of decline in the glomerular filtration rate in patients with chronic kidney disease.
Risks and side effects of treatment
Despite significant benefits, semaglutide therapy requires careful monitoring due to the likelihood of side effects and the presence of clinical limitations. The most common complications during drug intake are gastrointestinal disorders, such as severe nausea, vomiting, diarrhea, flatulence, and prolonged constipation. These symptoms typically occur during the dose escalation phase and gradually disappear. However, the medical community, relying on FDA data and clinical trial reports, draws attention to more serious risks. These include the threat of acute pancreatitis, acute kidney injury due to dehydration, as well as gallbladder diseases, including cholecystitis. In addition, data released at the ADA Scientific Sessions showed that rapid weight loss with GLP-1 agonists is accompanied by a significant reduction in muscle mass, which can range from 15% to 40% of the cumulative weight loss, requiring mandatory strength training and monitoring of protein intake. The drug is strictly prohibited for pregnant women, as well as patients with a personal or family history of medullary thyroid carcinoma and in multiple endocrine neoplasia syndrome type 2. There are also reports of a risk of diabetic retinopathy progression in patients with pre-existing vascular retinal damage.
Practical conclusion
Semaglutide represents a revolutionary direction in the treatment of type 2 diabetes, combining glycemic control, cardioprotection, and weight reduction, but its use is not a universal solution for everyone. Any steps regarding starting therapy, selecting an injectable or oral form, as well as adjusting the therapeutic plan must occur exclusively by recommendation of a doctor and after a comprehensive examination of the state of the heart, kidneys, and thyroid gland. To achieve a stable result and minimize adverse events, patients should discuss with their doctor a concomitant nutritional plan with sufficient protein content and regular physical activity to preserve muscle tone.
Sources
ADA. Ozempic | American Diabetes Association - ADA Consumer Guide (2026)
Cochrane Library. Semaglutide for adults living with obesity (2025)
NIH. Semaglutide: Double-edged Sword with Risks and Benefits (2025)
