Introduction: The expanding range of therapeutic options for type 2 diabetes (T2D) calls for a reassessment of clinical scenarios in which existing glucose-lowering therapies might be substituted with the oral glucagon-like peptide 1 receptor agonist (GLP-1 RA) semaglutide (OS). In light of the numerous unresolved questions, a panel of experts was convened to develop practical guidance for clinicians using the Delphi consensus method.
Methods: A panel of 13 experts formulated 31 statements addressing the following clinical scenarios: switch from injectable GLP-1 RA to OS; switch from sodium-glucose cotransporter 2 inhibitor to OS; switch from insulin to OS; switch from dipeptidyl peptidase 4 inhibitor (DPP4i) to OS; switch from "old" oral therapies (i.e., sulfonylureas, glinides, pioglitazone, acarbose) to OS. A panel of 28 diabetologists from the Emilia-Romagna region evaluated each statement by assigning a relevance score on a 9-point scale via a dedicated online platform. The RAND/UCLA Appropriateness Method was employed to determine the presence of disagreement among panelists.
Results: Panelists showed agreement for all 31 statements, all considered relevant. Panelists agreed that in many circumstances OS can represent a valuable alternative to injectable GLP-1 RAs, other oral glucose-lowering drugs, and insulin. The selection of OS is justified by its proven effectiveness in reducing glycated hemoglobin and body weight, as well as its positive impact on cardiovascular outcomes and all-cause mortality. Furthermore, OS can allow a simplification of therapy in patients treated with insulin.
Conclusion: In an ever-evolving therapeutic landscape, OS therapy stands as a valuable option in the management of patients with T2D.
Keywords: Delphi method; Expert consensus; Oral semaglutide; Type 2 diabetes.
© 2025. The Author(s).