GLP-1 receptor agonists (GLP-1 RAs) are among the most successful medications for treating people with type 2 diabetes mellitus (T2DM), giving reasonable glycemic control with a low risk of hypoglycemia in those who have failed to control their condition with other oral anti-diabetic drugs (OADs). However, GLP-1RAs are underutilized—as time patients remained on their last oral treatment regimen with inadequate glycemic control prior to GLP-1RA initiation is on average of 19 month—despite evidence supporting their effectiveness, safety, and possible CV outcome advantages. With the new advances in GLP-1 RAs, the first oral form for the semaglutide molecule was developed with proven efficacy, safety, and patient preferences that may help pave the road for more utilization of this class. Therefore, we, a Saudi task force, gathered to develop an explicit, evidence-based consensus on oral semaglutide use in Saudi patients with diabetes. The panel recommends a GLP-1RA in those T2DM patients with or without or at high risk for ASCVD, HF, and/or CKD when there is a need to minimize weight gain or promote weight loss, or when there is a need to minimize hypoglycemia. Ensure that people with T2DM and ASCVD, HF, or CKD are treated appropriately with an SGLT-2i or GLP-1 RA. This approach should be initiated independent of background therapy, glycaemic control, or individualized treatment goals. Healthcare professionals should do their best to prevent clinical inertia in T2DM to help people with T2DM achieve better glycemic control and prevent or delay diabetes-related complications. The availability of oral forms of GLP-1RA medications could help combat this problem of clinical inertia to start GLP-1RA at the right time, as patients prefer oral to injectable forms. The availability of oral GLP-1RA can help in starting this class early and encourage healthcare professionals in prescribing it at the right time. Moreover, it can help those patients who fear of the injections. The panel recommends the oral GLP-1RA semaglutide to be used early and encourage healthcare professionals in prescribing it at the right time. The injectable form can be preserved for further intensification of therapy whenever needed as add-on therapy particulary for poly-medicated patients for better compliance at this stage.
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