Doctors often consider switching GLP-1 therapies for patient convenience. This retrospective study looked at 18 patients with stable type 2 diabetes (T2DM). All had mean HbA1c of 6.99% on dulaglutide. In a study published in the British Journal of Diabetes, the researchers tracked what happened after moving them to oral semaglutide.
Methods Track Changes Over Six Months
The team measured HbA1c and key clinical parameters at baseline. They repeated checks at two, four, and six months. This setup let them see trends in glycemic control and other markers. Patient data came from routine care records.
Results Show Early HbA1c Spike
HbA1c jumped significantly at two months to 7.43 ± 0.72% from baseline 6.99 ± 0.39% (p = 0.003). Levels stabilized by four and six months with no big changes from start. HDL cholesterol rose notably at six months (p = 0.006). Among patients, five improved by six months. These had lower baseline gamma-glutamyl transferase (13.8 ± 3.0 vs. 47.9 ± 53.6 IU/L, p = 0.026).
Key Conclusion for Clinical Practice
Switching caused a short-term glycemic worsening that resolved by six months. Baseline liver enzyme levels may predict responders. HDL benefits add a plus point. This small study calls for larger trials before routine switches.
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Key highlights
- Switching from dulaglutide to oral semaglutide raised HbA1c significantly at two months (7.43% vs. 6.99%, p = 0.003) in well-controlled T2DM patients.
- HbA1c levels returned to baseline by four and six months with no lasting significant change.
- Patients with baseline gamma-glutamyl transferase below 13.8 IU/L showed glycemic improvement at six months.
- HDL cholesterol increased significantly at six months compared to baseline (p = 0.006).
- Clinicians should monitor closely for two months post-switch and consider baseline liver enzymes for patient selection.
Source
Watanabe K, Kosuda M, Nagasawa A, Nakayama K, Taro Saigusa, Ishihara H. Influence of switching from dulaglutide to oral semaglutide on glycaemic control and clinical parameters in Japanese patients with well-controlled type 2 diabetes: a retrospective, observational study. British Journal of Diabetes. Published online October 11, 2025. doi: https://doi.org/10.15277/bjd.2025.492
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A small study of 18 well-controlled T2DM patients found temporary HbA1c rise after switching from dulaglutide to oral semaglutide, with recovery by six months and HDL gains.
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