Cited by 135Diabetes Treatment and ManagementAdvanced Drug Delivery SystemsDiabetes Management and Research

A new era for oral peptides: SNAC and the development of oral semaglutide for the treatment of type 2 diabetes

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Aroda, Vanita R., Blonde, Lawrence, Pratley, Richard E.·2022·Reviews in Endocrine and Metabolic Disorders

Abstract

Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RAs) were first introduced for the treatment of type 2 diabetes (T2D) in 2005. Despite the high efficacy and other benefits of GLP-1RAs, their uptake was initially limited by the fact that they could only be administered by injection. Semaglutide is a human GLP-1 analog that has been shown to significantly improve glycemic control and reduce body weight, in addition to improving cardiovascular outcomes, in patients with T2D. First approved as a once-weekly subcutaneous injection, semaglutide was considered an ideal peptide candidate for oral delivery with a permeation enhancer on account of its low molecular weight, long half-life, and high potency. An oral formulation of semaglutide was therefore developed by co-formulating semaglutide with sodium N-(8-[2-hydroxybenzoyl]amino)caprylate, a well-characterized transcellular permeation enhancer, to produce the first orally administered GLP-1RA. Pharmacokinetic analysis showed that stable steady-state concentrations could be achieved with once-daily dosing owing to the long half-life of oral semaglutide. Upper gastrointestinal disease and renal and hepatic impairment did not affect the pharmacokinetic profile. In the phase III PIONEER clinical trial program, oral semaglutide was shown to reduce glycated hemoglobin and body weight compared with placebo and active comparators in patients with T2D, with no new safety signals reported. Cardiovascular efficacy and safety are currently being assessed in a dedicated outcomes trial. The development of an oral GLP-1RA represents a significant milestone in the management of T2D, providing an additional efficacious treatment option for patients.

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  • GLP-1RAs play a limited role in lipid management, suggesting that additional lipid-lowering therapies may be necessary for comprehensive metabolic control.

    “This highlights the limited role that GLP-1RAs play in lipid management, suggesting that additional lipid-lowering therapies may be necessary for comprehensive metabolic control27–29.”

    From Efficacy and safety of GLP-1 receptor agonists on weight management and metabolic parameters in PCOS women: a meta-analysis of randomized controlled trials (2025) · cites this paper as [28]

    The Introduction describes GLP-1RAs’ effects on glucose control, weight, and cardiovascular risk, while ‘From trials to translation: oral semaglutide in practice’ discusses treatment choices for glycemic control (page numbers unavailable). Searches for lipid management, cholesterol, triglycerides, and lipid-lowering therapy found no passage addressing whether GLP-1RAs have a limited role in lipid management or whether additional lipid-lowering treatment is needed. (LLM, conf=0.74)

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Cited by

Sorted by citations

Authors
Aroda, V. R., Blonde, L., & Pratley, R. E.
Affiliations
  • Brigham and Women's Hospital (US)
  • Ochsner Health System (US)
  • AdventHealth Orlando (US)
Corresponding author
Aroda, Vanita R.
Venue
Reviews in Endocrine and Metabolic Disorders
Published
2022-07-15
Volume
23
Issue
5
Pages
979-994
ISSN
  • 1389-9155 (ISSN-L)
  • 1573-2606
OpenAlex
W4285589154
Cited by
135
References
14
Citations by year
2026: 63 · 2025: 35 · 2024: 23 · 2023: 12 · 2022: 2
FWCI
2.60
Type
journal article
Language
en
Open access
Locations
  • Reviews in Endocrine and Metabolic Disorders (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Novo Nordisk Inc
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmaceutical Science › Advanced Drug Delivery Systems
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
oral semaglutide, SNAC, GLP-1 receptor agonists, type 2 diabetes, pharmacokinetics, HbA1c, weight loss, cardiovascular outcomes, PIONEER trial
MeSH terms
Glucagon-Like Peptide-1 Receptor, Glucagon-Like Peptide-1 Receptor Agonists, Semaglutide, Body Weight, Caprylates, Diabetes Mellitus, Type 2, Glucagon-Like Peptides, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Peptides, Sodium, Glucagon-Like Peptide 1

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