Dr. Ahmed
Ozempic has been approved by the FDA for the treatment of diabetes. Until now, the FDA recommended not to exceed 1 mg as the maximum dose. However, a recent trial demonstrated the superiority of the Ozempic 2 mg dose over 1 mg in diabetics.
Ozempic 2 mg dose is double the previously maximum recommended dose of Ozempic. But it is still lower than the dose used for weight loss. Semaglutide when used to treat obesity, the usual and the only dose approved is 2.4 mg once a week.
Ozempic (Semaglutide Injection) Full FDA Prescribing Information
The Efficacy of Ozempic 2 mg:
Although the SUSTAIN 3 Trial resulted in significant HbA1C reduction. More than 70% (73%) of the diabetic patients achieved the ADA recommended goal of A1C (<7%) with Ozempic 1 mg weekly injection.
However, still, a substantial number of patients required more A1C reduction. This could be achieved by either adding another oral antidiabetic drug, insulin or increasing the dose of Ozempic to 2 mg weekly.
To study the efficacy of the Ozempic 2 mg dose, the SUSTAIN FORTE Trial was conducted. Participants in the trial had a baseline A1C of 8.9% [Ref].
At week 40, Ozempic 2 mg resulted in a significant A1C reduction compared to Ozempic 1 mg. Similarly, the weight loss effects of Ozempic 2 mg were also greater than Ozempic 1 mg, however, the results were not statistically significant.
What is Wegovy, Rybelsus, and Ozempic? Efficacy in DM and Obesity
The results of the study are tabulated below:
| Efficacy at week 40 | Ozempic 1 mg | Ozempic 2 mg |
| A1C reduction (P <0.01) | ⇓ 1.9% | ⇓ 2.1% |
| Weight loss | ⇓ 12.5 lbs | ⇓ 14.1 lbs |
The trial demonstrated that Ozempic 2 mg can be used to treat diabetic patients who do not achieve their target A1C goals.
The better glucose control and weight loss effects came at a price of more gastrointestinal side effects. The percentage of gastrointestinal side effects in both the groups are tabulated below:
| Safety at week 40 | Ozempic 1 mg | Ozempic 2 mg |
| Gastrointestinal Side effects | 30.8% | 34% |
Ozempic 2 mg is not currently available in the US markets. However, it is soon going to be available to meet the needs of diabetic patients.
The maximum recommended dose of Ozempic is now going to be 2 mg. For weight loss, the dose of Wegovy is to remain the same i.e. 2.4 mg weekly subcutaneously.
Ozempic Dose escalation for Diabetes:
Ozempic is administered at a dose of 0.25 mg weekly for 4 weeks. This is followed by 0.5 mg weekly for four weeks.
After 8 weeks, the dose is increased to 1 mg weekly for four weeks. If the ADA A1C goals have not been achieved with 1 mg Ozempic, the dose is then increased to 2 mg once a week.
| Ozempic Dose | Duration in weeks |
| 0.25 mg | Four weeks |
| 0.5 mg | Four weeks |
| 1 mg | Four weeks |
| 2 mg | Continue |
Ozempic 2 mg dose for Diabetes and 2.4 mg for Weight Loss?
Semalgutide 2.4 mg has already been approved for the treatment of obesity and overweight individuals with at least one weight-related complication like hypertension, diabetes, and dyslipidemia.
With the approval of Semaglutide 2 mg for uncontrolled diabetes, there is going to be a very minute difference in terms of weight loss between the Ozempic 2 mg dose and Wegovy 2.4 mg dose.
Obese and non-obese individuals are all going to benefit from the drug. Diabetic patients who are not obese but still wish to lose some weight can easily go up to a dose of 2 mg Semaglutide.
If prices differ, that could become the only difference between Ozempic 2 mg and Wegovy 2.4 mg. People will try to go for the cheap alternative.
