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. 2025 Aug;16(8):1707-1725.
doi: 10.1007/s13300-025-01762-3. Epub 2025 Jun 20.

Oral Semaglutide as an Opportunity for an Appropriate Therapeutic Switch in People with Type 2 Diabetes: A Delphi Consensus

Matteo Bruglia  1 , Francesca Cardini  2 , Raffaella Di Luzio  3 , Stefania Fiorini  4 , Antonella Guberti  5 , Silvia Haddoub  6 , Valentina Lo Preiato  7 , Alessandra Luberto  8 , Francesca Lugli  9 , Massimiliano Maiello  2 , Elisa Manicardi  10 , Marco Marcello Marcellini  1 , Marcello Monesi  9 , Francesca Pellicano  8 , Daniela Piani  3 , Rosa Maria Trianni  11 , Anna Vacirca  12 , Antonio Nicolucci  13 , Paolo Di Bartolo  14
Affiliations

Oral Semaglutide as an Opportunity for an Appropriate Therapeutic Switch in People with Type 2 Diabetes: A Delphi Consensus

Matteo Bruglia et al. Diabetes Ther. 2025 Aug.

Abstract

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.

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Conflict of interest statement

Declarations. Conflict of Interest: Paolo Di Bartolo has served as a consultant or advisory board member for AstraZeneca, Boehringher Ingelheim, Eli Lilly and Company, and has also received honoraria from AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, Abbott Diagnostic, Mundipharna and Sanofi. Antonio Nicolucci received research funding from AlfaSigma, Novo Nordisk, Sanofi, Theras, Shionogi and SOBI. All other authors (Matteo Bruglia, Francesca Cardini, Raffaella Di Luzio, Stefania Fiorini, Antonella Guberti, Silvia Haddoub, Valentina Lo Preiato, Alessandra Luberto, Francesca Lugli, Massimiliano Maiello, Elisa Manicardi, Marco Marcello Marcellini, Marcello Monesi, Francesca Pellicano, Daniela Piani, Rosa Maria Trianni and Anna Vacirca) have no conflicts of interest. Ethical Approval: In Italy, the activities of ethics committees are regulated by Legislative Decree of May 14, 2019, No. 52, which implements EU Regulation 536/2014 on clinical trials and defines the scope within which ethics committee evaluation is mandatory. It applies exclusively to studies involving medicinal products or medical devices and to experimental or observational research involving human subjects. Since our project is a simple opinion survey, is addressed to healthcare professionals, is completely anonymous, does not involve the collection of clinical, health-related, or identifiable personal data, does not involve patients or medical interventions, then it is not classified as “research involving human subjects” under current regulations and does not require ethics committee approval.

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