Comment: Many commenters raised concerns related to the proposed claims-based methodology outlined in the CY 2026 PFS proposed rule
Be aware that these carry a small risk of euglycaemic diabetic ketoacidosis DPP-4 inhibitors (e.g., sitagliptin, linagliptin), which are generally well tolerated but less effective for weight reduction Metformin , if not already prescribed, remains the first-line oral agent for type 2 diabetes, though it can also cause gastrointestinal upset Insulin therapy , which may be necessary if oral agents and GLP-1 agonists are not tolerated or insufficient, though this carries a risk of hypoglycaemia When discussing alternatives with your GP, consider bringing up: The severity and duration of your symptoms Any dietary or lifestyle modifications you have already tried Your treatment priorities (e.g., cardiovascular protection, convenience) Other medical conditions or medications that may influence treatment choice NICE guidance (NG28) recommends individualised treatment approaches for type 2 diabetes, taking into account patient preferences, comorbidities, and tolerability
There is no medical requirement to follow the exact four-week titration timeline
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The STEP clinical trial program spanning multiple large-scale studies demonstrated that semaglutide produces approximately 15% body weight reduction over 68 weeks
