Oral semaglutide (Rybelsus) will now be used to lower cardiovascular risk in some adults with high-risk type 2 diabetes.
Injectable semaglutide (Ozempic) and other injectable GLP-1 agonists (dulaglutide, etc) are already used for lowering cardiovascular risk in some patients with type 2 diabetes.
Now evidence shows that oral semaglutide 14 mg/day is another option for lowering cardiovascular risk in these patients.
But it’s not known whether one GLP-1 agonist is better than another...and oral and injectable semaglutide have similar cost.
Continue to help prevent errors with all GLP-1 agonists.
Watch for look-alike/sound-alike errors with generic names of the GLP-1 agonists...dulaglutide, liraglutide, semaglutide, etc. They all end in “-tide.”
Include all of the prescriber’s instructions on the Rx label...especially for patients switching between oral and injectable semaglutide.
For example, patients on semaglutide 0.5 mg SC weekly will start oral semaglutide 7 or 14 mg/day up to 7 days after the last injection.
On the other hand, patients switching from semaglutide 14 mg po daily to semaglutide 0.5 mg SC weekly will start the day after the last oral semaglutide dose.
Double-check that you enter the correct administration frequency.
For example, injectable semaglutide and dulaglutide are given SC WEEKLY...but liraglutide is given SC DAILY...and oral semaglutide is given DAILY.
Pull in the pharmacist for counselling on proper use. For instance, oral semaglutidemust be taken with no more than half a cup or 120 mL of water...at least 30 minutes before the first food, other beverage, or oral meds of the day. Not doing so reduces efficacy.
For more comparisons of treatments, see our Stepwise Treatment of Type 2 Diabetes and Diabetes Medications: Cardiovascular and Kidney Impact.
- McGuire DK, Marx N, Mulvagh SL, et al. Oral semaglutide and cardiovascular outcomes in high-risk type 2 diabetes. N Engl J Med 2025;392:2001-12.
- Diabetes Canada. https://guidelines.diabetes.ca/home (Accessed February 4, 2026).