LA MEJOR HbA1c NO ES LA MÁS BAJA
La verdadera relación coste-beneficio de Ozempic® (Semaglutida) en 2026
DrRamonReyesMD ⚕️
EMS Solutions International
https://emssolutionsint.blogspot.com
Durante años, médicos y pacientes han utilizado la hemoglobina glucosilada (HbA1c) como uno de los principales indicadores del control de la diabetes mellitus tipo 2.
Sin embargo, la medicina moderna ha evolucionado.
En 2026 sabemos que la pregunta más importante no es cuánto baja la glucosa un tratamiento.
La pregunta realmente importante es:
¿Reduce infartos? ¿Reduce ictus? ¿Protege el riñón? ¿Evita discapacidad? ¿Ayuda a vivir más y mejor?
Porque la mayoría de los pacientes diabéticos no fallecen por una cifra elevada de glucosa.
Fallecen por las consecuencias cardiovasculares y renales acumuladas durante años de enfermedad metabólica.
Por ello, la evaluación actual de cualquier tratamiento antidiabético debe centrarse en resultados clínicos duros y no únicamente en parámetros analíticos.
EL CAMBIO DE PARADIGMA
Ozempic® (semaglutida) pertenece al grupo de los agonistas del receptor GLP-1.
Inicialmente fue desarrollado como tratamiento para mejorar el control glucémico.
Sin embargo, la evidencia acumulada durante los últimos años ha demostrado que sus beneficios van mucho más allá de la reducción de la HbA1c.
Actualmente se considera una terapia cardiometabólica integral capaz de actuar simultáneamente sobre múltiples factores de riesgo.
PROTECCIÓN CARDIOVASCULAR: EL BENEFICIO MÁS IMPORTANTE
El estudio SELECT, publicado en The New England Journal of Medicine en 2023, confirmó una reducción aproximada del 20 % en eventos cardiovasculares mayores.
Referencia:
Lincoff AM et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes.
DOI:
10.1056/NEJMoa2307563
URL:
https://www.nejm.org/doi/full/10.1056/NEJMoa2307563
Los eventos evaluados incluyeron:
- Infarto agudo de miocardio.
- Ictus.
- Muerte cardiovascular.
Este hallazgo representa uno de los avances más relevantes de la medicina metabólica contemporánea.
Cada infarto evitado significa menos discapacidad, menos hospitalizaciones, menos insuficiencia cardíaca y más años de vida funcional.
Cada ictus evitado significa menos dependencia, menos institucionalización y menos sufrimiento para pacientes y familias.
PROTECCIÓN RENAL
La enfermedad renal crónica constituye una de las complicaciones más devastadoras de la diabetes.
El ensayo FLOW demostró beneficios significativos sobre la progresión de la enfermedad renal.
Referencia:
Perkovic V et al. Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes.
DOI:
10.1056/NEJMoa2403347
URL:
https://www.nejm.org/doi/full/10.1056/NEJMoa2403347
Los resultados mostraron:
- Menor progresión de enfermedad renal.
- Menor riesgo de insuficiencia renal avanzada.
- Menor incidencia de eventos cardiovasculares asociados.
Desde una perspectiva clínica, retrasar o evitar la diálisis supone uno de los mayores beneficios que puede ofrecer cualquier tratamiento moderno.
EL PESO CORPORAL IMPORTA, PERO NO POR MOTIVOS ESTÉTICOS
La pérdida de peso inducida por semaglutida ha sido ampliamente documentada en los estudios STEP.
Referencia:
Wilding JPH et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity.
DOI:
10.1056/NEJMoa2032183
URL:
https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
Las reducciones ponderales observadas pueden superar el 10-15 % del peso corporal inicial.
Pero el beneficio real no reside únicamente en el número que aparece en la báscula.
Lo importante es la reducción de la grasa visceral.
La grasa visceral es metabólicamente activa y participa en la producción de mediadores inflamatorios como:
Estos mecanismos contribuyen al desarrollo de:
- Resistencia a la insulina.
- Inflamación crónica de bajo grado.
- Aterosclerosis.
- Enfermedad cardiovascular.
Reducir la grasa visceral significa reducir riesgo biológico.
BENEFICIOS MÁS ALLÁ DE LA PÉRDIDA DE PESO
Los análisis recientes sugieren que parte de los beneficios cardiovasculares observados con semaglutida no pueden explicarse exclusivamente por la pérdida ponderal.
Existen indicios de efectos favorables sobre:
- Función endotelial.
- Inflamación vascular.
- Estrés oxidativo.
- Metabolismo cardiometabólico.
La magnitud exacta de estos mecanismos continúa siendo objeto de investigación.
APNEA DEL SUEÑO Y OBESIDAD
Muchos pacientes experimentan mejoría clínica de la apnea obstructiva del sueño al reducir peso corporal.
Entre los beneficios observados destacan:
- Disminución de grasa cervical.
- Menor colapso de la vía aérea superior.
- Mejor tolerancia al tratamiento con CPAP.
- Reducción de somnolencia diurna.
Aunque la respuesta individual es variable, el impacto sobre calidad de vida puede ser considerable.
HÍGADO GRASO METABÓLICO
La evidencia disponible indica efectos favorables sobre la enfermedad hepática grasa asociada a disfunción metabólica (MASLD).
Los mecanismos implicados incluyen:
- Reducción de peso corporal.
- Mejoría de la sensibilidad a la insulina.
- Disminución de inflamación sistémica.
Se trata de un área de investigación especialmente activa.
LO QUE NO DEBE IGNORARSE
No todo son ventajas.
Uno de los problemas más infravalorados es la pérdida concomitante de masa muscular.
Perder peso no siempre significa perder exclusivamente grasa.
La reducción excesiva de masa magra puede favorecer:
- Fragilidad.
- Sarcopenia.
- Disminución de fuerza.
- Reducción de capacidad funcional.
Por ello, cualquier estrategia terapéutica con semaglutida debería acompañarse de:
- Ejercicio de fuerza.
- Ingesta proteica adecuada.
- Seguimiento nutricional individualizado.
EFECTOS ADVERSOS MÁS FRECUENTES
Los efectos secundarios observados con mayor frecuencia incluyen:
- Náuseas.
- Saciedad precoz.
- Reflujo gastroesofágico.
- Estreñimiento.
- Diarrea.
La mayoría aparecen durante la escalada de dosis y suelen mejorar progresivamente con el tiempo.
EL VERDADERO ANÁLISIS COSTE-BENEFICIO
Muchos pacientes centran el debate en el coste mensual del tratamiento.
Sin embargo, la evaluación económica correcta debe considerar los costes evitados.
¿Cuánto cuesta un infarto?
¿Cuánto cuesta un ictus incapacitante?
¿Cuánto cuesta una insuficiencia cardíaca avanzada?
¿Cuánto cuesta una diálisis crónica durante años?
La respuesta es sencilla:
Muchísimo más.
Cuando se analiza desde la perspectiva de prevención cardiovascular y renal, semaglutida presenta una de las relaciones coste-beneficio más favorables disponibles actualmente para pacientes correctamente seleccionados con diabetes tipo 2 y alto riesgo cardiometabólico.
CONCLUSIÓN
En 2026, Ozempic® ya no puede considerarse únicamente un medicamento para bajar la glucosa.
La evidencia científica actual lo sitúa como una herramienta terapéutica capaz de reducir simultáneamente el riesgo de infarto de miocardio, ictus, progresión de enfermedad renal y otras complicaciones asociadas a la diabetes tipo 2 y la obesidad.
La pérdida de peso es importante.
La reducción de la HbA1c es importante.
Pero ninguna de ellas constituye el beneficio principal.
El verdadero objetivo es disminuir enfermedad grave, discapacidad y mortalidad.
Porque la mejor HbA1c no es la más baja.
La mejor HbA1c es la que se acompaña de menos infartos, menos ictus, menos diálisis y más años de vida con buena calidad funcional.
DrRamonReyesMD ⚕️
:::
Bibliografía digital relacionada en EMS Solutions International
A medida que aumenta la popularidad de Ozempic, esto es lo que debe saber sobre la semaglutida y la pérdida de peso. As Ozempic’s Popularity Soars, Here’s What to Know About Semaglutide and Weight Loss
Link to the original post JAMA
Here’s what to know about this in-demand drug.
Semaglutide is a peptide sold by Novo Nordisk under the brand names Ozempic, Rybelsus, and Wegovy for long-term treatment of type 2 diabetes or obesity.
The drug belongs to the family of incretin glucagon-like peptide-1 (GLP-1) receptor agonists that have been used in type 2 diabetes treatment for almost 20 years. GLP-1 receptor agonists mimic the GLP-1 hormone, which increases insulin production when blood glucose levels are elevated. The GLP-1 hormone also slows gastric emptying—in turn prolonging the feeling of fullness after eating—and works as an appetite suppressant by targeting parts of the brain responsible for hunger and cravings.
What’s the Difference Between Brands?
The differences among these branded products are in the dosage, administration, and indication, explained Susan Yanovski, MD, the senior scientific advisor for clinical obesity research and codirector of the Office of Obesity Research at the National Institute of Diabetes and Digestive and Kidney Diseases.
The US Food and Drug Administration (FDA) approved Ozempic in 2017 to treat type 2 diabetes. Similar to other GLP-1 receptor agonists, it’s often added to improve glycemic control when patients have already tried metformin without much success. It’s available in doses of 0.5 mg to 2 mg and self-administered weekly with injectable pens.
In 2019, the FDA approved Rybelsus, a daily oral medication, to help control blood glucose in adults with type 2 diabetes. It’s available in 7-mg or 14-mg tablets.
Then, in 2021, Wegovy received FDA approval for chronic weight management for adults with obesity or those who are overweight with at least 1 weight-related condition, such as type 2 diabetes, high cholesterol, or hypertension. Last year, it was approved for adolescents aged 12 years or older.
Like Ozempic, Wegovy requires a weekly pen injection but at a higher dose of 2.4 mg. At that dose, semaglutide combined with a reduced-calorie diet and increased physical activity produced an average weight loss of about 15% at 68 weeks among clinical trial participants without type 2 diabetes, and those results were sustained at year 2 in a related trial.
There’s considerable overlap among all 3 products, Yanovski said in an interview with JAMA. For example, they’re all started at a low dose and then titrated up to limit adverse effects. Because the injectable forms of semaglutide contain the same medication, 1 mg of Ozempic is equivalent to 1 mg of Wegovy for managing weight.
Who Can Use Semaglutide Specifically for Weight Loss?
According to its indication, people without type 2 diabetes can be candidates for Wegovy if their body mass index is 30 or higher or if it’s 27 or higher and they also have a weight-related condition.
But even though Wegovy was specifically approved for this, Ozempic is better known as a weight-loss drug. “Ozempic appears to be getting more attention than Wegovy due to the name being put out more in the mainstream media and especially social media as a go-to medication for weight loss,” Peminda Cabandugama, MD, an endocrinologist and obesity medicine practitioner at the Cleveland Clinic, wrote in an email.
Prescribing Ozempic for weight loss is considered an off-label use. That said, “there’s nothing unethical about using the brand name Ozempic for someone with obesity,” Yanovski remarked. She pointed out, however, that it’s unavailable at the 2.4-mg dose shown to have the largest efficacy for weight loss.
People with uncontrolled type 2 diabetes may be ideal candidates for either injectable semaglutide product, noted Cabandugama, who is also the director of Digital Obesity at the Cleveland Clinic and a diplomate of the American Board of Obesity Medicine. Semaglutide helps bring down blood glucose levels without causing hypoglycemia, as long as it’s not used alongside insulin or oral antidiabetic medications such as sulfonylureas. Moreover, people with type 2 diabetes who are at high risk of heart disease may decrease their risk by using semaglutide. It’s unclear whether the same holds true for people without type 2 diabetes who use the drug strictly for weight loss, Yanovski said, but a cardiovascular outcomes trial is underway for this population.
The most common adverse events are gastrointestinal issues, including nausea, vomiting, diarrhea, and constipation. Semaglutide may also heighten the risk of pancreatitis, kidney failure, and medullary thyroid carcinoma, especially among patients with a family history of this cancer. And Yanovski cautioned that gallbladder disease can develop when patients lose a lot of weight quickly with semaglutide or other means.
Media reports have linked the drug to facial aging. But it’s not the medication as much as its potent weight-loss effects that can cause what’s now known colloquially as “Ozempic face,” according to Fatima Stanford, MD, MPH, an obesity medicine physician–scientist at Massachusetts General Hospital.
“This term is a misnomer as it presumes that facial aging is specific to semaglutide,” Stanford wrote in an email. Instead, skin sagging is due to the loss of fat in the face, which is associated with any method of weight loss, she explained.
It may occur when weight-loss strategies become too aggressive. “When persons regain lost weight from stopping behavioral strategies or anti-obesity medication, they will likely regain fat in their face and elsewhere,” said Stanford, who is also an associate professor of medicine and pediatrics at Harvard Medical School.
Patients prescribed semaglutide can mitigate excess facial fat loss by monitoring their diets carefully, advised W. Scott Butsch, MD, MSc, the director of obesity medicine at the Cleveland Clinic’s Bariatric and Metabolic Institute.
“Many patients and providers alike think that the purpose of these obesity drugs is to limit the amount of food intake, so it makes sense to increase the dose as high as possible to maximize the weight loss,” he wrote in an email. “This misconception around how these drugs work can lead to an inappropriate amount of weight loss.”
An unintentionally restricted diet may not only lead to fat loss but also nutrient deficiencies.
Patients “should be aware of how much protein they are consuming, because with weight loss comes the loss of muscle as well in some individuals,” Butsch explained, adding that the appearance of facial aging may also stem from muscle loss in the face.
He underscored that only a small percentage of people who lose weight experience facial aging, and that this reversable effect should not overshadow the potential benefits of weight loss.
“All drugs have side effects, and semaglutide is no exception,” Yanovski said. She noted that the benefits of controlling blood glucose levels, as well as lowering blood pressure and reducing the risk of fatty liver disease, may offset semaglutide’s risks for people with obesity-related complications.
Patients who experience severe adverse events or don’t achieve adequate weight loss should discontinue the drug, she said: “For them, the risks outweigh the benefits.”
What About Compounded Versions?
Compounded versions of semaglutide, which are often advertised online as cheap alternatives, are gaining traction, according to news reports.
Yanovski said it can be difficult to gauge where the compounds were mixed or how they were manufactured. Often, when people obtain compounded semaglutide, especially online, “they get the drug in a multidose vial, and a vial of saline—in some cases without ever seeing a clinician who’s evaluating them—and just given instructions on how to mix this up and inject it,” Yanovski explained.
She also warned of opportunities for bacterial and fungal contamination when mixing the drug with saline and using a vial with needles rather than injectable pens. And there’s a risk of misdosing.
“It’s not semaglutide itself that might cause serious problems but the compounded versions or inappropriate administration,” she said, adding that sometimes, the drug is even mixed with vitamins without evidence of safety and effectiveness.
“That’s all a recipe for bad outcomes,” Yanovski cautioned.
How Long Does Semaglutide Keep the Weight Off?
A clinical trial published in JAMA and a follow-up study of a related trial found that semaglutide is only effective for weight loss for as long as it’s used. In the follow-up study, published last year, participants who had been randomized to receive 2.4 mg of semaglutide regained up to two-thirds of their weight within a year of stopping the drug when the trial ended.
That’s why semaglutide is approved for long-term weight management. Because obesity is a chronic disease, “semaglutide, like any other anti-obesity medication, should be prescribed with the expectation that it will be used long term, possibly lifelong,” endocrinologist Daniela Hurtado, MD, PhD, wrote in an email.
Obesity stems from genetic and environmental factors that result in the dysregulation of calories that are consumed and burned, explained Hurtado, an assistant professor at the Mayo Clinic Alix School of Medicine in Florida and a researcher at the Mayo Clinic Precision Medicine for Obesity Program. “Anti-obesity medications, like semaglutide, help regulate this system. If these medications are stopped, the system goes back to where it was, resulting in weight regain.”
It’s also important to note that semaglutide should not be prescribed in isolation but as an adjunct to dietary changes and exercise.
“In my experience, this is seen more with patients who have been put on the medication without being given proper comprehensive therapy that also involves provider-directed lifestyle instructions involving diet and exercise,” said Cabandugama, who is a spokesperson for The Obesity Society.
What About Other Weight-Loss Medications?
Beyond semaglutide, 4 other drugs and drug combinations are approved for chronic weight management in the US: liraglutide (Saxenda), orlistat (Alli and Xenical), naltrexone plus bupropion (Contrave), and phentermine plus topiramate (Qsymia).
Introduced in 1959, phentermine is the oldest FDA-approved prescription drug for obesity and, according to a 2019 government report, the most prescribed weight-loss medication in the US.
Used alone, phentermine’s indication is only for short-term use—typically less than 12 weeks, although Yanovski said it’s often prescribed off-label for longer periods. It remains popular because of its price, which can be less than $30 per month. In stark contrast, the list price of a single Ozempic pen that lasts about a month is almost $900, and a package of Wegovy for a comparable period costs upwards of $1300. Insurance companies often don’t cover weight-loss medications, and phentermine is one of the least expensive options.
“This is particularly important in populations [that are] at greater risk for diabetes or obesity yet have trouble affording the most effective drugs,” Yanovski said. However, phentermine isn’t as effective as semaglutide, even when combined with topiramate in Qsymia.
What’s Next in the Pipeline?
Some think Eli Lilly’s tirzepatide, approved as Mounjaro in 2022 for patients with type 2 diabetes, could be the next popular weight-loss medication. The drug had substantial weight-loss effects in a trial involving people with obesity who did not have type 2 diabetes. In fact, the average weight loss of around 20% approached what’s observed after some forms of bariatric surgery.
Tirzepatide is a GLP-1 receptor agonist, like semaglutide, combined with a glucose-dependent insulinotropic polypeptide, or GIP, analogue. Similar to semaglutide, tirzepatide mimics natural hormones that suppress hunger. “These 2 classes of medications give approximately 3 times the weight loss that you would see with medications like phentermine,” Cabandugama said.
There are no head-to-head studies comparing semaglutide and tirzepatide, but “tirzepatide seems to result in greater diabetes control improvement and greater weight loss,” Hurtado said.
The FDA is now evaluating tirzepatide for obesity treatment. However, none of these drugs work for everyone. And they’re no panacea for the obesity crisis.
“We need more research and policy changes to help people not develop obesity in the first place,” Yanovski said. “Anti-obesity medications aren’t a magic bullet.”
Published Online: April 26, 2023. doi:10.1001/jama.2023.2438
Conflict of Interest Disclosures: Dr Butsch reported previously serving as a consultant for Novo Nordisk on education initiatives but has no current relationship with the company. Dr Cabandugama reported being a founding advisory board member of the Midwest Obesity Society, as well as a member of the Obesity Medicine Association Outreach Committee. Dr Stanford reported serving as an obesity consultant to Currax, Eli Lilly, Gelesis, Novo Nordisk, Pfizer, and Rhythm. No other disclosures were reported.
Ozempic y el Monstruo de Gila: Biología, Farmacología y Revolución Terapéutica
Por DrRamonReyesMD (2025)
Ozempic, agonistas del receptor GLP-1 (semaglutida) gastroparesia y deshidratación #DrRamonReyesMD
https://emssolutionsint.blogspot.com/2025/10/ozempic-agonistas-del-receptor-glp-1.html
