Diabetes Care

Flexible semaglutide titration improves adherence, reduces GI side effects in type 2 diabetes

September 4, 2025

Study details: This randomized, open-label pilot study enrolled 104 adults with T2DM to compare a 16-week flexible titration regimen of semaglutide with the standard 8-week label-recommended schedule. The flexible group began at 0.0675 mg/week with gradual weekly increases and allowed dose delays for GI intolerance. The standard group followed fixed 4-week dose escalations (0.25 mg → 0.5 mg → 1 mg).

Results: Final doses were similar across groups, but the flexible titration arm had significantly fewer withdrawals due to GI adverse events (2% vs. 19%; P = 0.005). Nausea (45.1% vs. 64.2%; P = 0.051), asthenia (9.8% vs. 24.5%; P = 0.047), and nausea duration (2.88 vs. 6.3 days; P = 0.017) were all reduced. Glycemic control and BMI changes were comparable.

Clinical impact: Gradual titration of semaglutide may enhance tolerability and treatment persistence without compromising efficacy, supporting a personalized approach to GLP-1 therapy initiation.

Source:

Emdor R, et al. (2025, July 17). Diabetes Care. Gradual Titration of Semaglutide Results in Better Treatment Adherence and Fewer Adverse Events: A Randomized Controlled Open-Label Pilot Study Examining a 16-Week Flexible Titration Regimen Versus Label-Recommended 8-Week Semaglutide Titration Regimen. https://pubmed.ncbi.nlm.nih.gov/40673973/