Oral semaglutide: Rybelsus for diabetes explained

Key Points

• Rybelsus, oral semaglutide, provides a needle-free alternative to injectable semaglutide for adults with type 2 diabetes
• The medication works through three mechanisms: slowing digestion, timing insulin release, and signaling the brain to reduce appetite
• Clinical trials show a 14mg daily dose can lower HbA1c by 1.2% over six months when combined with diet and exercise

Nearly 40 million Americans battle diabetes, with another 97 million living with prediabetes, the early warning sign for type 2 diabetes.

As diabetes medications evolve, we’re now in the era of blockbuster diabetes drugs like Ozempic, a once-weekly injectable semaglutide. The same medication is available as Rybelsus, a once-daily pill.

Here's everything you need to know about oral semaglutide, how it works, what results to expect, and how to optimize your success on Rybelsus.

How oral semaglutide works

"GLP-1 medications like Rybelsus work in three key ways," explains physician Gia Eapen, MD. "First, they slow down digestion, keeping food in your stomach longer so you feel satisfied after meals. Second, they help your body release insulin at just the right time to keep blood sugar steady. And third, they communicate directly with your brain to naturally reduce hunger."

The medication also tackles blood sugar control from another angle by suppressing the release of glucagon, a hormone that tells the liver to release stored glucose into the blood. By blocking this signal, Rybelsus is designed to prevent blood sugar spikes between meals.

Oral semaglutide for type 2 diabetes

Rybelsus (oral semaglutide) is approved by the FDA to improve blood sugar in adults with type 2 diabetes.

Clinical trials show that Rybelsus (oral semaglutide) helps regulate blood sugar levels. The PIONEER 4 study found that a 14 mg dose of oral semaglutide administered daily lowered HbA1c by 1.2% over 26 weeks (about 6 months).

"Rybelsus is a prescription medication, and your healthcare provider will determine the appropriate dosage schedule for you," notes Eapen, MD. "Typically, semaglutide treatment begins with a lower dose to allow the body to adjust to the medication. Your doctor will then gradually increase the dose based on your A1C levels, how well your body tolerates the drug, and the severity of any side effects."

Oral semaglutide results for weight loss

While some people may lose weight while taking Rybelsus, it's not approved by the FDA as a weight loss drug.

In a clinical trial:

• People taking a 50 mg dose of oral semaglutide lost around 15% of their starting weight on average over 68 weeks (just over a year)
• In the same trial, 85% of participants achieved at least 5% weight loss

Oral semaglutide results for heart health

Although a clinical trial suggested oral semaglutide may benefit heart health, Rybelsus is not FDA-approved for this use.

In the SOUL trial, conducted by Novo Nordisk with 9,650 adults with type 2 diabetes and cardiovascular risk, participants taking oral semaglutide had a 14% reduction in major cardiovascular events over a follow-up of nearly four years (49.5 months).

Oral semaglutide dosage

Currently, Rybelsus is available in 3 mg, 7 mg, and 14 mg tablet forms for the management of type 2 diabetes.

Treatment begins with 3 mg daily for 30 days, allowing gradual body adjustment to minimize side effects.

After 30 days, the dose increases to 7 mg daily for a minimum of another month. If additional glycemic control is needed, physicians may prescribe the maximum daily dose of 14 mg.

“Rybelsus is designed to be taken on an empty stomach in the morning with no more than 4 oz of plain water. Wait at least 30 minutes before eating, drinking, or taking other medications to ensure optimal absorption”, says Eapen, MD.

Oral semaglutide side effects

"Most patients experience digestive side effects when starting oral semaglutide, particularly nausea and stomach discomfort, but these typically improve as the body adjusts to treatment. If you continue to experience side effects, please talk to your healthcare provider, "says Eapen, MD.

Common Rybelsus side effects include nausea, stomach pain, diarrhea, decreased appetite, and occasional vomiting.

Importance of diet and lifestyle when on oral semaglutide

Oral semaglutide is most effective when paired with proper nutrition and lifestyle changes, working best as part of a comprehensive health plan rather than a standalone therapy.

Since Rybelsus is FDA-approved for type 2 diabetes when used with diet and exercise, registered dietitians can help people achieve their health goals and manage side effects.

Final thoughts: Oral semaglutide

Oral semaglutide (Rybelsus) is a pill for type 2 diabetes that helps lower blood sugar and avoids the need for injections.

Some studies also suggest that it may support weight loss; however, it is only FDA-approved for the treatment of diabetes. For optimal results, it should be taken at the right time each day and combined with healthy habits, such as a balanced diet and regular physical activity.

Get your personalized semaglutide diet plan from a dietitian who accepts your insurance.

Frequently asked questions (FAQs)

Can I get semaglutide in pill form?

Yes, oral semaglutide is available as Rybelsus in 3mg, 7mg, and 14mg tablets for type 2 diabetes.

Does oral semaglutide really work?

Yes, clinical trials have shown that it effectively lowers blood sugar. In one study, people taking a daily 14 mg dose saw their HbA1c drop by an average of 1.2%.

Can I lose weight with oral semaglutide?

Rybelsus is not FDA-approved for weight loss, so it cannot be prescribed for that purpose. However, people have lost weight on oral semaglutide in clinical trials. One study found that people taking higher doses of oral semaglutide over 68 weeks did lose weight.

Do I qualify for oral semaglutide?

Oral semaglutide is approved for adults with type 2 diabetes requiring better glycemic control despite diet and exercise. Please consult your doctor to learn if oral semaglutide is right for you.

Can I get Rybelsus in the USA?

Rybelsus is FDA-approved and available by prescription throughout the United States. Novo Nordisk manufactures the medication, which is available at most pharmacies with a valid prescription.

How much does Rybelsus cost in the US?

The list price for Rybelsus is about $997.58 per package without insurance. Please consult your insurance provider to learn if Rybelsus is covered. Additionally, manufacturer assistance programs may help reduce out-of-pocket costs.

Find a diabetes dietitian who accepts your insurance.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.