Anyone on the Ascend Plus trial?

[MrsBezzer]

I think the key here is that you should be talking about blood sugar control and not weight loss. If you are on the Ascend Plus trial it is for people with Type 2 diabetes. There are also more effective drugs for weight loss available through private prescription.

Rybelsus is not allowed to be prescribed for weight loss on the NHS, but it is prescribed for blood sugar control in type 2 diabetics, so you would not help your case by talking about weight loss, although that might happen, it also might not and is not a reason for them to prescribe the Rybelsus according to NICE guidelines, and also the use of Rybelsus for weight loss is off label.

The NHS is allowed to prescribe Wegovy (semaglutide) and Mounjaro (tirzepatide) for weight loss as far as I know, but it would be for people with a high BMI and with other co-morbidities, which rules many people out, and is subject to both the NICE and the local guidelines.

I was prescribed Rybelsus after requesting it at my GP practice on realising that I was on the placebo. Also pertinent to this is that I had tried Metformin and could not tolerate it, and that I would not be able to take any SGLT 2 inhibitor drugs as that would be the next line they would try, as I am on a low carb diet, and there can be a risk of DKA if you are low carb on SGLT2 inhibitor drugs. I was not prepared to up the carbs in my diet as the low carb approach was having a huge effect on both weight loss and bringing the blood sugar down.

I did the research and got ready to make my case with a list of reasons why I should be prescribed Rybelsus, but just looking at my results for blood sugar control (from my CGM) while I was on the run in and then the placebo was enough for them to prescribe the Rybelsus, and they are happy to carry on after my excellent HbA1c result this month after 3 months of the prescribed Rybelsus. See my signature for the results.

I have also lost weight, but this is mainly because of my low carb diet and exercise, and not really as much to do with the Rybelsus - the big effect the Rybelsus had was on my blood sugar, and in normalising my insulin response, and helping with the fatty liver.

It has been decided to keep me on the 7mg dose as this is working well to control the blood sugar numbers.

Thanks @AllieRainbow this is really interesting. I am also on a low carb diet and do loads of exercise…. For years this was enough to keep my HbA1c in the forties but then post menopause it started to creep up no matter how carefully I ate. So I have been on Metformin for a couple of years which I tolerate well, but I am not convinced it’s actually working for me. And the low carb diet is hard to stick to all the time! After just two weeks of 7mg oral semaglutide my BS is down from 7 to around 5.5 average daily. I don’t need to lose any weight although a few pounds would be nice, it’s just such a relief to eat how I normally do and for my BS to be back in normal range. If the side effects settle down I would rather be on Rybelsus but same dose as you, I wouldn’t cope with a higher dose although some trial participants have managed to argue their cases for the 7mg ongoing instead of 14mg. There’s a good article under boltpharmacy about why GPs are reluctant and/or unable to prescribe Rybelsus if Metformin is tolerated. Makes sense especially for non obese patients.

 

[AllieRainbow]

Thanks @AllieRainbow this is really interesting. I am also on a low carb diet and do loads of exercise…. For years this was enough to keep my HbA1c in the forties but then post menopause it started to creep up no matter how carefully I ate. So I have been on Metformin for a couple of years which I tolerate well, but I am not convinced it’s actually working for me. And the low carb diet is hard to stick to all the time! After just two weeks of 7mg oral semaglutide my BS is down from 7 to around 5.5 average daily. I don’t need to lose any weight although a few pounds would be nice, it’s just such a relief to eat how I normally do and for my BS to be back in normal range. If the side effects settle down I would rather be on Rybelsus but same dose as you, I wouldn’t cope with a higher dose which means I am probably going to give up the trial and see if GP will prescribe.

I wear a CGM and I have definitely seen my responses change so that they are more normal, so I think the Rybelsus is really doing a lot. The dawn phenomenom is going down now, and I am under 7.8mmol/L within 2 hours of eating almost 100% of the time, which is a normal response.

Looking at my graphs over the run in period and then during the placebo it seemed that it was working to get the blood sugar down (and then not working when I started the trial tablets and was on the placebo) - and then I ran a little experiment to see what the difference would be back on the real thing to confirm what I suspected.

I had about 3 weeks worth of tablets left from the run in period and it was very clear within the first few days of resuming the run in tablets that I had been on the placebo as my blood sugar started to go down straight away. I went back down around 3 mmol/L in just 2 weeks, from a daily average of 9.4mmol/L to 6.5mmol/L.

I had been unsure whether it really was the placebo or not, but this was very clear, and made my mind up about leaving the trial and seeing if I could get it prescribed as it was clearly making a big difference to the blood sugar numbers.

 

[AllieRainbow]

Thanks @AllieRainbow this is really interesting. I am also on a low carb diet and do loads of exercise…. For years this was enough to keep my HbA1c in the forties but then post menopause it started to creep up no matter how carefully I ate. So I have been on Metformin for a couple of years which I tolerate well, but I am not convinced it’s actually working for me. And the low carb diet is hard to stick to all the time! After just two weeks of 7mg oral semaglutide my BS is down from 7 to around 5.5 average daily. I don’t need to lose any weight although a few pounds would be nice, it’s just such a relief to eat how I normally do and for my BS to be back in normal range. If the side effects settle down I would rather be on Rybelsus but same dose as you, I wouldn’t cope with a higher dose which means I am probably going to give up the trial and see if GP will prescribe.

@MrsBezzer Just to note about what you said re leaving the trial so you could stay on 7mg - I know that people have asked to stay on the 7mg dose for the trial period due to side effects on the higher dose and also if they do not have much weight to lose and the Ascend people are OK with that - it could be worth you talking to them about your dosage if you do end up on the real stuff once you are past the run in and the trial starts.

 

[MrsBezzer]

@MrsBezzer Just to note about what you said re leaving the trial so you could stay on 7mg - I know that people have asked to stay on the 7mg dose for the trial period due to side effects on the higher dose and also if they do not have much weight to lose and the Ascend people are OK with that - it could be worth you talking to them about your dosage if you do end up on the real stuff once you are past the run in and the trial starts.

Yes, thanks @AllieRainbow I will wait and see what happens at randomisation. So far the worst side effect for me is the crippling bone achy fatigue which means some days I can barely do anything let alone lift weights and do all the other exercise that I aim to do to maintain muscle mass. And disturbed sleep which doesn’t help. Having recently retired to focus on my health and be less sedentary that’s quite ironic!! It’s all about finding the right balance. Thank you for your comments