The future is here, let's see how oral administration of Simei can reshape the treatment value of diabetes

The Zhitong Finance App learned that recently, the Chronic Disease Center of the Chinese Center for Disease Control and Prevention published a research report on the prevalence and non-fatal burden of diabetes in “Military Medical Research”, which once again sounded a wake-up call for the prevention and control of diabetes in China: without effective intervention, the total costs associated with diabetes in China are expected to reach 460 billion US dollars by 2030. This figure, which accounts for about one-third of the country's total public health expenses in 2024, reveals the huge financial burden caused by diabetes.

However, medical expenses directly related to diabetes are only the tip of the iceberg, hidden underneath which are frequent hospitalizations due to complications, loss of productivity in the workforce, and indirect costs of home care. Research shows that the medical costs for patients with type 2 diabetes with complications are more than 4 times that of patients without complications, accounting for 81% of the total cost. However, as the annual incidence of type 2 diabetes rises year by year and the length of treatment due to a decrease in the age of onset, our medical system is increasingly paying for the “consequences” associated with diabetes, rather than the treatment itself, to a greater extent.

Evolution of treatment paradigms under increasing treatment burden: “oral administration” has become an inevitable direction

In the past 30 years, with the rapidly growing population of patients and increasing and significant changes in the burden of disease, the concept and technology of diabetes treatment in China have also experienced a series of profound and rapid iterations.

The pathophysiological mechanisms of diabetes are complex and varied, and are closely related to insufficient insulin secretion, insulin resistance, genetics, and environmental factors. On the path of the evolution of drugs to treat diabetes, from traditional drugs to insulin treatment to novel hypoglycemic drugs, major pharmaceutical companies around the world have experienced continuous testing and development.

First-generation sulfonylureas (Sulfonylureas) control blood sugar by stimulating pancreatic beta cells to secrete insulin, but long-term use may cause islet failure. Metformin (Metformin) lowers blood sugar by inhibiting liver gluconeogenesis, and is considered a basic medication for type 2 diabetes. The combined application of second-generation long-acting and quick-acting insulin has become the core of advanced diabetes management, but it may face problems such as hypoglycemia and weight gain. In recent years, third-generation treatment options have received widespread attention. Sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) agonists have shown the potential to reduce cardiovascular protection and the risk of nephropathy while lowering sugar.

More and more endocrinologists are aware that treatment strategies that only target blood sugar level intervention are difficult to comprehensively address the problems associated with metabolic disorders in patients. As a result, the breakthrough direction of diabetes prevention and management is also anchored in achieving personalized treatment that matches the patient's specific metabolic state through precision medicine technology, combined with drug development with multiple clear targets.

While the focus of treatment is gradually shifting to “comprehensive metabolic management as the core,” dosage methods that are both convenient and improve patients' quality of life are also receiving increasing attention. Most of the previous treatments were injectable, and long-term injections caused inconvenience and psychological burden to patients. Under the premise of standardized and precise treatment, patients urgently need a treatment plan that is lighter, freer, and closer to real life situations. “Oral administration” will inevitably become a new direction in the development of diabetes treatment.

Technological Breakthrough: The Scientific Revolution of Oral Macromolecule Drugs

Oral medication is the most commonly used dosage form. It is easy to use and improves patient compliance. However, due to the physico-chemical properties of macromolecular drugs and gastrointestinal degradation, the possibility of oral administration of macromolecules has been largely ruled out for a long time. Faced with the rapid development of biological science and the current situation where more and more innovative therapies use larger molecules, “oral administration of macromolecular biologics” has become an urgent problem for drug developers and developers, and it is also a treatment plan that healthcare workers and patients are desperately seeking.

How to simultaneously meet the three major problems of “enabling drugs to cross biological barriers”, “minimising changes in pH in the gastrointestinal tract and drug degradation caused by enzymes”, and “maintaining the integrity of biological systems at the same time”? Major pharmaceutical companies around the world have carried out various experiments over a long period of time: for example, Emisphere's Eligen technology uses carriers to change the conformation or hydration sphere state of drug molecules so that they can be transported across membranes; MYCAPSSA achieves oral administration of octreotide by adding sodium caprate.

After many rounds of failure and thought, Novo Nordisk (NVO.US) scientists came up with the idea of “modifying natural amino acids to obtain a new, safer and more effective penetrating carrier.” As a result, SNAC ([N- (8- [2-hydroxybenzoyl] amino) sodium caprate) was discovered and first added to the formulation of semeglutide oral formulations as a key absorption enhancer in 2019.

As one of the artificially synthesized carriers that has gone through many experiments and clinical trials, SNAC can cause the macromolecule polypeptide drug simeglutide to be absorbed orally. In addition, the half-life of meglutide is very long, and the daily dosing regimen can increase the drug concentration at steady state to 10 times the cumulative amount; furthermore, the pharmacokinetic coefficient of variation is reduced from 150% during single dose administration to 70% to 80% at steady state, which also makes the curative effect more sustainable and stable. Simeglutide oral formulations combine these three key factors to create a technological revolution, completely disrupting the traditional pharmaceutical concept that “macromolecular drugs cannot be absorbed orally”; glucagon-like peptide-1 (GLP-1) receptor agonists (oral simeglutide tablets) also became the first commercially successful oral macromolecule drug in the world, in chronic diseases It has great medical value in treatment.

While achieving convenient treatment and ensuring curative efficacy, the performance of oral simeglutide in cardiovascular protection and reduction of the risk of kidney disease has also attracted industry attention. According to a recent article published in the “New England Journal of Medicine”, the results of the Phase 3 Oasis 4 trial of 25 mg of oral simeglutide tablets were comparable to those of injectable formulations. At the 61st European Diabetes Research Association Annual Meeting (EASD 2025) in September 2025, Novo Nordisk announced a recent SOUL trial results showing that compared with placebo, oral treatment with simeglutide tablets significantly reduced the risk of major cardiovascular adverse events (MACE) by 14%, and could achieve long-term cardiac and renal organ protection and improve clinical outcomes.

Transcendental Hypoglycemic: Comprehensive Metabolism Benefits of Oral Simeglutide Tablets Reshape Therapeutic Value

The multiple therapeutic benefits of GLP-1 receptor agonists (GLP-1 RA) are determined by their mechanism of action. GLP‑1 receptors are widely distributed in islet cells, gastrointestinal tract, lungs, brain, kidney, hypothalamus, cardiovascular system, liver, adipocytes, and skeletal muscle. GLP‑1RA stimulates insulin secretion and inhibits pancreatic glycogen secretion in a glucose-dependent manner by activating GLP‑1 receptors, while increasing glucose uptake in muscle and adipose tissue, suppressing liver glucose production, and suppressing gastric emptying and appetite; it can effectively reduce blood sugar, partially restore pancreatic beta cell function, and long-term use has cardiovascular and renal benefits; it also reduces body weight, improves blood lipid profile and blood pressure, and improves the effects of fatty liver disease. As a result, GLP‑1RA can be used alone or in combination with other hypoglycemic agents.

As a GLP-1 receptor agonist (GLP-1 RA) treatment, 12 PIONEER series phase 3 clinical studies conducted around the world showed that oral simeglutide tablets had significant hypoglycemic effects and multiple metabolic regulation abilities such as weight loss, blood pressure reduction, and fat regulation. Among them, after treatment with oral simeglutide tablets in Chinese type 2 diabetics, glycated hemoglobin (HbA1c) decreased by up to 1.6%, and the maximum compliance rate was 92.3%, and body weight The maximum reduction can reach 3.4 kg, the minimum decrease in blood pressure can reach 4 mmHg, and fasting blood lipids are significantly improved.

The latest results of the SOUL trial released at EASD 2025 further demonstrated the cardiovascular benefits of oral simeglutide: in the overall study population, oral administration of simeglutide tablets reduced the risk of complex heart failure outcomes by 10%; significantly reducing the main

The risk of cardiovascular adverse events (MACE) is 14%, and this figure is as high as 27% among Asians. In other aspects, oral simeglutide, as a representative drug for macromolecular oral treatment, also showed good safety: those with a history of heart failure had a 22% lower risk of complex heart failure outcomes; and heart failure (HFpEF) patients with preserved ejection scores benefited more significantly.

Currently, the benefits of comprehensive metabolic treatment for patients with type 2 diabetes in lowering sugar and reducing the risk of cardiovascular disease and nephropathy have become the focus of treatment for endocrinologists. The Chinese Medical Association and the Endocrinology Branch (CSE) of the Chinese Medical Association released the “Expert Consensus on Oral Hypoglycemic Drug Combined Treatment for Adult Type 2 Diabetes (2025 Edition)” at the 22nd Chinese Medical Association Endocrinology Conference held in August 2025. Based on this concern, they recommended the combined dosage procedures and dosage options for oral hypoglycemic drug treatment for adult type 2 diabetes, such as “metformin + DPP-4 inhibitor + SGLT2 inhibitor”. Among them, GLP‑1RA oral preparation (simeglutide tablets) is clearly recommended as the preferred drug for T2DM combined with ASCVD or CKD patients.

Innovative payments: opening up the “last mile” of accessibility to oral macromolecular hypoglycemic drugs

The widespread clinical application of innovative technology requires the collaboration of innovative payment systems to truly reduce the financial burden on patients and society.

The “Xinxiang Care” patient protection program for type 2 diabetics was launched in January 2025. It has effectively played a positive role in reducing the burden of medication use, improving treatment accessibility, and improving disease awareness and standardizing diagnosis and treatment rates for patients. It is believed that with the implementation of the Patient Assistance Program, diversified and innovative payment methods will clear barriers to medication use, provide high-quality treatment and medication guarantees, and improve the quality of life for many patients with type 2 diabetes.

Conclusion: The future has arrived, and the era of “invisibility” treatment has begun

We are at the beginning of a new era of diabetes treatment. The advent of oral GLP-1RA is not only a simple change in administration routes, but also a comprehensive upgrade in treatment concepts, technical philosophy, and patient experience. It allows diabetes treatment to gradually be integrated from a “medical task” that needs to be deliberately faced into the patient's daily life, making it more “invisible” and free.

As the first and currently only oral GLP-1RA proven to have cardiovascular benefits in the treatment of type 2 diabetes, oral simeglutide tablets have been widely proven to have therapeutic benefits for the treatment of blood sugar and long-term health management of patients in addition to the easy and convenient once-a-day oral treatment mode. Its story clearly indicates that in the next ten years, the innovative integration of technology and business will continue to reshape the future of chronic disease management with patients at the center.

Disclaimer: For advice on treatment and medication for diabetes, please consult a healthcare professional.