PharmacoVig_BOS said:

Oral semaglutide is absorbed in the stomach with the help of SNAC, which locally raises pH and protects the peptide long enough to cross.

I do not accept that the fasting window is a minor inconvenience. Adherence data on daily orals with timing requirements is consistently worse than weekly injections, and a drug you take imperfectly is a lower dose than the one on the box.

The figures, for anyone assembling their own picture. A quick sanity check on any figure quoted here: is it mean or median, is it intention-to-treat or completers, and what was the comparator. Three questions, and they resolve most disagreements in these threads.

Dr.RenalNash said:

I do not accept that the fasting window is a minor inconvenience.

There is a second half to this that has not been said yet. The gap between trial results and real-world results is consistent and it is not fraud. Trial participants get titration by protocol, scheduled contact, free drug and dietetic support; removing that infrastructure costs a few percentage points every time it has been measured. When your own curve sits below the published mean, that is the likeliest explanation before anything about you or your material.

Following on from HPLC_Greg — and this may be the naive question:

Whether the fasting requirement is as strict in practice as the label implies, and what people actually see when they get it wrong?

OP back with an update, since a thread like this is useless without one.

Update — I went back to the injectable. Not because the tablet did not work, but because the fasting window and my mornings were never going to agree.