Endocrinology

Novel diabetes medications and their role in reducing excess weight

Marina Virko
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Recent years have been in a way revolutionary for the drug treatment of type 2 diabetes. The pharmaceutical industry has developed, thoroughly tested and brought entirely new types of active ingredients to market.

These substances have proven effective both in treating diabetes itself and in combating overweight (doctors use the term "obesity, or "adipositas" in Latin).

A special role in the media promotion of these medications was played by Elon Musk - information that he lost weight using new-generation anti-diabetic injections quickly spread on social networks and caused a real stir.

What are the new drugs, how do they work, and who can benefit from them?

We will try to summarize the available data on the example of several drugs, referring first of all to the opinion of leading German specialists - diabetologists who have already accumulated experience in their use.

Professor Dr. Jochen Seufert, MD, head of the Endocrinology and Diabetology Department at a major university hospital, describes type 2 diabetes as part of the so-called metabolic syndrome.

Patients with this syndrome also suffer from excess weight, various metabolic disorders, blood clotting, etc. These conditions create a toxic combination giving rise to severe diseases which present the complications of the metabolic syndrome. First of all – cardiovascular and microcirculatory system issues, such as myocardial infarction, stroke, blood supply disturbance, as well as kidney failure, blindness, nervous system disorders and a diabetic foot syndrome.

The goal of metabolic syndrome management is to prevent the development of such complications.

Previously, doctors focused only on lowering blood sugar levels, but over time the situation has changed significantly. To improve the long-term prognosis, a simultaneous decrease in blood cholesterol, normalization of blood pressure, and getting rid of excessive weight have also proven very important. It is believed that its reduction by 15% gives diabetes patients a chance to achieve complete remission.

New antidiabetic drugs enable doctors not only to control blood glucose levels and HbA1c (glycated hemoglobin, an indicator that reflects the average blood glucose content over a long period), but also to influence fat metabolism, body weight and high blood pressure.

Semaglutide (sold under the brand name Ozempic)

This substance is one of the most studied and already approved for use in both the US and European markets. It is what was made so famous by Elon Musk.

There are precise recommendations as to the cases when the drug can be prescribed. First of all, it is approved for use in cases of type 2 diabetes. In such patients, semaglutide has been successfully administered for several years.

Its action is based on the fact that the substance stimulates the pancreas to release the hormone insulin, which utilizes glucose. This reduces blood sugar levels when they are too high. Hypoglycemia (too low blood sugar) usually does not occur, which is a great advantage.

But why does it reduce weight?

The answer to this question lies in the drug’s mechanism of action.

Semaglutide belongs to the group of so-called GLP-1 agonists. The hormone GLP-1 (glucagon-like peptide 1 or enteroglucagon) is formed in our intestines and regulates insulin secretion. Agonists are chemicals that affect receptors (increase their response).

In addition, semaglutide also affects the brain's satiety center. Under its influence the feeling of fullness appears, whereas the feeling of hunger quickly disappears. It also slows down the emptying of the stomach. Taken together, semaglutide injections make a person eat less because they have less need for food.

The drug also has certain side effects. Immediately after the start of its use or as the dosage increases during treatment, gastrointestinal problems up to nausea, vomiting, diarrhea may occur. In most cases, these side effects are mild to moderate. In addition, one soon gets used to the substance, and the complaints eventually go away.

Semaglutide should be used very cautiously in patients with gallbladder problems, because it slows down its activity, increasing the risk of gallstone formation.

Among other side effects, although very rare, the possibility of pancreatic inflammation has been reported.

Based on all this, before administering this medication, your physician should check and assess the possible risks. In addition, there are a number of genetic disorders in which the drug should not be given. Therefore, you can use it only by medical prescription.

The manufacturer also warns that it is contraindicated for those with a certain form of malignant thyroid disease or multiple endocrine neoplasia in their own or family history.

Semaglutide can be used both as subcutaneous injections and in tablet form.

Wegovy: a medicine that contains semaglutide

Semaglutide-containing drug wegovy (Wegovy®), is approved for use as a weight-loss medication.

It is recommended only in cases of abnormal overweight. The criterion is usually the Body Mass Index (BMI), namely its values greater than 30 or 27 given the presence of certain diseases (hypertension, high cholesterol, etc.). In such patients, semaglutide can be considered as a treatment option in combination with diet therapy and physical activity. After all, being overweight is not just a lifestyle problem that is simply solved by eating less food, and often such people need help from healthcare professionals.

Those who have a body mass index of 22 or even 26 and want to lose a few pounds are definitely not candidates for wegovy.

When compared to saxenda (containing the active ingredient liraglutide, similar to semaglutide), wegovy administered for weight loss needs to be given only once a week, whereas saxenda is administered every 24 hours.

Semaglutide-containing drug wegovy (Wegovy®), is approved for use as a weight-loss medication.

It is recommended only in cases of abnormal overweight. The criterion is usually the Body Mass Index (BMI), namely its values greater than 30 or 27 given the presence of certain diseases (hypertension, high cholesterol, etc.). In such patients, semaglutide can be considered as a treatment option in combination with diet therapy and physical activity. After all, being overweight is not just a lifestyle problem that is simply solved by eating less food, and often such people need help from healthcare professionals.

Those who have a body mass index of 22 or even 26 and want to lose a few pounds are definitely not candidates for wegovy.

When compared to saxenda (containing the active ingredient liraglutide, similar to semaglutide), wegovy administered for weight loss needs to be given only once a week, whereas saxenda is administered every 24 hours.

Prof. Harald Schneider, speaker of the Applied Endocrinology Section of the German Endocrine Society, emphasizes: «If your weight is only a little over the norm and you only want to lose a few pounds, you should refrain from using semaglutide».

Tirzepatide («mounjaro», «twinkretine»)

A new anti-diabetic drug, tirzepatide (trade names: mounjaro, twinkretine), has recently been approved for use.

This medication has an enhanced effect both on blood sugar and on weight. Its influence, so to speak, is doubled. Along with GLP-1 (enteroglucagon), it mimics another gastrointestinal hormone called glucose-dependent insulinotropic polypeptide (GIP).

Both of these hormones are secreted during food intake by various intestinal cells. They stimulate insulin production by the pancreas, which improves blood sugar distribution and mitigates the spike in blood sugar after a meal. It also slows down the emptying of the stomach. This creates a feeling of satiety, which prevents further food intake and glucose influx.

Numerous clinical studies have proven the high effectiveness of the drug both in relation to blood glucose levels and in relation to long-term complications of diabetes mellitus and weight loss in obese patients.

Nausea, vomiting, diarrhea, poor appetite, constipation, and upper abdominal pain are mentioned as the most frequent side effects.

Currently, tirzepatide is approved only for the treatment of type 2 diabetes mellitus in the form of subcutaneous injections.

It is contraindicated in patients with own or family history of thyroid carcinoma and in patients with multiple endocrine neoplastic syndrome.

Tirzepatide can be used in type 2 diabetes mellitus as an adjunct to diet and physical activity, or as monotherapy if metformin is not tolerated or contraindicated, or additionally in combination with other antidiabetic medications.

Summary conclusion

Thus, both semaglutide and tirzepatide, along with regulating blood glucose levels in diabetes patients, contribute to the reduction of their excess weight.

It should be kept in mind that these drugs only work as long as they are administered. Once they are withdrawn, the extra pounds may come back.

Being overweight is a very individual issue. One may have a satiety feeling disorder, another may have a slow basic body metabolism, a third person would eat too much against stress, etc. Whoever wants to lose weight should count on a long-term effort. Medication in this case can only be a support.

Stopping the systematic administration of semaglutide and other similar medications can be compared to the case when after being on a diet, one resumes the usual meal pattern and starts to gain weight again, sometimes even exceeding what there was before the diet ("yo-yo effect").

Specialists recommend the use of these drugs for weight loss as a supportive measure in combination with other measures related to lifestyle correction (motor activity, adequate nutrition, etc.). You should consult an endocrinologist before planning such therapy. If your physician does not have enough experience with the latest diabetes medications, it makes sense to seek remote telemedicine advice with a sufficiently knowledgeable expert.

References

  1. Statement » Neue Therapien: Interventionsmöglichkeiten bei Adipositas « – Professor Dr. med. Jens Aberle Tagungspräsident 12. Diabetes Herbsttagung; III. Medizinische Klinik und Poliklinik am UKE – Universitätsklinikum Hamburg-Eppendorf zur 12. Diabetes Herbsttagung der Deutschen Diabetes Gesellschaft (DDG) und der 34. Jahrestagung der Deutschen Adipositas-Gesellschaft (DAG), November 2018, Berlin
  2. Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG). Semaglutid (Diabetes mellitus Typ 2) – Nutzenbewertung gemäß § 35a SGB V. Dossierbewertung; Auftrag A18-75. 30.01.2019. (IQWiG-Berichte; Band 721).
  3. Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG). Semaglutid (Diabetes mellitus Typ 2) – Nutzenbewertung gemäß § 35a SGB V (neue wissenschaftliche Erkenntnisse). Dossierbewertung; Auftrag A20-93. 28.01.2021. (IQWiG-Berichte; Band 1032).
  4. Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG). Semaglutid (Diabetes mellitus Typ 2) – Addendum zum Auftrag A20-93; Auftrag A21-30. 26.03.2021. (IQWiG-Berichte; Band 1086).
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Алла

Здравствуйте! При первой стадии почечной недостаточности можно ли применять инъекции для похудения и диабета 2 типа? Какое действие на почки?

Marina Virko

Здравствуйте. В соответствии с действующими рекомендациями Европейского агентство лекарственных средств (EMA) применение Ozempic при почечной недостаточности не рекомендовано только на терминальной стадии заболевания, а на всех других стадиях лекарство может употребляться без изменения дозировки. Более того актуальные исследования предварительно показывают, что при применении препарата замедляется развитие почечной недостаточности.

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