New Weight Loss Anti-Diabetic Drugs Ozempic and GLP-1 Receptor Agonists

New Weight Loss Anti-Diabetic Drugs Ozempic and GLP-1 Receptor Agonists  by Jeffrey Dach MD

What is the big deal about the new FDA approved weight loss anti-diabetic drugs ? Maybe it is the celebrities going nuts on social media for these new weight loss drugs, thus creating massive demand and manufacturing shortages. April 25, 2023, Peter Loftus of The Wall Street Journal writes:

Demand for medications including Ozempic, for weight loss use, led to shortages that sometimes deprived people with diabetes of their prescription refills…A drug approved by the Food and Drug Administration to treat people with Type 2 diabetes has ignited a craze among social-media influencers, the rich and famous and everyday people alike. Ozempic, made by Novo Nordisk A/S, has gained popularity for its off-label use, helping users drop excess pounds within a matter of months. (7)

These drugs are named: Ozempic, Wegovy and Mounjaro. These areGLP-1 Receptor Agonists, liraglutide and semaglutide.

Header image, young woman wearing loose jeans courtesy of wikimedia commons.

The New Miracle Treatment for Weight Loss

In April 2023, Natan Ponieman, Editor for Benzinga writes demand for GLP-1 drugs for obesity may propel sales to $100 billion annually by 2031:

Ozempic, Wegovy and Mounjaro could very well have become the most sought-after weight-loss drugs of the past two years, as press reports and social media amplification help push these new medications as a new “miracle treatment” for weight management...A February analysis by Jefferies puts sales of GLP-1 drugs for obesity above $100 billion by 2031. But for the time being, most of these drugs continue to officially address the diabetes market, which could cause problems for the patients who need them the most.(9)

Weight Loss for Non-Diabetics

Although the GLP-1 agonist class of drugs were originally intended as anti-diabetic drugs to control blood sugar, these drugs were found to have significant weight loss effects as well. These weight loss effects in diabetes were found to extend to non-diabetics, making these drugs a viable competitor to bariatric surgery for the obese. (2)

Weight Regain After Cessation of Drug

When used as a weight loss drug, Ozempic and Wegovy are quite effective. However, upon cessation of the drug the lost weight is regained, requiring lifelong drug use to maintain the weight loss. (18-19)

Broad Health Benefits

GLP-1 agonists are incretin analogs and have additional broad health benefits, such as reduction in all-cause mortality, reduced rates for myocardial infarction, stroke.  One must also include protective effects on kidney and brain function with reduction in dementia and cognitive impairment.Roughly half the patients treated with these drugs reach Hemoglobin A1C values below 5.7% (normal). Obese patients experience 20% or more weight loss. These new GLP-1 receptor agonists are on track to radically change modern medicine’s approach to treating Type Two Diabetes and Obesity. In 2022,  Dr.  Darlene M. Sanders, writes:

Recent studies show that incretin hormone analogues effectively control blood glucose while producing major weight losses and reducing the risk of all-cause mortality, myocardial infarction, stroke and kidney function impairment. Furthermore, the risk of dementia and cognitive impairment is reduced. A monomolecular coagonist (tirzepatide) of receptors for both incretin hormones (glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide) produced HbA1c values below 5.7% in 50% of the treated patients and weight losses exceeding 20% in obese individuals. These new agents will radically change our approach to the treatment of T2DM and obesity alike….Glucagon-like peptide-1 receptor agonists access specific brain areas important for appetite regulation, resulting in weight loss. These mechanisms may help explain how treatment with GLP-1 agonists led to reduced appetite and food cravings and better control of eating. Evidence supports both GLP-1 agonists liraglutide and semaglutide as effective agents for weight loss in patients with obesity without diabetes, with semaglutide data providing a more significant weight loss in clinical trials. Although GLP-1 agonists have side effects, the weight loss benefits may outweigh their risks. (2)

Not for Type One Diabetes, Only for Type Two

The benefits for Type Two Diabetics are not extended to Type One Diabetes, involving a different mechanism, namely, autoimmune destruction of the Beta Cells of the pancreas. These are the cells that produce insulin. In 2020, Dr. Maria Redondo found no apparent benefit for beta-cell function or glycemia using GLP-1 receptor agonists as adjuvant therapy in type one diabetes. As a result, semaglutide type drugs are not routinely recommended for Type One Diabetics. (13)

Another matter for concern, in 2023,  Dr. Khary Edwards found more semaglutide users experienced diabetic ketoacidosis (DKA) at a rate of 12.8% of the study population. This is not a good thing. (14-16)

Not a Miracle Drug at All

In March 2023, Zee Krstic writes in Good Housekeeping magazine  about his personal experience with Semaglutide. Zee was obese his entire life and was concerned when his doctor found his diabetic marker was very high. Zee’s Hemoglobin A1C was 9.8% (very high). After 5 months on treatment with Ozempic, his HgbA1C declined to normal, 5.4%, and he had lost 64 pounds. Yes, Zee did lose 64 pounds, yet he found Semaglutide not a “miracle drug” because of the significant diet and lifestyle modifications needed. For example, Zee wore a continuous glucose monitor, and found the drug associated with a long list of adverse side effects, most notably constipation, nausea, diarrhea, etc. Zee writes:

I also must wear a continuous glucose monitor to ensure anything I eat doesn’t impact my blood sugar control…Even those with diabetes, who found that Ozempic successfully tamed blood sugar levels, put up with nausea, vomiting and abdominal pain, and commonly, either diarrhea or a total blockage in firm constipation. Semaglutide may also lead to pancreatitis, some forms of kidney failure or thyroid tumors in some. Stories of people dealing with dire hospitalizations stemming from incessant vomiting or even heart failure became commonplace in most reports. Most patients experience the worst symptoms as dosages are initially ramped up, with your gastrointestinal tract beginning to slow down…The symptom that caused me the most pain was constipation. Within five days of my first dose, my digestive tract slowed to a crawl, and I simply couldn’t go. Almost four days went by before I woke up one morning with crippling pain in my lower gut – it took an hour on the toilet to relieve myself. I suffered a tear in my rectum that had me lying on my stomach for the next 18 hours, crying in pain…For the first few weeks, I was so nauseous that I wouldn’t eat normally for up to 2 or 3 days afterward, skipping meals altogether. Even now, after being settled on a 1mg dose for over four months, I still feel sore after injections for at least 12 hours. My constipation eventually swung in the opposite direction and stayed there — I had severe diarrhea that lasted on and off for two weeks each time I changed my dose, per my doctor’s directions. Dr. Mathur says my experience is typical. (10)

High Cost and Limited Availability

A major barrier to use of the drugs is high cost and limited availability. For example one carton of pre-filled 4 mg Ozempic pens (Novo-Nordisc)  costs approximately $1,000 according to GoodRx.

Update Feruary 2024: Ozempic is Just Another Fraudulent Drug

Tucker Carlson Interviews an Ozempic Drug Rep, Calley Means:

Ozempic Targeted for obese teens.? Ozempic paralyzes your stomach, and may persist after discontinuing the drug. Also, the lost weight is gained back after stopping drug. The European Union is probing increased depression and suicide on Ozempic which interferes with Serotonin made in gut. Ozempic is the Rosetta stone for understanding corruption in the Medical Industrial Complex.  The average 65 year old in the US is on 7 drugs.

Ozempic is a ‘Band-Aid’ on the root of childhood obesity: toxic food, former pharma consultant says. Prescribing weight loss drugs for obese kids will make lifetime patients out of teenagers,
Teny Sahakian By Teny Sahakian Fox News February 23, 2023 . FORMER PHARMA CONSULTANT SAYS PUSHING OZEMPIC ON KIDS IS A DISTRACTION FROM ROOT ISSUE: Toxic Food.

Aug 2023 : Ozempic lawsuit filed for Gastroparesis.

Ozempic Lawsuit  Ozempic lawsuits claim the drug can cause severe gastroparesis, ileus and intestinal blockage and that the drug’s manufacturers failed to warn of this risk. The first Ozempic stomach paralysis lawsuit was filed on Aug. 2, 2023. Paul Pennock said in a statement.

“Ms. Bjorklund, as well as the over 500 clients across 45 states whose claims we continue to investigate, have suffered ongoing gastrointestinal problems that in many cases are severe, debilitating and disabling. Some of the injuries may be permanent.”

The main injury claimed in the most recent Ozempic lawsuits is gastroparesis, or a paralyzed stomach. This causes severe vomiting that can last for four weeks or more.

Conclusion:

The GLP-1 receptor agonist class of drugs is a major advance and will no doubt change the medical landscape for management of Diabetes. However, every new drug has issues which eventually surface. Adverse effects are real, and not yet completely characterized. As a drug treatment for obesity, alarm bells should be going off. This drug requires lifetime use. The lost weight returns after stopping the drug. What are the adverse effects of lifetime use? we don’t know. The drugs are insanely lucrative for the medical industrial complex, and public funding is driving this whole thing. In my opinion, this will not end well. Best to stay away from all weight loss drugs and instead use non-pharmaceutical weight loss plans.

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Jeffrey Dach MD
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www.jeffreydachmd.com
www.drdach.com
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www.naturalmedicine101.com
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www.truemedmd.com

Key Words: GLP-1 receptor agonist incretin pancreas insulin Ozempic Wegovy Semaglutide glucagon-like peptide-1

Books:
OZEMPIC (SEMAGLUTIDE) SIMPLIFIED: ALSO WITH 50 QUESTIONS YOU ALWAYS ASK AND DOCTORS ANSWERS ABOUT HOW OZEMPIC (SEMAGLUTIDE) HELPS CURE DIABETES AND OBESITY. Paperback – Large Print, August 12, 2022 by DR JOHN JAX (Author)

Life On Semaglutide Kody and Krystal Dunn (Author)
During this Podcast Kody and Krystal will take you on there adventure of obtaining, using and everything in between of this new weight loss drug called Semaglutide.

Weight Loss Unlocked: The GLP-1 Breakthrough: Introduction to medicines like Wegovy and Mounjaro by Lisa Pieranunzi MD (Author) Format: Kindle Edition

The Semaglutide Way: A Scientific Approach to Losing Weight Kindle Edition by Scarlett Byrd (Author) Format: Kindle Edition

Achieve Weight Loss Journal: Designed For Those Taking Weekly Weight Loss Injections Paperback – January 3, 2023
by Julie N Hagaman (Author)

Ozempic (semaglutide): A Comprehensive Guide book that teach about Antidiabetes medication used for the treatment of type 2 diabetes and Anti-Obesity medication used for Long-term weight management Paperback – Large Print, April 2, 2023
by Dr. Olivia H. Philip (Author)

OZEMPIC (SEMIGLUTIDE)
by DR. CARL T. KEY | Aug 9, 2018

Links and References:

1) Mahapatra, Manoj K., Muthukumar Karuppasamy, and Biswa M. Sahoo. “Therapeutic potential of semaglutide, a newer GLP-1 receptor agonist, in abating obesity, non-alcoholic steatohepatitis and neurodegenerative diseases: a narrative review.” Pharmaceutical Research 39.6 (2022): 1233-1248.

Many GLP-1 receptor agonists have shown hepatoprotective and neuroprotective activity in animal and human trials. As semaglutide is an already clinically approved drug, successful human trials would hasten its inclusion into therapeutic treatment of NASH and neurodegenerative diseases. Semaglutide improves insulin resistance, insulin signalling pathway, and reduce body weight which are responsible for prevention or progression of NASH and neurodegenerative diseases.

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2) June 16, 2022 Efficacy of GLP-1 Agonists for Weight Loss in Adults Without Diabetes ,  Darlene M. Sanders, DMSc, MPAS, PA-C

Recent studies show that incretin hormone analogues effectively control blood glucose while producing major weight losses and reducing the risk of all-cause mortality, myocardial infarction, stroke and kidney function impairment. Furthermore, the risk of dementia and cognitive impairment is reduced. A monomolecular coagonist (tirzepatide) of receptors for both incretin hormones (glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide) produced HbA1c values below 5.7% in
50% of the treated patients and weight losses exceeding 20% in obese individuals. These new agents will radically change our approach to the treatment of T2DM and obesity alike.

Glucagon-like peptide-1 receptor agonists access specific brain areas important for appetite regulation, resulting in weight loss.17
These mechanisms may help explain how treatment with GLP-1 agonists led to reduced appetite and food cravings and better control of eating.3,17
Evidence supports both GLP-1 agonists liraglutide and semaglutide as effective agents for weight loss in patients with obesity without diabetes,
with semaglutide data providing a more significant weight loss in clinical trials.
Although GLP-1 agonists have side effects, the weight loss benefits may outweigh their risks.

3) pdf
Holst, Jens Juul. “Incretin-based therapy of metabolic disease.” Danish Medical Journal 70.1 (2022): A10220597-A10220597.

Incretin analogues (semaglutide, tirzepatide) provide effective glucose control in type 2 diabetes mellitus (T2DM) and major weight losses in people without diabetes. HbA1c may reach normal levels in 50% of patients and weight losses by > 20% may be achieved. The agents reduce the risk of mortality, myocardial infarction, stroke, reduced kidney function, dementia and cognitive impairment. These new agents will change our therapy of T2DM and obesity

4) Holst, Jens Juul. “The physiology of glucagon-like peptide 1.” Physiological reviews 87.4 (2007): 1409-1439.
Glucagon-like peptide 1 (GLP-1) is a 30-amino acid peptide hormone produced in the intestinal epithelial endocrine L-cells by differential processing of proglucagon, the gene which is expressed in these cells. The current knowledge regarding regulation of proglucagon gene expression in the gut and in the brain and mechanisms responsible for the posttranslational processing are reviewed. GLP-1 is released in response to meal intake, and the stimuli and molecular mechanisms involved are discussed. GLP-1 is extremely rapidly metabolized and inactivated by the enzyme dipeptidyl peptidase IV even before the hormone has left the gut, raising the possibility that the actions of GLP-1 are transmitted via sensory neurons in the intestine and the liver expressing the GLP-1 receptor. Because of this, it is important to distinguish between measurements of the intact hormone (responsible for endocrine actions) or the sum of the intact hormone and its metabolites, reflecting the total L-cell secretion and therefore also the possible neural actions. The main actions of GLP-1 are to stimulate insulin secretion (i.e., to act as an incretin hormone) and to inhibit glucagon secretion, thereby contributing to limit postprandial glucose excursions. It also inhibits gastrointestinal motility and secretion and thus acts as an enterogastrone and part of the “ileal brake” mechanism. GLP-1 also appears to be a physiological regulator of appetite and food intake. Because of these actions, GLP-1 or GLP-1 receptor agonists are currently being evaluated for the therapy of type 2 diabetes. Decreased secretion of GLP-1 may contribute to the development of obesity, and exaggerated secretion may be responsible for postprandial reactive hypoglycemia.

5) pdf
Bergmann, Natasha Chidekel, et al. “Semaglutide for the treatment of overweight and obesity: A review.” Diabetes, Obesity and Metabolism 25.1 (2023): 18-35.

6) https://www.mdpi.com/2077-0383/12/5/1909
Genser, Laurent, Dominique Thabut, and Judith Aron-Wisnewsky. “Precision Bariatric/Metabolic Medicine and Surgery.” Journal of Clinical Medicine 12.5 (2023): 1909.

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7) What Is Ozempic and why is it such a big deal right now? FOX Business April 25, 2023 By Peter Loftus The Wall Street Journal

Demand for medications including Ozempic, for weight loss use, led to shortages that sometimes deprived people with diabetes of their prescription refills.
A drug approved by the Food and Drug Administration to treat people with Type 2 diabetes has ignited a craze among social-media influencers, the rich and famous and everyday people alike. Ozempic, made by Novo Nordisk A/S, has gained popularity for its off-label use, helping users drop excess pounds within a matter of months.

8) FDA News Release September 20, 2019
FDA approves first oral GLP-1 treatment for type 2 diabetes
The U.S. Food and Drug Administration today approved Rybelsus (semaglutide) oral tablets to improve control of blood sugar in adult patients with type 2 diabetes, along with diet and exercise. Rybelsus is the first glucagon-like peptide (GLP-1) receptor protein treatment approved for use in the United States that does not need to be injected. GLP-1 drugs are non-insulin treatments for people with type 2 diabetes.

9)  Want To Lose 10 Pounds? ‘Miracle’ Weight Loss Drugs Create Winners And Losers
by Natan Ponieman, Benzinga Editor April 18, 2023

Ozempic, Wegovy and Mounjaro could very well have become the most sought-after weight-loss drugs of the past two years, as press reports and social media amplification help push these new medications as a new “miracle treatment” for weight management.
A February analysis by Jefferies puts sales of GLP-1 drugs for obesity above $100 billion by 2031. But for the time being, most of these drugs continue to officially address the diabetes market, which could cause problems for the patients who need them the most.

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10) I Lost 64 Pounds on Ozempic, But I’m Here to Tell You It’s Not a Miracle Weight Loss Drug   If you’re thinking a once-weekly injection will magically help you lose weight, think again. By Zee Krstic Mar 11, 2023 Medically reviewed by Rekha B. Kumar, M.D. and Joshua J. Joseph, M.D., M.P.H, FAHA Good Housekeeping

GLP-1 receptor agonist incretin pancreas insulin Ozempic Wegovy Semaglutide glucagon-like peptide-1,

The medication’s manufacturer, Novo Nordisk,

Semaglutide is an injectable medication, known to doctors as a GLP-1 receptor agonist. It mimics a gut hormone called incretin, prompting the pancreas to naturally produce more insulin when blood sugar levels are high, something that the pancreas usually does on its own. Long before it was regarded as a so-called “miracle” drug, Ozempic attracted the attention of obesity medicine specialists after extensive clinical trials in 2017 revealed weight loss was a significant side effect of the medication. Since over 80% of those with type 2 diabetes are clinically obese,

“When you look at studies that were done for [semaglutide use] in both obesity and diabetes, they were all in conjunction with lifestyle changes,” says Ruchi Mathur, M.D., an endocrinologist specializing in thyroid disorders at Cedars-Sinai Medical Center in Los Angeles. “Those clinical studies were all done with a calorie deficit of at least 500 calories a day, along with an exercise goal of about 150 minutes a week, plus monthly healthcare check-ins to ensure lifestyle was being optimized… Benefits are always achieved in conjunction with lifestyle changes, it can never occur without them.”

I also must wear a continuous glucose monitor to ensure anything I eat doesn’t impact my blood sugar control.

Even those with diabetes, who found that Ozempic successfully tamed blood sugar levels, put up with nausea, vomiting and abdominal pain, and commonly, either diarrhea or a total blockage in firm constipation. Semaglutide may also lead to pancreatitis, some forms of kidney failure or thyroid tumors in some. Stories of people dealing with dire hospitalizations stemming from incessant vomiting or even heart failure became commonplace in most reports. Most patients experience the worst symptoms as dosages are initially ramped up, with your gastrointestinal tract beginning to slow down, Dr. Mahali explains.

The symptom that caused me the most pain was constipation. Within five days of my first dose, my digestive tract slowed to a crawl, and I simply couldn’t go. Almost four days went by before I woke up one morning with crippling pain in my lower gut – it took an hour on the toilet to relieve myself. I suffered a tear in my rectum that had me lying on my stomach for the next 18 hours, crying in pain.

For the first few weeks, I was so nauseous that I wouldn’t eat normally for up to 2 or 3 days afterward, skipping meals altogether. Even now, after being settled on a 1mg dose for over four months, I still feel sore after injections for at least 12 hours. My constipation eventually swung in the opposite direction and stayed there — I had severe diarrhea that lasted on and off for two weeks each time I changed my dose, per my doctor’s directions. Dr. Mathur says my experience is typical.

Phase 1: 0.25mg

All patients start at a dosage of 0.25mg once weekly; they’ll be closely monitored by doctors while on this dose for at least two weeks, if not a full month. Early on-set symptoms may feel severe but may progress as doses increase.

Phase 2: 0.5mg

Patients graduate to a weekly 0.5mg dose if they can tolerate Ozempic well, and stay on this dose for at least a month, per manufacturer instructions. This is when many experience the bulk of their symptoms, doctors tell us.

Phase 3: 1mg

Those who need further blood sugar control may continue onto 1mg doses once each week, which is when the author’s own healthcare provider completed HbA1C tests to determine Ozempic’s efficacy in his case. He currently remains on 1mg weekly injections, more than 7 months into his treatment.

Phase 4: 2mg

The maximum dosage for Ozempic is 2mg, and is only used after patients remain at 1mg for at least one month, if not longer. Missing more than two doses at this strength means patients will likely start the schedule from 0.25mg once they resume injections.

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11) Wegovy vs Ozempic for Weight Loss
Mochi Health, where board-certified obesity medicine physicians
Dr. Constantine Joseph Pella, MD
Boston University Medical Center
Wegovy (semaglutide) and Ozempic (semaglutide) are two prescription weight-loss medications that are cut from the same cloth. Both medications belong to the same class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists, and they work by mimicking the action of the hormone GLP-1, which regulates glucose metabolism and appetite. Despite their similarities, they are not interchangeable. There are differences between Wegovy and Ozempic that patients and healthcare providers should be aware of. In this blog post, we will compare and contrast the two medications to help you make an informed decision about which one may be right for you. April 21, 2023

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12) A new treatment for obesity September 10, 2021
By Chika Anekwe, MD, MPH, Contributor; Editorial Advisory Board Member, Harvard Health Publishing

On June 4, 2021, the FDA announced the long-anticipated approval of Wegovy, an injectable medication taken once per week for weight management.

Wegovy received significant media attention in the months preceding approval, with a New York Times article declaring it a “game changer,” MedPage Today reporting its “unprecedented results,” and the BBC announcing it could mark a “new era” in treating obesity.
Wegovy, like all other prescription medications designated for the treatment of obesity, is approved for use in those with a body mass index (BMI) of 30 kg/m2 or greater, or those with a BMI of 27 kg/m2 with a weight-related medical condition such as high blood pressure, type 2 diabetes, or high cholesterol.

The widely reported STEP 1 trial, the results of which were published in the New England Journal of Medicine, demonstrated an average of 14.9% body weight reduction after 68 weeks of therapy in those assigned to the medication group, versus only 2.4% weight loss in those assigned to the placebo group. The average weight loss seen with existing anti-obesity medications is typically about 5% to 9%, while those engaged in lifestyle and behavioral therapy alone are expected to lose only 3% to 5% of their body weight.

The most common side effects of Wegovy are nausea, diarrhea, vomiting, and constipation. The medication also comes with a warning for risk of a specific tumor of the thyroid, and thus it is not recommended for those with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 (a genetic condition associated with endocrine tumors). It should be noted that tumors were only observed in animal studies, and not seen in the human trials.

Wegovy is the latest in a line of medications, starting with phentermine in 1959, that have achieved FDA approval for the treatment of obesity. Currently there are 10 FDA-approved anti-obesity medications in the US: phentermine, diethylpropion, benzphetamine, phendimetrazine, orlistat, phentermine/topiramate ER (Qsymia), bupropion/naltrexone (Contrave), liraglutide (Saxenda), setmelanotide (Imcivree), and now semaglutide (Wegovy). Of note, setmelanotide is only approved for the treatment of obesity caused by specific, rare genetic conditions. Other medications such as metformin, zonisamide, and other GLP-1 RAs normally used for treating diabetes are often prescribed “off label” and at the discretion of the prescriber for the treatment of obesity.

=======================================================Type One Diabetes

13) Redondo, Maria J., and Fida Bacha. “GLP-1 receptor agonist as adjuvant therapy in type 1 diabetes: No apparent benefit for beta-cell function or glycemia.” The Journal of Clinical Endocrinology & Metabolism 105.8 (2020): e3000-e3002.

14) Edwards, Khary, Xilong Li, and Ildiko Lingvay. “Clinical and Safety Outcomes with GLP-1 Receptor Agonists and SGLT2 Inhibitors in Type 1 Diabetes: A Real-World Study.The Journal of Clinical Endocrinology & Metabolism 108.4 (2023): 920-930.

Context: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) are used off-label in the management of type 1 diabetes mellitus (T1DM) in real-world practice as adjuvant therapies to insulin. There are few real-world data regarding efficacy and safety of this practice.
Objective: This work aimed to determine the efficacy and safety of GLP-1RAs and sodium-glucose SGLT2is in the management of T1DM in real-world practice.
Methods: A retrospective chart review was performed of all instances of GLP-1RA and/or SGLT2i use greater than 90 days in adult patients with T1DM at a single academic center. We report the clinical and safety outcomes over the duration of use.
Results: We identified 104 patients with T1DM who ever used a GLP-1RA (76 patients) or SGLT2i (39 patients) for more than 90 days. After 1 year of therapy, GLP-1RA users had statistically significant reductions in weight (90.5 kg to 85.4 kg; P < .001), glycated hemoglobin A1c (HbA1c) (7.7% to 7.3%; P = .007), and total daily dose of insulin (61.8 units to 41.9 units; P < .001). SGLT2i users had statistically significant reductions in HbA1c (7.9% to 7.3%; P < .001) and basal insulin (31.3 units to 25.6 units; P = .003). GLP-1RA users compared to SGLT2i users had greater reduction in weight (P = .027) while HbA1c reduction was comparable between the groups. Over a mean total duration of use of 29.5 months/patient for both groups, more SGLT2i users experienced diabetic ketoacidosis (DKA) (12.8% vs 3.9%). Therapy was discontinued because of adverse events 26.9% of the time for GLP-1RA users vs 27.7% for SGLT2i users.
Conclusion: GLP-1RA and SGLT2i use in T1DM is associated with clinically relevant benefits. DKA remains a clinical concern with SGLT2i use, requiring careful patient selection and monitoring, with the risk to benefit ratio of treatment evaluated at an individual level.

MICE

15) Gu, Liangbiao, et al. “Combination of GLP-1 receptor activation and glucagon blockage promotes pancreatic β-cell regeneration in situ in type 1 diabetic mice.” Journal of Diabetes Research 2021 (2021): 1-7.

16)  Wei, Tianjiao, et al. “Glucagon Acting at the GLP-1 Receptor Contributes to β-Cell Regeneration Induced by Glucagon Receptor Antagonism in Diabetic Mice.” Diabetes (2023): db220784.

17) How Effective is Weight-Loss Medication vs. Supplements? New Phase of Weight-Loss Meds | Feat. Dr. Damon Noto Oct-20-2023 Vital Signs Epoch Times

18) Chao, Ariana M., et al. “Clinical insight on semaglutide for chronic weight management in adults: patient selection and special considerations.” Drug Design, Development and Therapy (2022): 4449-4461.

Obesity is a chronic disease and as shown in the STEP 1 extension study and STEP 4 trial, weight regain occurs with cessation of the medication. Thus, patients should be advised about the need for continued care for long-term weight loss.

19) Wilding JP, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553–1564.

Conclusions: One year after withdrawal of once‐weekly subcutaneous semaglutide 2.4 mg and lifestyle intervention, participants regained two‐thirds of their prior weight loss, with similar changes in cardiometabolic variables. Findings confirm the chronicity of obesity and suggest ongoing treatment is required to maintain improvements in weight and health.

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One thought on “New Weight Loss Anti-Diabetic Drugs Ozempic and GLP-1 Receptor Agonists

  1. Weight Watchers is now making Ozempic available to their members. I think this is totally ridiculous and offensive. I would never use WW again ever for this!!!!!

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