Approximately 74 million people live with diabetes in India. With the rising rates of obesity, the prevalence of diabetes is also expected to further rise in India. It is well known that obesity is one of the strongest risk factors for type 2 diabetes. With significant weight loss, remission of diabetes has also been shown to occur in a large number of cases. Till now, however, treatment for obesity and diabetes had to be done independently from each other. Indeed, one of the problems with older anti diabetic medicines like insulin, sulfonylureas and pioglitazone is the weight gain which accompanies them. Hence, while the sugar levels usually get under control, one of the unwanted side effects of these medicines was weight gain.
Let’s understand the effects of diabetes medicines on weight loss!
There are some medicines which are known to be weight neutral, for instance metformin and DPP4 inhibitors. More recently, however, two groups of agents, the SGLT2 drugs and the GLP1 receptor agonists (GLP1RA’s) developed to control diabetes have been found effective in helping patients lose weight.
While the weight loss with SGLT2 groups is modest, the GLP1RA’s is quite remarkable. Indeed, the latter group of drugs have been approved in some countries as weight loss agents. The problem with the GLP1RA is that they were mostly injectables. Hence, many people were not very keen to start using them. With the development of oral semaglutide, that problem was solved. Oral semaglutide is indeed the first ‘peptide in a pill’.
The GLP1 receptor analogs have additional benefits. Apart from weight loss and blood sugar control, they are also cardio-protective and have been shown to protect against atherosclerotic cardiovascular disease.
The SGLT2 drugs also have multiple other benefits apart from blood sugar control and weight reduction. Most importantly, they prevent heart failure. Cardiologists now use this drug as the first line in the treatment of heart failure, even in those without diabetes. SGLT2 drugs also have a kidney protection effect. Hence, nephrologists have started using these drugs to protect the kidney even in those without diabetes.
The SGLT2 drugs and the GLP1 receptor analogs can be used along with other oral antidiabetic drugs, as well as with insulin. Thus, the treatment of diabetes has come a long way with the introduction of these newer agents. Some of the SGLT2 agents, for example, apagliflozin are now available in generic form. This has made the drug more affordable and therefore available to a larger section of people living with diabetes in India.
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(Disclaimer: The views and opinions expressed in the article are of the writer.)