With celebrities like Elon Musk swearing by the Type-2 diabetes drug Semaglutide for remaining in shape and Kim Kardashian allegedly using it to fit into the Marilyn Monroe dress for the Met Gala, Indian diabetologists have suddenly seen an increase in queries about the wonder drug that can help people shed up to 15 per cent of their body weight. Dr SK Wangnoo explains how the higher dose for weight loss is not yet available in India and even if it were, it could not be arbitrarily used by everyone.
Drugs like Ozempic and Wegovy have become popular on social media as weight-loss therapies. Can people get this medicine on demand?
Drugs like Ozempic and Wegovy are basically a drug called Semaglutide, which is an injectable that has to be taken once a week. It is mainly used to control the blood sugar levels in people with Type-2 diabetes in lower doses of 0.5 or 1mg. However, the US Food and Drug Administration has approved a higher 2.4 mg dose for weight loss. So, this is the dose that people like Elon Musk are taking.
Of course, because of news like this, now I am getting many requests for the drug. In India, however, only the lower dose is available for the treatment of diabetes but the higher dose may become available by next year.
If Semaglutide becomes available, can anyone take the medicine?
Even for weight loss, this medicine is meant only for those who have a high BMI and have tried diet and exercise but have failed to lose weight. Right now, though, we give the medicine only to people with diabetes.
But there are three things we need to check for before prescribing the medicine – the patient must not consume alcohol while on the medicine, the patient must not have any past history of pancreatitis (inflammation of the pancreas), and the patient must not have any gall stones.
Also, we have to warn the patients that initially, during the first few weeks of treatment, they might experience nausea and vomiting. If they can tolerate it, then over a period of three to four weeks, the patient becomes tolerant to the medication. We tell the patients to have small, frequent meals.
Can they consume no alcohol at all while on the medicine?
Well, the medicine and alcohol together might lead to pancreatitis, so it must be avoided. Social drinking may be acceptable but to me social drinking is say once in a month. It’s just better to refrain from any alcohol.
Do diabetics also lose weight when on the medicine? And, does the medicine lead to a drop in blood sugar levels of non-diabetics with obesity?
Even the lower doses meant for diabetics do lead to weight loss. And what we have seen is that Indians tend to lose more weight than Caucasians. I have had a patient who lost around 14 kg over a period of six months.
The drug, however, is meant to be prescribed to obese people without diabetes as well. That’s what the higher dose Semaglutides are meant for. And, it may cause a slight lowering of the blood sugar levels but not enough to cause any problem.
We are talking about the drug leading to a significant weight loss. Does this translate to remission of type 2 diabetes in some people?
Remission means that the HbA1c is less than 6.5 per cent for one year without using any drug. Now, if there is a 15 to 20 per cent loss in body weight with this medicine in a diabetic, it may lead to remission in some for up to a year or two but not more than that. It can’t be permanent. They have to go back to it.
The medicine has to be taken lifelong. And, that is the major drawback. This drug is not inexpensive – it will cost perhaps Rs 4,000 per week and that is not very affordable for most.
How does the drug work? Why does it lower body weight along with blood glucose levels?
This medicine has multiple mechanisms to lower blood glucose levels and body weight. First, it stimulates the satiety centre in the brain, which results in your hunger going down. You feel full with smaller meals.
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Second, it increases the gastric transit time. Whenever you consume any food, it takes a certain amount of time to go through the digestive system. The drug increases this time – it takes longer for the food to travel from the stomach to the small intestine to the large intestine. This means that the food is digested very slowly and there is no rapid rise in the calories or blood glucose levels.
Third, it also stimulates insulin secretion in the pancreas thereby reducing blood sugar levels. Fourth, it reduces fat across the body — over the liver, pancreas, and heart — what you call ectopic fat that usually gets deposited in diabetics.
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Why Dr Wangnoo? Dr Wangnoo heads the Apollo Centre for Obesity, Diabetes, and Endocrinology (ACODE). He has over 30 years of experience and was instrumental in establishing the department of endocrinology at the Sher-I-Kashmir Institute of Medical Sciences in Srinagar. He is an honorary fellow of the Royal College of Physicians-London and was previously the honorary endocrinologist to the President of India.
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