Control weight with blood sugar: 25 mg and 50 mg doses of Semaglutide can speed up weight loss, even among Indians

How can these new findings support adherence to lifestyle modification protocols? Dr Ashu Rastogi, Associate Professor, Department of Endocrinology and Metabolism, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, reflects on the new study and says that obesity is the mother of all non-communicable diseases (NCDs), especially diabetes and hypertension. India, he adds, has seen a transition from a predominantly agrarian to an urban lifestyle in the past few decades that has led to the rocketing trend of obesity in the country. By current estimates, every third person in our country is obese, with generalised obesity in 28.6 per cent of the population and abdominal obesity in 39.5 per cent of the population. The problem is particularly acute in urban areas of India that require immediate attention to curb rising numbers of NCDs, including diabetes.

Lifestyle modification, including eating habits and exercise, has shown to reduce weight and improve metabolic outcomes. A five per cent weight loss from existing weight significantly reduces hypertension and blood glucose in addition to the reduction of cholesterol. “However, it has been observed that the maintenance of weight is difficult and almost impossible to sustain unless somebody is motivated to the core. This culminates in weight regain. Hence, there comes the need for pharmacotherapy for weight loss and improved outcomes,” says Dr Rastogi.

Previously, he adds, many pharmaceutical agents have been tried for obesity but were discontinued for safety reasons. Semaglutide is a novel oral glucagon receptor-1 analogue that causes increased satiety and a decreased sense of hunger, reducing food cravings, thus causing weight loss. Oral Semaglutide is approved in India in doses of 14 mg for people with diabetes requiring blood glucose control that additionally causes weight loss of 5-8 per cent. “The recent study published in Lancet with 25 mg or 50 mg oral Semaglutide in obese people without diabetes was associated with overall 15 per cent weight loss over a period of 68 weeks. Interestingly, more than two-thirds achieved at least 10 per cent weight loss which is remarkable. The point to note is that the study also included Asian subjects (11 per cent) that had similar responses to Semaglutide as other races. Weight loss was also associated with a significant improvement in the quality of life of the patients. Some adverse events predominantly related to the gastrointestinal system were noted, including nausea and constipation, but were tolerable. In our country, with more than one-third of the population being obese, this class of drug may be a useful addition to the therapeutic armamentarium for treating the obese population. However, being a patented molecule, the cost of the drug is prohibitory at this moment in our country,” says Dr Rastogi.

Dr Sandeep S Chhatwal, Internal Medicine Specialist, Omni Clinics, Chandigarh, says that “at present, 3, 7, and 14 mg dosages of Semaglutide are being used in obese patients with diabetes. The drug helps to reduce weight and, therefore, helps in addressing the demand-supply mismatch in diabetes.  Most patients tolerate the drug well although gastrointestinal side effects are more common with higher doses.”

The latest study, he adds, will open a new frontier for higher dosage use in patients who are obese provided they tolerate the medication. Cost no doubt is and will be a big deterrent and Semaglutide as of date is a medicine that only the higher income group can afford.