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Over 80 per cent overweight users of the diabetes cum obesity drug Semaglutide achieved significant weight loss after 12 months, according to a new study by the International Journal of Obesity. Interestingly those without diabetes achieved a more substantial weight loss (16.9 per cent) than those with it. But what matters most is that overweight or obese patients experienced significant improvements in metabolic health, lipid profiles, blood pressure, liver function and cardiovascular disease risk factors.
Dr Vivek Mahajan, Consultant, Interventional Cardiology, Fortis Hospital, explains how Semaglutide-induced weight loss can improve cardiovascular health.
Humans produce a peptide or protein known as GLP-1, secreted by the gut in response to food intake. This stimulates insulin release from the pancreas, which regulates blood glucose levels. Second, it delays gastric emptying, promoting satiety. Third, it signals the brain, reducing the desire for additional food intake.
Semaglutide, a GLP-1 agonist, operates through these mechanisms, reducing food intake and thereby aiding in weight loss. Additionally, it lowers blood glucose levels and minimally reduces blood pressure, alongside minor reductions in bad cholesterol levels. It majorly reduces vascular inflammation in the endothelium or walls of arteries, reducing the likelihood of arterial blockages in organs such as the heart or brain. Vascular inflammation occurs in the inner lining of blood vessels throughout the body, independent of weight loss mechanisms.
How would you quantify the weight loss that happened because of Semaglutide in clinical trials?
Semaglutide has led to around 4 kg weight loss on average in clinical trials, though in our clinical practice, it often exceeds this figure. The extent of weight loss after the initial drop also depends on the patient’s adherence to lifestyle modifications and dietary practices.
How does Semaglutide complement existing cardiovascular therapies?
It lowers triggers in a rather short time. In terms of blood glucose control, Semaglutide is among the most effective drugs, reducing HbA1c (average blood sugar) levels by 1.5 to 1.8 per cent. Only insulin surpasses this effectiveness. In terms of weight loss efficacy, Semaglutide surpasses other weight loss drugs like SGLT2 inhibitors, which prevent your kidneys from reabsorbing sugar.
The injectable form of Semaglutide has reduced cardiovascular event rates in high-risk diabetes patients. Results of trials for oral Semaglutide in people with diabetes, like the SOUL trial, are awaited, but if positive, they will further validate Semaglutide’s effectiveness in reducing cardiovascular risks.
Are there specific patient subgroups, such as those with obesity-related cardiovascular risk, who seem to benefit more from Semaglutide?
Any patient of diabetes with multiple risk factors for cardiovascular events will benefit from Semaglutide. The recent SELECT trial shows that injectable Semaglutide protects non-diabetic obese patients with pre-existing cardiovascular disease.
For patients with existing atherosclerosis or plaques in the heart, GLP-1 receptor agonists or SGLT2 inhibitors are recommended as the initial treatment. In cases where patients have kidney disease or a high risk of heart failure, GLP-1 receptor agonists like Semaglutide become one of the preferred treatment options, followed by SGLT2 inhibitors, for managing diabetes and preventing kidney disease and heart failure. However, in these scenarios, SGLT2 inhibitors remain the preferred choice.
Any side effects?
Although Semaglutide induces sustained weight loss, patients may initially experience side effects such as bloating, dyspepsia, gastritis, acidity, constipation or diarrhoea. However, these side effects typically diminish within 15 to 20 days of starting or increasing the dosage of the drug.
