Diabetes drug may very well be a contributing issue to weight problems, a brand new research exhibits
A drug recently approved to treat type 2 diabetes is also extremely effective in reducing obesity, according to a new study.
The drug, called tirzepatide, acts on two naturally occurring hormones that help control blood sugar and are involved in sending signals of satiety from the gut to the brain.
The researchers found that people who took the drug for their diabetes also lost weight. The new study focused on people with obesity without diabetes and found even more weight loss.
Those taking the highest of the three doses studied lost up to 21% of their body weight – in some cases as much as 50-60 pounds.
Nothing but surgery has resulted in this kind of weight loss, said Dr. Robert Gabbay, Chief Scientific and Medical Officer of the American Diabetes Association. The full study was presented at the ADA annual meeting in New Orleans on Saturday and published simultaneously in the New England Journal of Medicine.
Another anti-obesity treatment approved last year called Novo Nordisk’s Semaglutide causes weight loss of up to 15% on average. previous Generations of diet drugs reduced weight by only about 5% and many had prohibitive side effects.
“We didn’t have tools like this before,” Gabbay said. “I think it’s really exciting.”
For most study participants, the side effects of tirzepatide were not serious, said Jeff Emmick, vice president of product development for the diabetes division of drug giant Lilly, which makes the drug.
About 15% of participants receiving the active drug dropped out of the 72-week study, about a third because of gastrointestinal side effects. Meanwhile, 26% of subjects who received a placebo dropped out of the study. Emmick said he thinks they were frustrated with their lack of weight loss.
On May 13, the Food and Drug Administration approved tirzepatide under the trade name Mounjaro for the treatment of type 2 diabetes.
Tirzepatide isn’t yet available for weight loss, but Lilly hopes to submit data to the FDA later this year, Emmick said. Before approving the drug for weight loss, the regulator may want Lilly to complete other ongoing studies evaluating tirzepatide in people with obesity and diabetes, and include lifestyle modifications in the drug regimen.
Weight loss of 15% to over 20% also has the potential to change how doctors treat diabetes from focusing on lowering blood sugar to the goal of achieving complete remission, Gabbay said.
A previous study of tirzepatide in diabetes showed that half of the participants who had their diabetes early in the course went into remission while taking the drug.
“This is a potential game-changer in how we think about treating people with type 2 diabetes,” he said.
What’s not yet known, Gabbay said, is whether remission achieved in this way will reduce the typical complications of diabetes, which can include cardiovascular disease, nerve and kidney damage, and limb amputations.
It’s also still unclear whether tirzepatide will provide the cardiovascular benefits that semaglutide does, said Dr. David Rind, family physician and chief medical officer of the Boston-based Institute for Clinical and Economic Review.
It would be helpful, Rind said, to conduct a head-to-head study between the two drugs to see if there are any differences in their health benefits.
“The question is, is tirzepatide one step better than all of these (other weight loss) drugs?” said beef. “There’s certainly reason to believe that might be the case, but I don’t think it’s proven yet.”
Positive side effect
It certainly made a difference for Mary Brühl, 63, of Norman, Oklahoma.
She entered the diabetes trial for tirzepatide in August 2019 after hearing that weight loss could be a side effect of the drug. After years of “doing everything right”, Brühl’s diabetes and weight control slipped.
A hip replacement had rendered her nearly unable to move, resulting in weight gain and lack of energy. “It just seemed like there was nothing I could do to get rid of it,” said Brühl, an attorney. “My stomach knew no end of all the food in the world.”
When diagnosed with fatty liver in June 2019, a concerned Brühl began skipping breakfast — except for coffee — to save calories and lost a bit of weight.
When she started Tirzepatide in September, she started losing 5 to 10 pounds a month. As of July 1, 2020, she had lost nearly 60 pounds, giving her one of the best results to date on the drug.
The more Brühl lost, the better she felt, and the more she was able to resume weekend hiking and other physical activities, she said, which helped her feel even better.
The drug prevented her from overeating, Brühl said. If she ate too much, the food would come back up. “I’ve learned to stop before I get that feeling,” she said.
Brühl no longer needed metformin for her diabetes and her fatty liver resolved. The only negative side effect was nausea, which Brühl felt the day after each of her weekly tirzepatide vaccinations. An anti-nausea pill this morning took care of that, she said.
The biggest challenge for Brühl was adjusting to how differently people treated her after weight loss. “I went for a consultation about my body image and to sort out some of the issues I was having,” she said, adding that she needed time to accept what she was seeing in the mirror and to stop throwing up anger Comments about her new number to respond. “It took a while before I felt comfortable in my own skin again.”
Brühl began dating after being single for many years and now has a long-term partner.
“I feel rounder. I feel more myself now,” she said. “This exam gave me my life back.”
The new tirzepatid study, called SURMOUNT-1, enrolled more than 2,500 volunteers who either met the medical definition of obesity, had a body mass index of 30 or more, or had a slightly lower BMI but had at least one weight-related health condition.
The average BMI of the participants was 38, 70% were white and almost as many were women. Almost everyone who took the drug saw improvements in blood sugar, blood pressure, and lipid levels. The study began in December 2019 and was completed despite the ongoing COVID-19 pandemic.
dr Ania Jastreboff, an obesity specialist at Yale Medicine who helped lead the study, said her patients responded to tirzepatide in different ways just like any other drug, with some having no benefit at all. But nine out of ten lost weight, and at the highest dose, 15 mg, each lost an average of 52 pounds.
Drugs like semaglutide and now tirzepatide “allow us to actually care for our patients the way we need them,” Jastreboff said. “They effectively re-regulate biology and help people restore their body weight.”
Jastreboff said she was able to help most of her patients through the side effects of the newer weight-loss drugs, either by reducing certain foods or eating less overall. “If you eat past the point of satiety on these drugs,” she said, “you’re going to feel like you’ve eaten three Thanksgiving dinners.”
Jastreboff said she often has to help patients through the self-blame they feel for carrying extra pounds. She sees obesity not as an individual’s fault, but as a struggle against the biological urge to hold on to extra pounds. “These drugs target that physiology safely and effectively,” she said.
Patients must continue to take weight-loss medications, as well as medications to treat other chronic conditions, such as diabetes, high cholesterol and high blood pressure, she said. It’s possible that once they maintain a lower weight for a period of time, they’ll be able to continue at a lower dose or even taper off entirely, but that needs to be investigated, she said.
A barrier for many people will be the price of weight loss drugs.
It’s too early to know what price Lilly will set for Tirzepatide. Mounjaro, the same drug used to treat diabetes in the same doses, costs just under $1,000 a month.
Semaglutide hit the market for weight loss last year and has been in short supply ever since, Rind said. The 2.4 mg dose for weight loss costs about $1,600 per month, which is higher than the 1 or 2 mg doses used to treat diabetes. Like other weight loss drugs, semaglutide is not covered by many insurance plans.
“Access and cost – we work on that every day as a provider,” said Jastreboff.
Brühl recently started on a low dose of Semaglutide to treat her diabetes and the weight that is creeping back up. Insurance covers all but about $30 a month.
She agrees she’ll probably have to take it forever to keep the weight off, just as her hereditary risk for diabetes means she’ll likely have to treat that forever too. Exercise and careful eating must also be part of her ongoing regime, she said.
“It will take a lifetime of dedication.”
Contact Karen Weintraub at [email protected].
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