A few years ago, one word began to do the rounds amongst people with diabetes and those struggling to lose weight: Ozempic. Touted as a wonder drug, it soon took the world by storm. Celebrities such as Elon Musk revealed that they had used it. Reports of “Ozempic parties” followed, and, as the drug’s popularity surged, supply became a drag in various countries.
Ozempic, known generically as semaglutide, is an injectable prescription drug. It was approved in 2017 by the United States Food and Drug Administration (FDA) for use in adults with type 2 diabetes. In 2021, the FDA approved of another injectable semaglutide, Wegovy, for chronic weight management in adults with obesity/overweight and with at least one weight-related condition (such as high blood pressure, type 2 diabetes, or high cholesterol). Ozempic and Wegovy are manufactured by Danish drugmaker Novo Nordisk.
So what is semaglutide and who uses it in India? Semaglutide belongs to the class of drugs called Glucagon-like peptide-1 (GLP-1) receptor agonists. This drug mimics the actions of the hormone GLP-1 made by the small intestine, which the gut releases after eating. What this does is slow down digestion and reduce the appetite, while triggering the pancreas to release more insulin.
The use of the drug therefore, leads to weight loss, and some benefits to the heart and kidney have also been noted, explains V. Mohan, chairman of Dr. Mohan’s Diabetes Specialities Centre, Chennai.
Semaglutide is available in oral (Rybelsus) and injectable (Ozempic/Wegovy) forms. The injectables result in weight losses of about 10 to 15% in patients, Dr. Mohan says. “The daily oral tablet (Rybelsus), which was launched in India a few years ago, is a breakthrough, though it cannot be compared with the effectiveness of the injectable forms that are still not available in the country,” he says.
In a country that has an estimated 10.13 crore people with diabetes and where the prevalence of abdominal obesity is estimated to be 40% among women and 12% in men, a drug like semaglutide has attracted widespread interest, though costs remain a significant barrier to its use, while side effects deter some patients.
Making gains in diabetes control
Doctors across India have been prescribing oral semaglutide to patients for about two years now, and say they have seen results in terms of diabetes control and weight management.
Anoop Misra, chairman, Fortis CDOC Hospital for Diabetes and Allied Sciences in Delhi, says he has seen a rise in the number of patients who want to start on Rybelsus. “An increasing number of patients are asking for prescriptions for it. Most have heard about it from relatives or friends abroad who have used it, and where these drugs are popular,” he says.
In his clinical practice, S. Chandrasekar, professor and head, Department of Medicine, Government Stanley Medical College, Chennai, has been prescribing oral semaglutide to his patients . “This is a good add-on drug for persons with diabetes as it can be used with the current line of treatment, for instance, for those already taking metformin,” he said.
While the weight loss factor often overshadows the diabetes management aspect, and has led to a surge of interest from patients looking for a quick fix, doctors emphasise that this drug is not for simple weight management and is not a first-line option.
“Diabetes is not a single disease and it comes with a host of complications, all of which need aggressive management. Semaglutide, with the added benefits it gives as far as renal, cardiovascular and hepatic issues are concerned, is primarily used by physicians to treat diabetes itself. The weight loss benefits are just the cherry on top for many diabetes patients for whom weight gain, because of insulin use is a concern,” says Mathew John, a senior endocrinology consultant, in Thiruvananthapuram.
Diabetes is not a single disease and it comes with a host of complications, all of which need aggressive management, say doctors
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In Bengaluru for instance, doctors say patients, especially those from the IT sector, who have relative or friends working in the United States, Canada and Australia, have heard about the use of the drug for weight loss, and ask for it. “But we do not prescribe this drug just for weight loss,” says Subrata Das, Head of the Department of Internal Medicine and Diabetology at Sakra World Hospital.
Also, not everyone who wants the drug is eligible, say doctors: “While I receive 15-20 enquiries a week, only 2-3 patients are actually eligible for it. We prescribe it to those with diabetes who are at a high risk for cardiovascular disease, since the drug reduces the risk of heart attack, stroke, and cardiovascular deaths in such adults,” says Mahesh D. M., consultant in endocrinology at Aster CMI Hospital in Bengaluru.
The fact that semaglutide does not produce hypoglycemia, unlike insulin does make it suitable for obesity management, in patients without diabetes too, but even so, the drug is not for all.
“We do not recommend the drug for people just looking to shed 10–15 kg. This is a drug for the obese, for whom weight loss is an uphill task even with a healthy diet and moderate physical activity. We generally see that along with a healthy diet and physical activity, semaglutide leads to significant weight loss in many. At the same time, I have also seen patients for whom the drug did not work,” says Akhil Krishnan, Associate Consultant in Endocrinology, Kimshealth in Thiruvananthapuram.
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