I have been a GP for 30 years and in practice I was the lead doctor for Diabetic patients.
At that time, the holy grail for diabetic treatment was to find a medicine that reduced sugar levels and helped weight loss as it was understood that obesity was a key factor in Type 2 Diabetes.
In 2005 a drug called Exenatide was licensed for use. This was the first GLP-1 agonist or Incretin medication which stimulated insulin and lowered the sugar levels but also reduced the appetite leading to weight loss.
Patients hated it because it was a daily injection. The government hated it because it was so expensive. As a result, doctors struggled to persuade many patients to take it and the government said it should be stopped if patients had not significantly improved their diabetes and lost 5% of their bodyweight in 3 months. For those patients who could tolerate it, it worked really well but the numbers were relatively small.
The next breakthrough was weekly injections with less side-effects but again this was used to treat diabetes and not for weight loss. In 2017 Semaglutide branded as Ozempic came out as a weekly injectable for diabetes and within a few years the unlicensed use purely for weight loss had rocketed with the help of celebrity endorsements and social media campaigns. A licensed version specifically for weight loss came out in 2023 however issues with manufacture and supply have caused problems for doctors and patients,
In late 2023 Mounjaro received a license for weight loss. It was the first medication to combine 2 types of Incretin – GLPI and GIP. The GIP stands for Glucose–dependant Insulinotropic Polypeptide which in human language means it does help stimulate insulin and lower blood sugar but only if the glucose is raised which thankfully reduces the risk of low blood sugar attacks. GIP also reduces gastric secretions and gastric emptying as well as having an effect on the control centres for cravings within the brain.
This combined approach seems to be the most effective in terms of weight loss with 20% loss being seen in trials compared to 15% for Semaglutide. What is getting doctors excited is that diabetic control is much better and there seems to be a real benefit in terms of heart disease prevention. So even if I can remember a time when I literally couldn’t give them away the future looks bright for these injections and the benefits that they bring.