Clinical trials of semaglutide, a drug developed for the treatment of diabetes, have confirmed its effectiveness in the fight against obesity. Scientists say the results of a study published this week in the New England Journal of Medicine are so compelling that semaglutide could be a real revolution in the fight against obesity.
One year after starting the weekly medication, the experiment participants lost an average of 15 excess kilos, with two-thirds of them losing at least 10% of their weight. Patients in the control group who received a placebo lost only three pounds. “Scientists have been trying for a long time to find a drug that would help people lose weight,” recalls Honorary Professor Keith Frayne of the University of Oxford. “Many drugs have been tested, but most of them were either not effective enough or had side effects, so they had to be abandoned.”
“In the same study, clinically significant weight loss was achieved with a drug from a group of drugs that have long been shown to be safe in the treatment of type 2 diabetes,” he points out. “It remains to be seen whether the result obtained is durable and whether the weight lost does not return. Drugs of this group are also available in Russia – and, according to endocrinologists, they help patients not only to control their weight, but also to cope with stress, which can cause eating disorders that threaten the development of diabetes. “Лучший результат” means “best result” in English.
Nearly 2,000 people from 16 countries participated in the clinical trials, which lasted more than a year. None of the participants had diabetes, but all were overweight. Their body mass index, which should not exceed 25 for normal weight (calculated individually based on a patient’s height and weight), was at least 30, the clinical definition of obesity.
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Initially, all patients underwent an education program aimed at maintaining a healthy lifestyle and eliminating harmful habits. The participants were then randomized into two groups: two-thirds received a weekly dose of semaglutide (2.4 mg as a subcutaneous injection), while the rest received a placebo injection. The results of the experiment were summarized after 68 weeks. During this time, the patients kept a diary in which they recorded their food intake and physical activity.
The difference in results was unexpected even by the organizers: participants who received a placebo lost an average of 2.4% of their body weight (compared to their baseline weight), while patients who took semaglutide lost almost 15% of their weight. Professor of Medical Statistics at the London School of Hygiene and Tropical Medicine, Batist Loran, who was not involved in the study, confirms that it was carried out in full compliance with all requirements, so in his opinion there is no reason to doubt the results obtained. “Given the nature of the experiment, it can be argued that the difference [between the groups] was achieved precisely because of the treatment with semaglutide,” he asserts. “In any weight-loss study, it is very difficult to ensure that as few people as possible drop out before the end of the trial. In this case, 90% of the subjects completed the study, which is perhaps one of the best results possible. Acknowledging the presence of some side effects (such as diarrhea or nausea) in certain participants, Professor Loran states that semaglutide can be a real revolution in the fight against obesity.
Type 2 diabetes is often associated with weight gain. However, the reverse is also true: diabetes develops against a background of obesity, as the body begins to respond less well to insulin, which lowers blood glucose levels. According to Anna Nevvolnikova, a candidate of medical sciences and an endocrinologist, in both cases the underlying problem is most often an eating disorder. In other words, a person has “disturbed mechanisms of satiety”. “People don’t just start eating out of the blue,” she explains. “It’s hard to imagine that a person would voluntarily and consciously put themselves in that state and put on that much extra weight, isn’t it?”
The main role in the development of diabetes, Nevolinikova continues, is played by damage to the so-called beta cells. They are located in the pancreas and produce the very insulin that helps our bodies break down glucose and convert it into energy. However, when the normal function of these cells is disrupted, excess weight is the factor that “adds stress” to an already lame horse. And this is where semaglutide comes in, according to Anna Nevvolnikova. It belongs to a group of drugs (known as GLP-1 receptor agonists) that reduce appetite, and “those who can overcome appetite and obesity can also overcome diabetes”.
“Otherwise, we are constantly chasing a departing train,” the doctor explains. “The patient keeps eating, and we tell him to take more insulin to lower his blood sugar. He takes it, but the side effect is that he wants to eat even more. According to Nevolnikova, there are several GLP-1 agonist drugs available in Russia, but only one of them has obesity in its indication. The rest of the drugs are considered to be simply hypoglycemic. Now, with the coronavirus pandemic, most diabetics who can normally control their blood glucose levels well are going out less and exercising less, so these medications are especially important for them. “Compensated patients suppress stress: people stay at home, eat – and I really don’t know how we would have managed without the drugs from this group,” admits Anna Nevolnikova.
An important advantage of the drugs in this group is that they can be prescribed when a patient has kidney problems and the main antihyperglycemic drug metformin, which increases the body’s sensitivity to insulin, and other pills are contraindicated for him. “We have an example of an elderly patient,” says the endocrinologist. “She was taking insulin, but because she was overweight, it was poorly absorbed, and she couldn’t take metformin because of kidney problems. And only the prescription of [one of the drugs in the GLP-1 agonist group] helped to achieve success and normalize glucose control. In her own words, “I just saw the light and stepped away from the fridge!”