Daunting Height, Mt Chocorua

High Hopes for a New Diabesity Drug

Call us superstitious. The hopes for a new diabesity drug – semaglutide – are growing higher. And to us, that’s a good news, bad news story. The high hopes are coming from good clinical results for this new GLP-1 agonist in a head-to-head comparison with dulaglutide from Eli Lilly.

Dulaglutide is a GLP-1 activator that’s already on the market for diabetes. Semaglutide is under review at FDA for the same indication. Both of them are once-weekly injections. The once-weekly dosing is a big improvement over older GLP-1 drugs. Patients don’t like daily injections. Duh.

But along with high hopes come risks. Call it a fear of heights. Expectations in diabetes, and even more so in obesity, can easily become overblown. When that happens, a backlash can follow and kill a promising new option. Then everyone suffers.

Efficacy in Diabetes Compared to Dulaglutide

Novo Nordisk announced the results of large study comparing semaglutide with dulaglutide on Wednesday. This was a study of treating diabetes and the outcomes were impressive. Semaglutide provided better glucose control with similar safety. Chief Science Officer Mads Krogsgaard Thomsen was clearly pleased:

The superior glucose control and weight loss achieved with semaglutide compared to dulaglutide in this trial reinforces the unprecedented results observed in the entire SUSTAIN programme. We are excited about the potential of semaglutide to set a new standard for treatment of type 2 diabetes.

Obesity treatment was not a primary goal of this study. Dulaglutide doesn’t have an indication for treating obesity. But these were patients with type 2 diabetes and an average BMI in the range of obesity (33.5). And patients in the semaglutide group lost twice as much weight as patients receiving dulaglutide. Together with earlier reports of impressive efficacy in obesity, these results add another reason to think semaglutide might offer good efficacy in obesity.

Diabetes Care No Longer Ignores Obesity

An approval for semaglutide could come as early as the end of this year for diabetes. Pivotal studies are not yet complete in obesity, so that indication is likely a couple of years away from approval.

But what we are witnessing is a slow evolution away from treating type 2 diabetes while neglecting obesity. In fact, many older drugs for dieabetes might have actually contributed to weight gain. To a large extent, weight gain was not a key concern. Controlling blood sugar was.

Now, prescribing for diabetes typically avoids causing weight gain. Increasingly, some of newer drugs tend to provide a bit of weight loss. And among those newer drugs, some of them can also cut the risk of premature deaths from heart disease.

It adds up to quite an encouraging picture. Fingers crossed.

Click here for more on prospects for semaglutide and here for the results reported by Novo Nordisk.

Daunting Height, Mt Chocorua; photograph © Ted Kyle / flickr

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August 18, 2017

2 Responses to “High Hopes for a New Diabesity Drug”

  1. August 18, 2017 at 10:13 am, Allen Browne said:

    Ted,

    I think you have a typo “many older drugs for obesity might have actually contributed to weight gain”. Should this be “many older drugs for type 2 DM might have actually contributed to weight gain”?

  2. August 18, 2017 at 10:41 am, Ted said:

    Absolutely right, Allen! Thanks!!!!!