Why This Oral Drug Is Being Called An Innovative Solution to Diabetes Management

Representative image of a diabetic person doing a blood test at home.

Source : Getty

Did you know that the first mention of diabetes was found in the ancient texts of Egypt in 1552 B.C. Though a serious challenge to public health, cases of diabetes continue to rise across the world. Diabetes occurs when the body is unable to convert the sugar (glucose) in food into energy due to some problem with the levels or utilisation of the hormone, insulin. This leads to very high blood glucose levels.

Type 1 diabetes mellitus develops when the pancreas fails to produce insulin and Type 2 diabetes mellitus or T2DM (90% of the diabetic population) occurs when the pancreas produces insufficient insulin or when it cannot utilise the insulin produced. According to latest reports, it is estimated that around 537 million adults between 20-79 years suffer from diabetes. At 74.2 million, nearly 14% of the world’s diabetes population lives in India. Moreover, another 39.4 million Indians remain undiagnosed.

Current management of T2DM

The rising prevalence of T2DM is mainly attributed to lifestyle variations such as diet, physical inactivity and stress. Unfortunately, nearly half the patients with T2DM also live with obesity. Sustained control of blood glucose levels is the core of T2DM management. This is important as uncontrolled levels can damage several organs such as the kidney, eyes, nerves, heart and brain. It can even cause death. Nearly 0.6 million deaths in India are attributed to diabetes. Upon diagnosis, lifestyle changes such as routine physical activity, keeping body weight in check, smoking cessation and healthy diet form the basis of T2DM management.

If this proves insufficient to achieve blood glucose control, the patient is prescribed antidiabetic medication (ADM). The first ADM recommended along with lifestyle changes is metformin, though it should be used with caution in T2DM patients with kidney issues. The patient’s blood glucose levels are evaluated every 3 to 6 months to gauge the impact of the treatment. If control is inadequate, after assessing patient-related factors such as age, duration of disease, comorbid conditions, etc., one of several other drugs is added to the treatment plan.

Some of the older ADMs include sulphonylureas, thiazolidinediones and injectable insulin. However, these medications often result in side-effects such as hypoglycaemia (blood glucose lower than normal) and weight gain, both of which are detrimental to the patient.

More recently, other drugs such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs), dipeptidyl peptidase 4 inhibitors (DPP-4i) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) have become available. The Research Society for the Study of Diabetes in India-Endocrine Society of India (RSSDI-ESI) 2020 guidelines for T2DM management advocate the addition of GLP-1 RAs as one of the second-line treatments, especially in patients who are overweight or living with obesity due to their beneficial impact on body weight. If patients are unable to tolerate metformin, GLP-1 RAs can also be used as the primary treatment along with lifestyle changes. However, since GLP-1 RAs were only available as injectables until recently, their extensive use was limited by the fact that most T2DM patients prefer oral medications.

Oral Semaglutide 

The quest to improve the lives of T2DM patients by providing efficacy combined with convenience and decreased side effects has resulted in the development of oral semaglutide. Semaglutide, a GLP-1 RA, is now available in a first-in-class oral form (peptide in a pill). Oral semaglutide combats the common challenges faced with other ADMs. Studies with oral semaglutide reinforce its safety and efficacy. Along with blood glucose control, it causes weight loss (up to 5 kgs) with minimal hypoglycaemia and offers cardiovascular safety. Its efficacy has been tested across several patient categories including those at high risk for or with established heart and kidney diseases. In comparative studies, it decreased blood glucose and weight to a greater extent than other GLP-1 RAs (liraglutide), DPP-4 inhibitors (sitagliptin) or SGLT-2 inhibitors (empagliflozin). Moreover, oral semaglutide is effective both as a single agent as well as in combination with other ADMs.

Effective diabetes management and cardiovascular safety

Clinical trials show that oral semaglutide, along with effective HbA1c reduction, also shows promising cardio safety among people with diabetes. In clinical trials, the drug showed a reduction in risk of heart attack, stroke, and deaths from cardiac cause. It also showed improvement in lipid profile, reduction in inflammatory markers, and lowering of blood pressure.

The number of diabetes cases are increasing at an alarming rate in India. Along with lifestyle changes, our growing T2DM population needs to be managed with a drug that is safe, convenient and effective. Moreover, since most T2DM patients present with other coexisting conditions such as obesity, an agent which targets multiple problems is ideal. In this regard, the latest innovation i.e. oral semaglutide ticks most of the boxes for an agent which has the potential to truly alter the paradigm for T2DM management in India. 

Dr Sandeep Bansal is Consultant and HOD, Cardiology, at Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi.

[Disclaimer: The opinions, beliefs, and views expressed by the various authors and forum participants on this website are personal and do not reflect the opinions, beliefs, and views of ABP News Network Pvt Ltd.]