A few years ago, a word started circulating among diabetics and people trying to lose weight: ozone. It was touted as a miracle drug and quickly became a global hit. Celebrities like Elon Musk have revealed that they have used it. Reports of “ozone parties” followed, and supply became a drag on countries as the drug’s popularity soared.
Ozempic, commonly known as semaglutide, is an injectable prescription drug. It was approved by the U.S. Food and Drug Administration (FDA) in 2017 for use in adults with type 2 diabetes. In 2021, the FDA approved Wegovy, another injectable form of semaglutide, for long-term use in adults who are obese/overweight and have at least one weight-related condition (such as high blood pressure, type 2 diabetes, or high cholesterol) Weight management. Ozempic and Wegovy are made by Danish drugmaker Novo Nordisk.
So what is semaglutide and who uses it in India? Semaglutide belongs to the glucagon-like peptide-1 (GLP-1) receptor agonist drug class. This drug mimics the effects of GLP-1, a hormone produced by the small intestine and released after eating. It works by slowing digestion and reducing appetite, while triggering the pancreas to release more insulin.
Therefore, weight loss is possible with the use of the drug and some benefits on the heart and kidneys are also noted, explains V. Mohan, Chairman, Dr. Mohan Diabetes Specialty Centre, Chennai.
Semaglutide is available in oral (Rybelsus) and injectable (Ozempic/Wegovy) forms. Dr. Mohan said the injections can cause patients to lose about 10 to 15 percent of their body weight. “The daily oral tablet (Rybelsus) launched in India a few years ago was a breakthrough, although it could not match the effectiveness of the injectable form that was not yet available in the country,” he said.
In a country with an estimated 10.13 million people with diabetes, and where the prevalence of abdominal obesity is estimated at 40% in women and 12% in men, drugs like semaglutide have generated widespread interest, although cost remains a significant barrier to their use obstacle.
Diabetes Control: Doctor
Doctors across India have been prescribing oral semaglutide to patients for two years and say they are already seeing results in diabetes control and weight management.
Anoop Misra, chairman of Delhi’s Fortis CDOC Hospital for Diabetes and Allied Sciences, said he has seen an increase in the number of patients who want to start taking Rybelsus. “More and more patients are asking for prescriptions. Most have heard about the drugs from relatives or friends abroad who have used them and where they are popular,” he said.
While the weight-loss factor often overshadows problems with diabetes management and leads to a surge in interest among patients looking for a quick fix, doctors stress the drug is not intended for simple weight management and is not a first-line option.
“Diabetes is not a single disease; it brings with it a range of complications, all of which require aggressive treatment. Semaglutide has additional benefits in renal, cardiovascular and liver problems and is primarily used by doctors to treat Diabetes itself. For many diabetics, the benefit of weight loss is just the icing on the cake as weight gain due to insulin use is a concern,” says Mathew John, senior consultant endocrinologist in Thiruvananthapuram.
In addition, the doctor said that not everyone who wants the drug is eligible: “Although I receive 15-20 inquiries a week, only 2-3 patients are actually eligible. We prescribe this drug to the heart This drug may reduce the risk of heart attack, stroke, and cardiovascular death in adults at high risk for vascular disease.
“We do not recommend this drug to people who only want to lose 10-15 kilograms of weight. It is a drug for obese people for whom weight loss is a difficult task even with a healthy diet and moderate physical activity. A tall order. We generally see that in addition to a healthy diet and physical activity, semaglutide results in significant weight loss in many people, but I’ve also seen patients for whom the medication didn’t work,” Thiruvan said. Akhil Krishnan, Associate Consultant, Endocrinology, Kimshealth, Nanthapuram said.
For people who take medications, the experience is different. While many people swear by it, for some the side effects are a problem.
Because this drug acts on the stomach, the most common side effects are bloating, nausea, and vomiting. In rare cases, it can cause gastric paralysis, inhibition of gastric contractions and pancreatitis, Dr. Mohan said.
KVS Hari Kumar, consultant endocrinologist at Fernandez Hospital in Hyderabad and honorary secretary of the Endocrine Society of India, said 5 to 10 per cent of patients cannot tolerate the side effects and stop taking the medication.
patient experience
For Arundhati, 47, of Hyderabad, the drug worked wonders. After taking semaglutide for six months, she initially experienced nausea and vomiting, but she said her body eventually adapted. “I lost about 10 to 12 kilograms in six months. The weight loss also allowed me to reduce my thyroid medication,” she said.
Saumya, also from Hyderabad, started taking semaglutide after she was unable to lose weight despite intermittent fasting. “After I started taking the medication, my hunger and cravings decreased, and I lost seven kilograms in the first month and six kilograms in the second month.” In addition, her blood sugar levels stabilized. She did experience acidification as a side effect.
Doctors say to help combat side effects, they start with a low dose and then gradually increase it. “We start with a low dose of 3 mg and gradually increase the dose over time. The biggest advantage is not weight loss but the reduction of insulin consumption by almost 80%,” says diabetes expert K. Jothdev, director of the Southern Region Approximately 1,500 patients at four comprehensive diabetes centers receive semaglutide.
Arun, a patient from Bangalore, was prescribed semaglutide because he was unwilling to start insulin. Arun, who is obese and suffers from diabetes, said he started taking the 3 mg dose. “After six weeks, my blood sugar levels and blood pressure were under control, and I had lost nearly 5% of my weight in three months. Although I had nausea and vomiting, the symptoms subsided after a while. This drug reduced My doctor has now increased my dosage and advised me to change my lifestyle,” the 40-year-old said.
Doctors say India’s obesity crisis needs to be addressed – data from the National Family Health Survey 5 shows obesity rates among women are 24% and among men 23%. S. Chandrasekar, Professor and Chairman, Department of Medicine, Government Medical College, Stanley, said obesity is known as the mother of all diseases. “At least 40% of people with diabetes are overweight or obese. Blood sugar levels resolve when a person with diabetes loses 15% of their weight from baseline. Many of my patients lose 10 to 15 kilograms in 9 months to 1.5 years. This The medication not only lowers blood sugar levels, but also lowers blood pressure through weight loss and improves physical agility over a period of time.
But not everyone has an exemplary experience. Gopi, a 50-year-old media consultant from Thiruvananthapuram who is obese, suffers from diabetes and sleep apnea, has found his weight loss journey difficult due to his busy work schedule. He took Rybelsus before undergoing weight loss surgery. However, he was unable to follow his medication regimen due to stomach problems. Despite his experience, he plans to start taking medication again soon.
Chitra, a 38-year-old woman with a body mass index of 32 and a history of gallbladder problems that predisposed her to pancreatic problems, began vomiting shortly after taking semaglutide. “Three weeks later, I developed severe abdominal pain that developed into pancreatitis. I needed to be hospitalized and stopped taking medication. My doctor said it was unclear whether it was the semaglutide or the history of gallstones that was causing the pancreatic inflammation. .My treatment has now been changed to insulin.
Cost remains a barrier
However, cost remains a major barrier to access. Rybelsus is available in three strengths: 10 tablets of 3 mg priced at Rs 3,170; 7 mg priced at Rs 3,520; and 14 mg priced at Rs 3,870, said B. Thirunavukkarasu, president of the Bangalore District Chemists and Pharmacists Association. Even at the low end of 3 mg, 30 tablets per month equates to nearly Rs 10,000 per month – a huge cost in a country where out-of-pocket spending as a percentage of total health expenditure remains high. High, close to 40%.
Rybelsus is sold only as a prescription drug and sales are modest because of its higher cost, state chemists said.
However, Shivam Sharma, consultant and director, Department of Medicine and Diabetes, SHALBY Sanar International Hospital, warns that a black market has emerged. “Self-medication can be dangerous. Users should be aware that each patient must undergo a medical evaluation before prescribing this medication, as it can interfere with the digestive process and may cause sudden weight loss, low blood sugar levels and electrolyte imbalances,” he said. Media reports also indicate that a gray market for imports and substitutes is flourishing.
This is also a drug that patients must take for life. “For those who do not develop any complications, we prescribe and adjust the medication based on their lifetime blood sugar levels, just like any other diabetes medication,” said Subrata Das, head of the Department of Internal Medicine and Diabetes at Sakra World Hospital.
However, the weight loss may be reversed: Patients may gain weight again, although they may try to control it with lifestyle changes or other medications, he noted.
In many ways, semaglutide is likely to remain a wonder drug for some time to come. New research currently underway suggests the drug could be used to treat a variety of conditions related to heart failure, arthritis, Alzheimer’s and even cancer, and may also have benefits for cognition and nicotine dependence.
However, for those who can and do want to get the shot in India, there may be a wait of several months, although Indian drugmakers are now joining the race for weight loss and anti-obesity drugs. Novo Nordisk’s Wegovy has not been approved in India so far, while rival drugmaker Eli Lilly’s drug Mounjaro/Zepbound (active ingredient – tezeparatide) was imported and sold in July Licensing is awaiting final approval but is not expected to launch until perhaps next year.
(Some names have been changed to protect privacy.)
(Compiled by Zubeda Hamid, edited by Bindu Shajan Perappadan from Delhi, C. Maya from Thiruvananthapuram, Afshan Yasmeen from Bangalore, Siddharth Kumar Singh from Hyderabad and Serena Josephine M. from Chennai. provide advice)
Published – November 8, 2024 at 06:00 AM (US Standard Time)
