Is Semaglutide Right For You? Demystifying The Evidence

Written By Rhea Waite

Introduction

By now you’ve inevitably heard of semaglutide and the other drugs like it. News of these medications are everywhere reporting their benefits in weight loss and diabetes type-2. Glucagon-like peptide-1(GLP-1)receptor agonists like semaglutide, Wegovy, and others are used in the treatment of various health conditions, particularly type 2 diabetes and obesity. This post aims to explore the evidence supporting the use of these medications.

**Keep in mind, this article discusses weight, obesity, and type-2 diabetes. People should never be shamed for their body shape/size especially by their providers. The purpose of this post is to demonstrate where/how these medications can be helpful. It is educational only and not intended as medical advise. Your health journey is strictly between you and your provider.

Understanding GLP1 agonists

GLP1 agonists are designed to mimic the action of the natural hormone GLP1. This hormone plays a crucial role in regulating blood sugar levels by stimulating GLP1 receptors in the pancreas leading to enhanced insulin release and reduced glucagon release. This combined action reduces appetite, slows glucose absorption/lowers blood sugar and slows gastric emptying. GLP1 agonists are currently used as a therapeutic approach for conditions characterized by insulin resistance, such as type 2 diabetes and obesity.

Efficacy of GLP1 agonists

Numerous clinical trials have demonstrated the efficacy of GLP1 agonists in managing type 2 diabetes which is why you’re seeing in the news all the time. It is estimated that over 38 million people in the US have diabetes and 90% of those people have Type-2 diabetes. Type-2 diabetes is a metabolic disease that is caused by long term, poorly managed blood sugar. This causes insulin resistance where your cells do not respond to insulin and therefore you cannot lower your blood glucose levels. Diabetes type-2 leads to many down stream health concerns such as high blood pressure, cardiovascular disease, high cholesterol, kidney disease, high inflammation, etc. In the SUSTAIN and PIONEER trials, GLP1 agonists consistently showed significant reductions in A1c levels, an indicator of long-term blood sugar control.

Additionally, GLP-1 agonists are proven to be cardio-protective. A reduction in weight helps protect the heart but these medications also lower blood sugar, blood pressure, the “Bad” cholesterol and inflammation. All of these conditions are part of all metabolic disorders which damage the heart and other organs.

Beyond diabetes, GLP1 agonists have shown remarkable potential in helping people lose unwanted weight. Many current trials have provided compelling evidence of its effectiveness in promoting weight loss. Some people have been concerned that the weight loss is from lean muscle loss. It appears this can be the case if patients are not engaging in resistance training and exercise. More recent studies are suggesting that lean muscle mass is preserved when people are actively strength training. They will gain lean muscle mass and lose fat mass in this process. This shows the need for patients to use these medications as an addition to their lifestyle changes.

I find that GLP1 agonists are most effective when patients eat a balanced diet, do strength based exercise, manage their stress, and optimize their sleep. These medications are an adjunct to a healthy lifestyle not a replacement for one. No medication or supplement will take the place of regular movement, a healthy diet, and good sleep.

Safety Profile

Thus far, GLP1 agonists have exhibited a generally favorable safety profile in clinical trials, with common side effects being mild and transient gastrointestinal related symptoms. These are typically transient and avoidable when using a titrated approach.

Conclusion

In my practice I use these medications along with strength based exercise, a balanced diet rich in fiber, protein and health fats, better stress management, and getting high quality sleep. I find they are a reasonable adjunct therapy to help people reach their goals.

Weight and weight loss is very personal. As providers, we should refrain from shaming patients or implying that all their problems are related to their weight. This simply isn’t the case.

As patients, bring your concerns and goals to your provider. Ask if GLP1 agonists are a good option for you if you’re interested.

As friends/family we should keep our judgements and thoughts to ourselves. Body/health shaming is never supportive or kind. Leave those conversations to your friend and their provider.

Resource links:

  • Brief summery of many of the trials completed and ongoing: https://diabetes.medicinematters.com/tirzepatide/type-2-diabetes/a-quick-guide-to-the-surpass-and-surmount-trials/18478154

  • https://pubmed.ncbi.nlm.nih.gov/26371721/#:~:text=These%20agents%20work%20by%20activating,consequent%20low%20risk%20for%20hypoglycemia.

  • https://www.nature.com/articles/s41569-023-00849-3#:~:text=In%20cardiovascular%20outcomes%20trials%2C%20glucagon,with%20type%202%20diabetes%20mellitus.

  • https://journals.lww.com/jcma/fulltext/2023/02000/hypoglycemic_drug_liraglutide_alleviates_low.6.aspx

  • https://journals.sagepub.com/doi/full/10.1177/11795514231161885

  • https://gethealthspan.com/science/article/the-negative-effect-of-glp-1-receptor-agonist-drugs-on-lean-mass

Rhea Waite
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