What’s more practical, Ozempic, Mounjaro, Trulicity, or one other drug entirely? Which causes more weight reduction? Which lowers A1C more effectively?
The medications referred to as GLP-1 receptor agonists don’t just powerfully lower your blood sugar — they also can offer weight reduction and protection against cardiovascular diseases. Those are advantages that almost all older diabetes drugs (reminiscent of sulfonylureas, DPP-4 inhibitors, and insulin) just can’t claim.
This text will take a look at the perfect and most rigorous studies of the newer type 2 diabetes drugs and can share the info.
What Are GLP-1 Receptor Agonists?
Glucagon-like peptide 1 (GLP-1) is a hormone that stimulates insulin secretion after you eat — it helps you are feeling full and regulates your blood sugar. In individuals with type 2 diabetes, nonetheless, this healthful hormone release and response will be ineffective or absent. GLP-1 receptor agonists are drugs that mimic the effect of GLP-1. They assist your body use each GLP-1 and insulin properly, helping to maintain blood sugar levels regular after meals.
One related drug, tirzepatide (Mounjaro), also mimics a second hormone named glucose-dependent insulinotropic polypeptide (GIP). Tirzepatide is formally classed as a dual GIP/GLP-1 receptor agonist, though it’s casually grouped together in the identical drug family as GLP-1 receptor agonists.
These drugs also can provide help to feel full after eating. People using GLP-1 receptor agonists often find themselves naturally eating fewer calories, resulting in effortless weight reduction.
The primary GLP-1 receptor agonist reached the market over a decade ago, but it surely’s still fair to think about them “latest.” Diabetes authorities have only steadily endorsed their use over older drugs, and a few clinicians have been slow to recommend them to their patients. It’s taken a social media-fueled craze to actually bring them to mainstream attention.
Most individuals with type 2 diabetes will only be prescribed a GLP-1 receptor agonist if metformin and lifestyle changes haven’t been enough to maintain their blood sugar well-controlled. Nonetheless, diabetes authorities have recently moved to recommend GLP-1 inhibitors earlier for patients, even patients with new-onset type 2 diabetes, especially in the event that they have obese, obesity, or atherosclerotic heart problems.
Sadly, there’s one other major factor that’s slowed down the adoption of GLP-1 receptor agonists — they’re incredibly expensive. Ozempic currently has an off-the-shelf price of about $900 per thirty days in america, and it could be over a decade before an approved generic version becomes available. The value you pay, after all, will likely depend utterly on the small print of your medical insurance plan.
Every GLP-1 Receptor Agonist
The next lists every GLP-1 receptor agonist that’s currently approved in america for the treatment of type 2 diabetes.
- Semaglutide (Ozempic) — a weekly injection
- Semaglutide (Rybelsus) — a every day pill
- Tirzepatide (Mounjaro) — a weekly injection
- Liraglutide (Victoza) — a every day injection
- Dulaglutide (Trulicity) — a weekly injection
- Exenatide (Bydureon BCise) — a weekly injection
- Exenatide (Byetta) — a twice-daily injection
Two of the drugs above are also marketed under different names as a weight reduction therapy for people without diabetes: semaglutide (Wegovy) and liraglutide (Saxenda). It’s widely expected that tirzepatide will win the same approval from the FDA soon.
Whether all of those drugs are literally available is one other query entirely. The manufacturers of semaglutide and tirzepatide have been unable to satisfy the unprecedented demand for his or her drugs, fueled by their popularity as weight-loss treatments. Persistent shortages have made it difficult for individuals with diabetes to search out the Ozempic and Mounjaro they’ve been prescribed, and the makers have intermittently paused their marketing efforts or the production of starter doses.
How We Compared Drugs
It’s not at all times easy to match the consequences of 1 drug against one other, since the clinical trials that provide our most rigorous data don’t share equivalent baselines.
Drugmakers test their latest drug candidates in lots of distinct trials, assessing the consequences on various kinds of people over different periods of time. Ozempic, for instance, was the topic of at the very least fifteen different major final-phase trials in individuals with type 2 diabetes. One experiment, for instance, evaluated the drug in those also using basal insulin, one other in those also using an SLGT-2 inhibitor, one other in individuals with high cardiovascular risk, one other with patients outside of the US and Western Europe, and so forth.
We did our greatest to search out a level playing field. We’ve pulled the info from the longest phase 3 trials that tested the utmost approved dosage of every drug. The participants of those studies were adults with type 2 diabetes who had been otherwise using standard treatment (typically metformin, with or without additional oral drugs reminiscent of sulfonylureas or pioglitazone). We avoided trials that tested the drugs in latest patients or in those with established cardiorenal complications.
Comparing GLP-1 Receptor Agonists
Semaglutide (Ozempic)
There’s a reason it’s the world’s buzziest diabetes drug: Ozempic delivers impressive glucose improvement and weight reduction. This weekly injection is so popular that, well over a yr after demand spiked as a consequence of a social media craze, shortages are still making it difficult for individuals with diabetes to search out the drug. (This, in turn, has led some patients to show to potentially dangerous sources of off-brand Ozempic).
Ozempic also reduces the danger of severe cardiovascular outcomes, and there may be early evidence that it could help prevent or treat chronic kidney disease, too. The manufacturer recently decided to conclude its pivotal kidney outcomes trial early since the evidence that it will succeed was overwhelming.
Semaglutide (Rybelsus)
Rybelsus is actually Ozempic in pill form. The semaglutide in a pill is just as potent because the semaglutide in an injected solution, but Rybelsus has less powerful effects than Ozempic since it is simply available in lower dosages. (The manufacturer is studying higher doses and should seek FDA approval soon).
Rybelsus can also be form of a hassle to take. In response to the FDA label, it is advisable to take Rybelsus on an empty stomach, every morning, half-hour before eating, drinking, or using another oral medications. You will have as much as 4 ounces of plain water only during this time. If you have got your breakfast too early, the pill will probably be less effective.
Nevertheless, it’s still a really effective drug, and should be an especially attractive option for individuals with needle phobia.
Tirzepatide (Mounjaro)
Mounjaro, strictly speaking, is just not a GLP-1 receptor agonist but a dual GIP/GLP-1 receptor agonist; it mimics the function of a second hormone, which is possibly the key of its effectiveness.
It seems fair to say that Mounjaro is probably the most powerful drug on this family that’s currently available. It offers probably the most weight reduction for individuals with diabetes, with glucose-lowering effects which might be higher than Ozempic’s.
For the time being, Mounjaro is just too latest to know what form of heart and kidney health advantages it’d offer. That research is happening straight away. Early data suggests that it is going to offer protection for the heart and kidneys, but diabetes authorities are waiting for the outcomes of major trials dedicated to the query before they render an official judgment.
Dulaglutide (Trulicity)
Although not quite as buzzy as Ozempic or Mounjaro, Trulicity is sort of as effective, offering truly significant weight reduction and glucose-lowering effects, especially at its highest dosage. It is usually known to guard heart health and should help protect the kidneys.
Liraglutide (Victoza)
Victoza appears to be barely less powerful than most of its competitors within the GLP-1 family of medicine. It also requires a every day injection, somewhat than a weekly one, which can make it less appealing.
Still, Victoza is a big step up from metformin, and causes enough weight reduction to have been approved as an obesity medication (when labeled as Saxenda). It is usually known to have cardioprotective effects and should help protect against kidney disease.
Exenatide (Bydureon BCise, Byetta)
Exenatide is the least heavily hyped GLP-1 available.
Bydureon BCise is just not as powerful as other options in the category, but it may possibly still have strong positive effects for individuals with type 2 diabetes, including each weight reduction and A1C reduction.
We omitted Byetta from the chart above since it is mostly considered a less attractive option. In reality, it seems that the manufacturer is barely marketing the drug anymore. Byetta is a shorter-acting version of exenatide and requires rather more fuss: two every day injections, one each inside an hour of breakfast and dinner. It’s also barely less effective than Bydureon.
Heart and Kidney Health Advantages
This text has targeting glucose control and weight reduction, perhaps the 2 central goals of type 2 diabetes management. Nonetheless, some GLP-1 receptor agonists offer additional advantages.
A very powerful of those advantages might be protection from cardiovascular and kidney disease, two of probably the most common causes of early death in individuals with type 2 diabetes.
In response to the American Diabetes Association, three GLP-1 receptor agonists offer heart health protection: liraglutide, semaglutide, and dulaglutide. The ADA recommends all three GLP-1 receptor agonists as preferred treatments for individuals with either demonstrated atherosclerotic heart problems or a high risk of it.
There may be also encouraging evidence that the identical three drugs offer kidney protection, but the info isn’t definitive yet. Patients with chronic kidney disease are really useful to make use of SGLT2 inhibitors first, only adding a GLP-1 receptor agonist in the event that they don’t tolerate the drug or need more pharmaceutical help getting blood sugar levels under control.
For the time being, tirzepatide (Mounjaro) is just too latest to know what form of heart and kidney health advantages it’d offer. That research is happening straight away. Early data suggests that it is going to offer protection for the heart and kidneys, but diabetes authorities are awaiting the outcomes of major trials dedicated to the query before they render an official judgment.
Side Effects
For those who’ve paid attention to social media these days, you realize that Ozempic is related to a dizzying variety of unwanted effects. A large percentage of users endure gastrointestinal troubles reminiscent of nausea, vomiting, and diarrhea. There are also risks of rare but serious complications reminiscent of gastroparesis (stomach paralysis), medullary thyroid cancer, gallstones, and pancreatitis. Some users who’ve successfully slimmed down have complained about “Ozempic face” and hair loss. Other drugs within the GLP-1 receptor agonist family have broadly similar effects, though individual medications will differ in the small print.
Though it could be secure to assume that more powerful GLP-1 receptor agonists also induce more unwanted effects, that isn’t necessarily the case. Mounjaro, for instance, causes nausea and vomiting in about 18 percent and 9 percent of patients, in keeping with its FDA label (PDF), which is barely lower than the numbers reported for Trulicity (PDF). Inside anybody particular drug, nonetheless, higher dosages nearly at all times create a greater incidence of unwanted effects.
For those who are particularly concerned about hostile reactions, let your doctor know in order that they will remember to select a medicine that matches your personal health situation best.
Takeaways
The brand new family of GLP-1 receptor agonists is taking the diabetes world by storm. These drugs offer remarkable health advantages, particularly enhanced blood sugar control and weight reduction that may seem effortless.
The several drugs on this family differ in some ways, including delivery method, glucose-lowering efficacy, weight-loss efficacy, and cardioprotective strength.
To be clear, this text is not expert advice. It has been reviewed by a physician for accuracy, but it surely was not written by a physician and doesn’t try and recommend individual drugs. While we hope that this evaluation will provide some food for thought, only a clinician can determine which medications are best for you.