Diabetes drugs used in weight reduction and obesity treatment: What is the current situation?

Recently, certain drugs for treating diabetes have received some notable attention in the media. This was because they were indicated for type 2 diabetes treatment but were shown to have had a significant effect on weight reduction. What is the situation with these drugs in Spain?
There are two medications involved, semaglutide and liraglutide, which help control glucose or blood sugar levels and reduce hunger, facilitating weight loss. The benefit in diabetes is double: in addition to the direct effect, losing weight also has a positive impact on the control of blood glucose levels.

If these drugs have to be prescribed by a doctor, why have they achieved such a reputation outside of medical consultations?

This is due to the second of the effects mentioned above: a reduction in appetite leading to weight loss. Modern society has a serious problem with the increase in the number of overweight and obese people. So having treatments that may help in the complex struggle to lose weight is very important. Weight loss has effects at different levels: at a metabolic level, regarding the internal functioning of the organism, at a mechanical level, related to mobility, and at a psychological level.

One of the drugs that has had a lot of coverage in the press is semaglutide. We must point out that this media interest arose as a result of its lack of availability in pharmacies. It could be said to be a victim of its own success. In our environment, this drug is approved only for the treatment of people with diabetes; however, its effectiveness for weight loss has led to its use being expanded beyond this disease.
 

To make the situation more complex, there is a difference between a drug being indicated or authorised for use with it being financed. So far we have talked only about the former. However, not all drugs approved for a specific use receive public financing (i.e., being paid for with our collective taxes). In fact, liraglutide is not financed, so the full cost of the drug must be paid for by the person to whom it has been prescribed.

What about semaglutide?

This drug is financed. However, for it to be prescribed to a patient, as well as having diabetes, there is a series of other restrictive requirements the patient must meet, such as having a body mass index (BMI) over 30 kg/m2, considered as obese. Nevertheless, semaglutide is expected to be approved in a short period of time for the treatment of obesity, outside the context of diabetes. However, its financing by the national health system is even more uncertain. Moreover, other even more powerful drugs are being studied, such as tirzepatide and retatrutide, among others. These have been shown to have had a highly significant health effect on weight loss, at a percentage approaching that of bariatric surgery. Bariatric surgery is, to date, the most effective treatment for severe obesity.

If semaglutide is not yet officially authorised for use in obesity, are there other similar drugs that are?

Only liraglutide is currently indicated for overweight or obese people with a BMI over 27, regardless of whether they also have diabetes or not.

However, the Ministry of Health and Spanish Agency for Medicines and Medical Devices are expected to approve the use of tirzepatide in the coming months. We still do not know under what indication or financing conditions this will take place, but what does seems certain is that it will be in the same context as semaglutide from the beginning. That is, it is expected to be approved for use only in people with diabetes. This is despite the fact that it has an even greater capability of promoting substantial weight loss than semaglutide, according to published clinical trials. In countries where the use of tirzepatide is already approved, the media “noise” has not been long in coming.

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