February 1, 2023

Ozempic is a new once-weekly injection for type 2 diabetes. In this videos, Diabetes Specialist Dr Sultan explains how to get the best out of Ozempic and understand how it works, the benefits, the side effects and the evidence about it’s use.

Today i’d like to talk about azimpik my name is dr sultan linchaui i’m a certified diabetes specialist and endocrinologist let’s talk about it ozenpig or semeglotide so it’s a megalotide is a once weekly injection for people with diabetes it’s something called a glp-1 analog and i’ll explain a little bit what glp ones but in essence it looks very similar to a

Naturally occurring chemical that we all produce that helps us regulate our appetite as well as our blood sugar levels and this treatment is for people with type 2 diabetes where it’s been tested and investigated fairly heavily it’s not approved for people with type 1 diabetes and shouldn’t be taken in women who are pregnant or breastfeeding and it’s ill-advised at

The moment to be using it in children so what is a glp glp-1 well glp-1 is an extremely powerful chemical that’s produced in response to eating by our gut and it does a number of things but there are four main actions so the first is that when the chemicals released it circulates into our system and it gets to our brain and there it leads to uh reduced appetite

It’s the it’s the thing that people experience when they’ve eaten too much where suddenly they feel they’re just over full that sense of sickness or fullness that you might feel if you engorged yourself is actually glp1 hitting the brain and saying that’s enough now some people seem to produce fantastic glp1 responses that are really effective generally people

That are thinner they stop eating a lot more quickly but we know that in people with type 2 diabetes that sense is often impaired and if you give someone glp1 you can switch off the appetite to some extent and achieve some weight reduction now how else does it work in the body well in the liver it reduces the amount of glucose or sugar that’s released by the

Liver the normal situation for a person would be to release sugar into the circulation unless you don’t need it but in type 2 diabetes there’s impaired release of glucose out of the liver continually the spores are being released into the circulation even though the blood sugar level is elevated so the third mechanism of action is around slowing stomach emptying

And slowing what we call gastric emptying and that process leaves food in the stomach for longer therefore there’s less necessity to go looking for food and finally the action is around the effect on the pancreas where glp ones both increase the amount of insulin that’s produced as well as increase the amount that’s released and the interesting thing about it

Is that that is predominantly when the blood sugar is elevated in other words glp ones and uh and there are a range of these treatments all have an effect which is predominantly around high sugars and if the sugar becomes low the effect is switched off and it’s the reason we see very low rates of low blood sugars so-called hypos or hypoglycemic episodes that

Occur with glp1 treatments so if you’re on a zim pig or cementite what dose should you use well essentially there are two doses that are sort of prescribed and talked about one is 0.5 milligrams and the other one is one milligram and the way we take it well this is how you start taking it in the clinical trials it was a weekly injection and they started at 0.25

Milligrams a week and that was for four weeks and at the end of four weeks and predominantly that was around getting used to the drug but at the end of four weeks the dose was increased to 0.5 milligrams weekly and for many people that is an extremely effective dose in fact for some people the lower dose is still going to be highly effective in terms of 0.25 and

There may not be a need to increase the dose even though the clinical trials suggested that that’s what needed to happen we do not know what the actual effect of 0.25 is now if 0.5 milligrams isn’t enough and you waited some times and the blood sugars are still not where they need to be then we do have the option of increasing it to the one milligram dose so

It’s a stepwise process 0.25 initially for four weeks to get used to it then 0.5 milligrams and if that’s the dose for you fantastic but if you need escalating further then up to one milligram i i want to say this because i think this is important a zen pig will take five weeks to get going and get into your system it won’t reach what we call steady state until

That time its main effect won’t be felt for 12 to 24 weeks so if you think i’m gonna take this drug and in two or three days my sugars are going to be perfect that’s not how it works so you have to wait for its effect to have so you can make those judgment about when you need to increase the dose and if you stop it it clears the system of the body in about four

Or five weeks so how does a zimpic compare to other glp-1 therapies well i think it’s just worth mentioning there are a lot of glp-1 treatments available at the moment and some of them you’ll be familiar with there are weekly versions and daily versions the weekly versions that we’re looking at are things like licity which is called lagletide or bygerion which

Is known as xenotide extended release and then we have daily versions and daily versions would be loragliotide or baeta and maybe the only other agent that’s used a bit is lycee xenotide so we have quite a bit of options in terms of glp1 treatments and most of those options have been tested and looked at so the first study i’m going to show you is this one and

This was looking at whether or not a zenfit worked and it was comparing a zompick to a placebo so a dummy injection and across the whole of this image the light blue bars are the low 0.5 milligram dose of magnetite and the dark blue bars are one milligram and you can see that both of the ozimpic doses lowered hpmc by around 1.5 1.6 percent compared to placebo

Incredibly effective compared to by durian or exemption extended release the one milligram dose lowered the hva1c by about 1.5 percent compared to xenotide at 0.9 so there was about a 0.6 percent reduction but ozympic was superior they compared it to insulin and in this case insulin glycine or lantis and you can see while slantus was effective at lowering the

Blood sugar about by about 0.8 percent of an hpa1c against there was superiority in both the 0.5 and 1mg dose of cementite and the only drug that really got close and it really did get very close and there’s a reasonable comparison is trulicity or delaglotide and there are two different doses of uh trulicity as there are two different doses of a zen pick but to

Both ends it looks like a zen pig was superior by about 0.4 milligrams so that’s impressive because trelicity is a very very effective drug for many many people what about weight loss we talked about the fact that these drugs are exceptionally impressive at weight reduction and in fact out of all the drugs that we have to date in the glp one category olympic

Seems to be the most effective around weight reduction and if you just look at this graph anything above the line is a weight increase so you can see that in the middle there with the little green mark there around uh insulin glycine which put on a bit of weight but across all the other drugs and the other trials there was weight reduction and consistently it

Looks like there was a weight loss of between three and a half and six and a half kilograms favoring ozempic with the bigger weight loss seen in the higher dose so what are the side effects of a zen pig well the common side effects are nausea diarrhea vomiting abdominal pain and decreased appetite well that’s what was reported but in fact if you talk to people

Who are using it it is that sense of fullness that’s just that queasy feeling that you have if you’ve eaten too much imagine going to a wedding and just stuffing your face and then someone’s saying would you like another dessert and just thinking no i can’t eat anymore that’s the sensation that you get with glp-1 therapies and it’s experienced by about 10 to 20

Percent of people but the vast majority of these symptoms settle after around about eight to 12 weeks in most people and if somebody were in a situation where they felt nauseated there is no reason that they need to escalate from 0.25 milligrams up to 5 milligrams until that nausea has settled because it’s a very powerful drug and it would be a shame if we gave

Up on it because the side effects were bad in the first week or two and we didn’t find a way to persist now there are a few serious side effects that are noted so there’s a always concern with the glp ones around inflammation of the pancreas that is extremely rare low blood sugars are unlikely but possible and of course there are allergic reactions so there’s a

Zympic a new treatment that’s being launched all over the world that is for people with type 2 diabetes that seems to not only lower blood sugars but also in lowering blood sugars at least there’s some weight loss there’s some good evidence also that in people who have cardiovascular risk factors in other words people who are either susceptible to heart attacks

And strokes or people who’ve had one in the past this reduces the likelihood of having a further event by around 25-26 percent now that’s in common with another number of other glp-1 drugs so these are really powerful agents that are really helping us as healthcare professionals provide great care and outcomes for people with diabetes and certainly a great tool

If you have diabetes to help you moving forward because with the benefits of weight loss and the reduction in blood sugar being so powerful and the potential benefit of reducing heart attacks and strokes this is part of the future of diabetes that’s here right now

Transcribed from video
Ozempic – Type 2 Diabetes Medication – Everything you need to know By My Health Explained