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Treatment for type two diabetes

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One of the world's greatest medical challenges

Morbid overweight or obesity, as it is termed in professional language, is one of the world's greatest medical challenges and a colossal societal problem. The World Health Organization (WHO) classified obesity as a chronic disease in 1997, and in 2021 the EU did the same. It is a disease that increasingly affects more people and it is one of our time's major health challenges, increasing the risk for other serious diseases. Moreover, obesity is affecting younger ages. Today, many children and young adults are already morbidly obese. In Sweden, over one million adults have obesity with a BMI over 30. In the USA, as much as 40 percent of the population has the disease. In total, it is estimated that 650 million people worldwide suffer from obesity.

Treating subsequent diseases instead of the root cause

Diseases that cause tremendous suffering and cost society enormous amounts. Up until now, this large patient group has mostly received reactive care. Instead of addressing their fundamental problems, subsequent diseases such as high blood pressure, type 2 diabetes, and cardiovascular diseases have been treated in various ways. And mortality in the group has been and remains high. But now, we are facing a paradigm shift.

A medical revolution

For the first time, we have a treatment that truly works. New medications in combination with lifestyle changes and the latest health innovations, including accessible, continuous, and equitable care through digital platforms, are creating conditions for healing and weight loss, regardless of where one lives in the country. Patients are losing weight, maintaining their weight, and step by step changing their lifestyle. All the while with the support of a competent team of doctors, dietitians, psychologists, and personal trainers available around the clock via a digital platform.

Treating obesity

The best way to treat obesity is to eat a healthy reduced-calorie diet and exercise regularly.

To do this, you can:

  • eat a balanced calorie-controlled diet as recommended by a GP or weight loss management health professional (such as a dietitian)
  • take up activities such as fast walking, jogging, swimming or tennis for 150 to 300 minutes (2.5 to 5 hours) a week

You may benefit from joining a local weight management programme with group meetings or online support. Your GP can tell you about these.

You may also benefit from receiving support and counselling from a trained healthcare professional to help you better understand your relationship with food and develop different eating habits.

If you're living with obesity and lifestyle and behavioural changes alone do not help you lose weight, a medicine called orlistat may be recommended.

If taken correctly, this medicine works by reducing the amount of fat you absorb during digestion. Your GP will know whether orlistat is suitable for you.

A specialist may prescribe other medicines called liraglutide or semaglutide. They work by making you feel fuller and less hungry.

For some people living with obesity, a specialist may recommend weight loss surgery.

Source: NHS

Appetite-regulating medications

The first generation of GLP-1 analogs was initially developed for type 2 diabetes, and when they were found to be effective against obesity, they were also approved for the treatment of obesity, including liraglutide and semaglutide. A newer generation of active substance - Tirzepatide - contains both GLP-1 analogs and GIP. Both are incretins, i.e., appetite-regulating hormones that are secreted in the gastrointestinal tract when we eat.

It's important to note that the results of weight loss can vary from person to person and that these substances and medications should always be used under the supervision of a doctor and in combination with a healthy lifestyle, including proper diet and regular exercise.

The following medications are approved for the treatment of morbid obesity by the FDA and EMA.

Newest generation: GLP-1 and GIP

  • Tirzepatide (Mounjaro, Zepbound)

Previous generation: GLP-1

  • Semaglutide (Ozempic, Wegovy, Rybelsus)

First generation: GLP-1

  • Liraglutid (Saxenda/Victoza)
  • Dulaglutid (Trulicity)
  • Exenatid (Byetta)

GLP-1 (glucagon-like peptide-1)

analogs are a group of medications used to treat obesity and type 2 diabetes. They work by mimicking or enhancing the effects of the natural hormone GLP-1 in the body. GLP-1 is a hormone that is normally released from the small intestine after you have eaten and has several important functions, including the regulation of blood sugar levels and appetite control.

Here's how GLP-1 analogs work for weight loss:

  • Reduced appetite: GLP-1 analogs affect appetite centers in the brain and increase the feeling of fullness. This results in individuals taking these medications feeling full faster and for longer after a meal, which reduces their food intake and thus calorie intake.
  • Delayed gastric emptying: GLP-1 analogs extend the time it takes for the stomach to empty after a meal. This can help reduce appetite and control blood sugar levels by limiting rapid increases in blood sugar after eating.
  • Reduced hunger: These medications can decrease the overall feeling of hunger, making it easier for individuals to adhere to a calorie-restricted diet.
  • Reduction in fat storage: GLP-1 analogs can also reduce the negative effects of insulin resistance and contribute to reduced fat storage in the body.

The newest generation of weight loss medications: What you need to know about Tirzepatide and Semaglutide

The most common medical substances used for weight loss can be divided into different categories based on their mechanisms of action and use. It's important to note that the use of these substances should occur under medical supervision, as they can have side effects and are not suitable for everyone. Here is a list of some commonly used substances:

Active Substance: Tirzepatide (For reference)

Weight Loss: 18%

Brand Name: Mounjaro

FDA/EMA Status: Approved for Type 2 Diabetes and obesity treatment.

Tirzepatide is a newer medication that has shown promising results for both diabetes control and weight loss. It works by affecting multiple biological pathways that regulate blood sugar levels and appetite, which can lead to significant weight loss.

Active Substance: Semaglutide (For reference)

Weight Loss: 16%

Brand Name: Wegovy, Ozempic

FDA/EMA Status: Approved for chronic weight management, and Type 2 Diabetes, respectively.

Semaglutide is a medication known for its ability to reduce appetite and increase the feeling of fullness. It is primarily used for weight control and Type 2 Diabetes and has proven effective in helping people lose weight.

Active Substance: Liraglutide (For reference)

Weight Loss: 7 kg*

Brand Name: Saxenda, Victoza

FDA/EMA Status: Approved for chronic weight management, and Type 2 Diabetes, respectively.

Liraglutide works in a similar way to semaglutide and is used for both weight management and diabetes management. It helps to reduce appetite and increase the feeling of fullness, resulting in weight loss.

*Note: The weight loss value for Liraglutide is given in kilograms to reflect its effectiveness in terms of weight reduction.

Active Substance: Orlistat (For reference)

Weight Loss: 3 kg*

Brand Name: Xenical

FDA/EMA Status: Approved for chronic weight management.

Orlistat is a fat blocker that works by reducing the absorption of fat from your diet. It can help to reduce calorie intake and thereby lead to weight loss.

Active Substance: Naltrexone/Bupropion (For reference)

Weight Loss: 5%

Brand Name: Mysimba

FDA/EMA Status: Approved for chronic weight management.

Naltrexone/Bupropion is a combination of two different medications that affect the brain to reduce appetite and increase the feeling of fullness. It is used to assist individuals in losing weight by reducing calorie intake.

*No percentage information available

Semaglutide: Efficacy and Safety in Studies for Type 2 Diabetes and Morbid Obesity

Semaglutide, a medication that has undergone extensive clinical trials, has shown promise in the treatment of both type 2 diabetes and weight loss. By reviewing the studies included in the SUSTAIN, STEP, PIONEER, SELECT, and SUSTAIN FORTE series, we can gain an overview of Semaglutide's efficacy and safety in these two important treatment areas. The results suggest that Semaglutide can be a significant resource for patients struggling with these health issues, but it's crucial that its use is monitored by a doctor.

Semaglutide has been the subject of extensive clinical studies to evaluate its efficacy and safety, particularly in the treatment of type 2 diabetes and weight loss. Here are some of the key scientific studies conducted on Semaglutide:

  • SUSTAIN Studies: SUSTAIN (Semaglutide Unabated Sustainability in Treatment of Type 2 Diabetes) is a series of studies that evaluated Semaglutide's effect and safety for the treatment of type 2 diabetes. These studies showed that Semaglutide could lower HbA1c levels (a long-term measure of blood sugar control) and lead to weight loss in patients with diabetes.
  • STEP Studies: STEP (Semaglutide Treatment Effect in People with Obesity) is a series of studies focusing on the use of Semaglutide for weight loss in individuals with overweight or obesity. These studies have demonstrated that Semaglutide can lead to significant weight loss and improvements in health-related parameters in overweight individuals.
  • PIONEER Studies: PIONEER (Peptide Innovation for Early diabetes Treatment) is a series of studies that evaluated Semaglutide's use as an early treatment for individuals with type 2 diabetes. The results showed that Semaglutide was effective in lowering blood sugar and was safe to use.
  • SELECT Studies: SELECT (Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity) are studies that evaluated Semaglutide's effect on cardiovascular events in individuals with overweight or obesity. These studies aim to assess whether Semaglutide can reduce the risk of cardiovascular diseases.
  • SUSTAIN FORTE Study: This study focused on Semaglutide's use in individuals with severe untreated type 2 diabetes. The results showed that Semaglutide was superior to other diabetes medications in terms of lowering blood sugar.

It's important to note that these studies were conducted by various research groups and published in scientific journals. The results indicate that Semaglutide is an effective medication for the treatment of both type 2 diabetes and weight loss in individuals with overweight or obesity. However, it's crucial that the use of Semaglutide is monitored by a doctor and that patients follow their advice and instructions.

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Here are some scientific references that support the aforementioned health risks for people with obesity


Cardiovascular diseases:

Pi-Sunyer, FX (2002). Medical hazards of obesity . Annals of Internal Medicine, 136(11), 857-864.

Poirier, P., Giles, TD, Bray, GA, Hong, Y., Stern, JS, Pi-Sunyer, FX, & Eckel, RH (2006). Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. Circulation, 113(6), 898-918.

Here is a summary of the two studies on cardiovascular disease:

Pi-Sunyer (2002) in " Medical hazards of obesity ":

The study highlights the medical risks associated with obesity. The author discusses that obesity can increase the risk of various health problems and diseases, including cardiovascular disease. It emphasizes the importance of managing and preventing obesity to reduce these risks.

The study " Medical Hazards of Obesity " by F. Xavier Pi-Sunyer, published in the Annals of Internal Medicine in 2002, aims to highlight the medical dangers associated with obesity. The author explores and describes the health risks and medical complications that can arise due to overweight and obesity.

The study discusses several important aspects of obesity and its impact on health. The author addresses the following points:

Health Effects: Pi-Sunyer reviews the many medical problems that can occur as a result of obesity. This includes diseases such as cardiovascular disease, type 2 diabetes, high blood pressure, sleep apnea, joint problems, and certain types of cancer. Risk increase: The study emphasizes that the risk of these diseases and health problems increases proportionally with the degree of obesity. This means that people with a higher body mass index (BMI) have a greater risk of suffering from these diseases.‍

Pathophysiology: The author discusses the biological and physiological mechanisms that link obesity to increased risk of disease. It includes changes in insulin resistance, inflammation, blood lipids, and other metabolic processes.‍

Importance of weight loss: The study underscores the importance of weight loss as a strategy to reduce the medical dangers associated with obesity. The author points out that even a moderate weight loss can have positive health effects.‍

Treatment Options: Finally, treatment options for obesity are discussed, including lifestyle changes, diet, exercise, and in some cases drugs or surgery.‍

In conclusion, Pi-Sunyer's study is a comprehensive overview of the medical dangers that obesity can bring. It emphasizes the importance of managing and preventing obesity to reduce the risk of serious health problems, particularly cardiovascular disease. The study serves as an important resource for healthcare professionals as well as the general public who want to understand the link between obesity and health.

Poirier et al. (2006) in "Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss":

This study focuses on the relationship between obesity and cardiovascular disease. The authors discuss the pathophysiology behind this association and emphasize the importance of evaluating and treating obesity to reduce the risk of cardiovascular problems. They also discuss the effects of weight loss on improving cardiovascular health.

The study "Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight Loss" by Poirier and co-authors, published in the journal Circulation in 2006, aims to shed light on the relationship between obesity and cardiovascular disease and to discuss the pathophysiological mechanisms behind this relationship . The study also focuses on how weight loss can affect cardiovascular health.

Here is a summary of the main points of the study:

Obesity and cardiovascular disease: The study emphasizes that obesity is a significant risk factor for cardiovascular disease, including heart attack, stroke, and heart failure. The authors discuss how obesity can lead to the development of these diseases.

Pathophysiological Mechanisms: Poirier and co-authors review the complex biological and physiological mechanisms by which obesity affects cardiovascular health. This includes insulin resistance, inflammation, high blood pressure and changes in blood lipids.

The positive effects of weight loss: The study points out that weight loss can have significant benefits for cardiovascular health. It can improve risk factors such as blood pressure, cholesterol levels and glucose metabolism.

Challenges in Achieving Weight Loss: The authors address the challenges that obese patients may face when trying to lose weight and discuss various strategies for achieving and maintaining weight loss.

Treatment options: Finally, the study discusses different treatment options for people with obesity that aim to reduce the risk of cardiovascular disease. This includes lifestyle changes, diet, exercise and, in some cases, medication or surgery.‍

In summary, Poirier and coauthors provide a comprehensive overview of the association between obesity and cardiovascular disease. The study highlights the importance of managing obesity as a strategy to reduce the risk of cardiovascular complications. It serves as a valuable resource for healthcare professionals and researchers working in the field of cardiovascular health and obesity.

Both studies emphasize that obesity is a significant risk factor for cardiovascular disease and emphasize the importance of preventing and treating obesity to improve long-term cardiovascular health.

Type 2 Diabetes:

Kahn, SE, Hull, RL, & Utzschneider, KM (2006). Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature, 444(7121), 840-846.

Hossain, P., Kawar, B., & El Nahas, M. (2007). Obesity and diabetes in the developing world—a growing challenge. New England Journal of Medicine, 356(3), 213-215.

Sleep apnea:

Young, T., Peppard, PE, & Taheri, S. (2005). Excess weight and sleep-disordered breathing. Journal of Applied Physiology, 99(4), 1592-1599.

Punjabi, NM (2008). The epidemiology of adult obstructive sleep apnea. Proceedings of the American Thoracic Society, 5(2), 136-143.

Fatty liver:

Neuschwander-Tetri, BA (2010). Hepatic lipotoxicity and the pathogenesis of nonalcoholic steatohepatitis: the central role of nontriglyceride fatty acid metabolites. Hepatology, 52(2), 774-788.

Ratziu, V., Bellentani, S., Cortez-Pinto, H., Day, C., Marchesini, G. (2010). A position statement on NAFLD/NASH based on the EASL 2009 special conference. Journal of Hepatology, 53(2), 372-384.


Blagojevic, M., Jinks, C., Jeffery, A., & Jordan, KP (2010). Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis and Cartilage, 18(1), 24-33.

Oliveria, SA, Felson, DT, Cirillo, PA, Reed, JI, & Walker, AM (1999). Body weight, body mass index, and incident symptomatic osteoarthritis of the hand, hip, and knee. Epidemiology, 10(2), 161-166.


Calle, EE, Rodriguez, C., Walker-Thurmond, K., & Thun, MJ (2003). Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. New England Journal of Medicine, 348(17), 1625-1638.

Renehan, AG, Tyson, M., Egger, M., Heller, RF, & Zwahlen, M. (2008). Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. The Lancet, 371(9612), 569-578.

Mental illness:

Luppino, FS, de Wit, LM, Bouvy, PF, Stijnen, T., Cuijpers, P., Penninx, BW, & Zitman, FG (2010). Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Archives of General Psychiatry, 67(3), 220-229.

Atlantis, E., & Baker, M. (2008). Obesity effects on depression: systematic review of epidemiological studies. International Journal of Obesity, 32(6), 881-891.

Reproductive problems:

Pasquali, R., Patton, L., & Gambineri, A. (2007). Obesity and infertility. Current Pharmaceutical Design, 13(33), 3649-3657.

Bellver, J., Pellicer, A., García-Velasco, JA, & Ballesteros, A. (2013). Obesity reduces uterine receptivity: clinical experience from 9,587 first cycles of ovum donation with normal weight donors. Fertility and Sterility, 100(4), 1050-1058.

Breathing problems:

Wang, Y., Beydoun, MA, Liang, L., Caballero, B., & Kumanyika, SK (2008). Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic. Obesity, 16(10), 2323-2330.

Castro-Rodriguez, JA, Holberg, CJ, Morgan, WJ, Wright, AL, & Martinez, FD (2001). Increased incidence of asthmalike symptoms in girls who become overweight or obese during the school years. American Journal of Respiratory and Critical Care Medicine, 163(6), 1344-1349.

Premature Death:

Adams, KF, Schatzkin, A., Harris, TB, Kipnis, V., Mouw, T., Ballard-Barbash, R., ... & Leitzmann, MF (2006). Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. New England Journal of Medicine, 355(8), 763-778.

Peeters, A., Barendregt, JJ, Willekens, F., Mackenbach, JP, Al Mamun, A., & Bonneux, L. (2003). Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Annals of Internal Medicine, 138(1), 24-32.

These references provide an overview of the scientific literature on the risks to people with obesity. It is important to note that this is only a sample and that there is much more research in this area.