Last week the 83rd American Diabetes Association (ADA) Scientific Sessions wrapped up, and we brought you some of the conference’s most exciting developments in type 1 diabetes research. Now it’s time to hear about the biggest news in type 2 diabetes treatments, hot off the press from ADA.
Weight loss drugs
Research on new era type 2 diabetes and weight loss drugs made waves at this year’s meeting. The drugs belong to a family of medications called GLP-1 analogues. This family includes Ozempic and Wegovy, which are already approved to treat type 2 diabetes in the NHS.
GLP- analogues analogues work by mimicking the effects of hormones that we make naturally in our gut. The gut hormones play an important role in telling our bodies how and when to release insulin, so boosting their effects can help to bring down blood sugar levels in type 2 diabetes. The hormones also work to slow down digestion and send signals to the brain that make us feel full.
This means GLP-1 analogues are becoming powerful tools to help people with type 2 manage blood sugar levels and people living with obesity lose weight.
Just like insulin, or any medical treatments, if you stop taking GLP-1 analogues the benefits will go away.
The dual benefits of tirzepatide
A recent addition to the GLP-1 analogue family is a drug called tirzepatide (also known as Mounjaro). Tirzepatide hasn’t been approved for use in the UK yet. It’s the first drug that mimics the effects of two different gut hormones, called GIP and GLP-1.
At ADA, results from the latest clinical trial of tirzepatide were announced, exploring its effects on weight loss for people living with both type 2 diabetes and obesity or overweight. 938 people took part in the trial. They were treated with a once-weekly injection of a medium or high dose of tirzepatide or with a dummy drug, called a placebo.
Researchers found that participants who were given tirzepatide lost an average of 15% of their initial body weight (14.8 kg) after 72 weeks of treatment. In comparison, those taking the placebo lost an average of 3% body weight. Both the medium and high doses of tirzeaptide were effective, but the higher dose led to greater weight loss.
People taking tirzepatide also saw bigger improvements in their blood sugar levels compared to the placebo group. Their HbA1c decreased from 64 mmol/mol (or 8%) at the start of the trial to 41 mmol/mol (or 5.9%) at the end – a reduction of 23 mmol/mol (or 2.1%). Whereas in the placebo group, HbA1c only dropped by 6 mmol/mol (or 0.5%).
Three quarters of participants receiving tirzepatide had HbA1c levels in the target range (below 48 mmol/mol or 6.5%), without any severe hypos, at the end of the study.
What is the future of tirzepatide?
Weight loss can be more difficult for people living with type 2 and obesity or overweight than those without diabetes, particularly as some diabetes medications can promote weight gain. So, these results are important in helping us understand the promising twin benefits tirzepatide holds for people living with both conditions.
Tirzepatide is currently being assessed by the National Insititute for Health and Care Excellence (NICE) for treating type 2 diabetes. NICE make recommendations to the NHS on how medications should be used and who should be prescribed them.
If tirzepatide is approved it would be recommended as a treatment for people with type 2 as an alternative to GLP-1 analogues such as dulaglutide, liraglutide and semaglutide, which are already recommended for use in the NHS. NICE are expected to make their final recommendations on tirzepatide in October this year.
A new triple action weight loss drug
At ADA we were introduced to a new type 2 and weight loss drug, called retatrutide, that’s currently only available in a research setting. While drugs that are already approved in the UK, like Ozempic and Wegovy, mimic one hormone (GLP-1) and tirzepatide mimics two hormones (GLP-1 and GIP), retatrutide goes one further.
It’s what we call a ‘triagnoist’ because it mimics three hormones: GLP-1 and GIP, plus glucagon. Glucagon helps to balance blood sugar levels, and to reduce appetite and help the body burn more energy.
In a new trial, researchers investigated if retatrutide could help people with type 2 diabetes to lower their blood sugar levels and lose weight. And they tested the effects of different doses.
They followed 281 people living with type 2 diabetes and overweight or obesity for 36 weeks. Participants were either treated weekly with:
One of four different does of retatrutide: a very low, low, medium, or high dose
Dulaglutide, an existing GLP-1 analogue for type 2 diabetes
The results showed that people treated with the highest dose of retatrutide saw the biggest improvements in blood sugar levels. Their HbA1c reduced on average from 66 mmol/mol (or 8.3%) to 43 mmol/mol (or 6.1%) - a reduction of 23 mmol/mol (or 2.2%). This compared to no change with placebo and a 16 mmol/mol (1.4%) HbA1c reduction with dulaglutide.
People taking the highest dose of retatrutide also lost significantly more weight than those taking the placebo. On average people on the high dose lost nearly 17% of their body weight (17.2kg), compared to just 3% (3.3kg) with placebo.
Having an arsenal of drugs for the management of blood sugars and body weight in type 2 diabetes will help more people find a treatment that’s right for them. The next step will be larger and longer ‘phase 3’ trials of retatrutide to build more evidence of its effectiveness. This will be essential before the first-of-its-kind drug could be approved for use outside a research setting.
Getting to the heart of statin alternatives
People living with diabetes can be at a higher risk of cardiovascular problems, including heart attacks and strokes. Many people can reduce this risk by taking medications called statins. They help to lower the amount of “bad” cholesterol in the blood.
But around one in every 10-12 people who could benefit from taking statins are intolerant to them, making the treatment unsuitable.
At ADA, researchers presented the latest on a possible alternative. Bempedoic acid is a new non-statin drug that can lower cholesterol.
A team of researchers in Cleveland recruited nearly 14,000 people with statin intolerance to test how effective it is in lowering the risk of cardiovascular problems. 67% of the participants had type 2 diabetes. Around half the participants received bempedoic acid daily for 40 months, and half received a placebo.
The team found that bempedoic acid reduced the amount of cholesterol by an average of 22%. Those taking the treatment were less likely to experience heart problems compared to the placebo group. The researchers calculated it led to a 30% drop in the number of heart-related problems, such as heart attack or stroke, and a 39% decrease in the risk of death from cardiovascular disease.
These findings suggest that bempedoic acid should be considered when statins aren’t an option, but more research is still needed to fully understand its benefits, or any risks. The research also drives home the importance for people with diabetes who could benefit to take cholesterol-lowering medication to reduce their risk of preventable complications.
We've barely scratched the surface of all the cutting-edge research presented at the 83rd American Diabetes Association Scientific Session, which included our type 1 diabetes research highlights.
Thanks to all the brilliant scientists around the globe who are joining us on our mission for a world where diabetes can do no harm.