Semaglutide, tirzepatide, and dulaglutide obtain related outcomes and have related mechanisms of motion, so the selection typically comes all the way down to desire and tolerability.
Glucagon-like peptide-1 receptor agonists (GLP-1) medicines are used to deal with sufferers with kind 2 diabetes and weight problems. GLP-1 medicines akin to semaglutide, tirzepatide, and dulaglutide assist management blood glucose and urge for food. The most recent of the three is tirzepatide, permitted by the FDA in 2023. Its notable distinction is that it really works on each GLP-1 and glucose dependent insulinotropic polypeptide receptors (GIP).1,2
Analysis reveals that semaglutide, tirzepatide, and dulaglutide are every efficacious in reducing HbA1c and physique weight1, and the newer once-weekly injectable tirzepatide has proven related weight reduction outcomes as semaglutide.1 The SOURMOUNT-1 trial, nonetheless, discovered that discount in baseline weight of 15 %, 19.5 %, and 20 % at 72 weeks with the 5mg, 10mg, and 15mg doses of tirzepatide surpassed the efficiency of semaglutide3; it’s additionally reported that tirzepatide resulted in larger weight reduction than dulaglutide1, which is nice information for sufferers due to its current FDA approval for weight reduction.4
As a result of semaglutide, tirzepatide, and dulaglutide produce related ends in the context of kind 2 diabetes and weight reduction, the selection relating to which medicine to prescribe comes all the way down to desire, affected person tolerance, value, administration (oral or injectable), and affected person responsiveness. Beneath is a basic overview of every medicine.
| Medicine | Model Title | Who? |
| Semaglutide (oral and injectable)
|
Ozempic®
Wegovy® Rybelsus®
|
Adults with poor glycemic management and/or these taking a couple of oral antihyperglycemic agent (e.g., metformin); sufferers with weight problems (BMI ³ 30 kg/m2); insulin sufferers who want extra intense remedy; renal or hepatic impairment; sufferers in danger for CVD or established CVD.5,6,7
|
| Tirzepatide
|
Mounjaro®
Zepbound® |
Adults with kind 2 diabetes or weight problems |
| Dulaglutide
|
Trulicity® | Adults with kind 2 diabetes and weight problems, and kids 10 or older with kind 2 diabetes; sufferers who haven’t responded to oral medicines. |
| Medicine | Model Title | What? |
| Semaglutide | Ozempic
Wegovy Rybelsus
|
Semaglutide works through the incretin hormone system. As an artificial type of the hormone glucagon-like peptide (GLP-1), semaglutide is launched from the proglucagon gene discovered within the L-cells of the small distal gut and colon. GLP-1 binds itself to GLP-1 receptors in pancreatic beta cell, gastric mucosa, kidney, coronary heart, and hypothalamus tissue, the place it stimulates the discharge of insulin in hyperglycemic sates and inhibits glucagon launch in hyperglycemic states. It additionally slows gastric emptying and suppress one’s urge for food.1
Adjunct remedy to food regimen and train.
|
| Tirzepatide
|
Mounjaro
Zepbound |
Twin glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 (GLP-1) receptor agonist; it mimics naturally occurring GLP-1 and GLP-1 hormones, reduces urge for food, and slows abdomen emptying.
Adjunct remedy to food regimen and train.
|
| Dulaglutide
|
Trulicity | Mimics naturally occurring GLP-1 and GLP-1 hormones, reduces urge for food, and slows abdomen emptying. Dulaglutide stimulates insulin secretion after meals and reduces the quantity of glucose produced by the liver.8
Adjunct remedy to food regimen and train. |
| Medicine | Model Title | When? |
| Semaglutide | Ozempic
|
As soon as weekly subcutaneous single dose pre-filled pen
|
| Wegovy
|
As soon as weekly subcutaneous single dose pre-filled pen
|
|
| Rybelsus
|
As soon as each day oral pill taken with water half-hour earlier than consuming
|
|
| Tirzepatide
|
Mounjaro
Zepbound |
As soon as weekly subcutaneous single dose pre-filled pen
|
| Dulaglutide
|
Trulicity | As soon as weekly subcutaneous single dose pre-filled pen |
| Medicine | Model Title | How? |
| Semaglutide
|
Ozempic
|
0.25mg, 0.5mg, 1.0mg, 2.0mg.
Throughout week 5 (5), the dose will increase to 0.5mg; for adults with kind 2 diabetes, the dosage might improve to the utmost 2.0mg for higher glycemic management.
|
| Wegovy
|
0.25mg, 0.5mg, 1.0mg, 1.7mg, 2.4mg
Dosing begins with 0.25mg for 4 (4) weeks and improve each 4 (4) weeks till the utmost dose, to not exceed 2.4mg, is decided by the treating doctor.
|
|
| Rybelsus
|
7mg or 14mg | |
| Tirzepatide
|
Mounjaro
Zepbound |
2.5mg, 5mg, 7.5mg, 10mg, 12.5mg, 15mg
Should be refrigerated.
|
| Dulaglutide
|
Trulicity | 0.5mL, 0.75mL, 1.5mg, 3.0mg, 4.5mg
Grownup advisable beginning dose: 0.75mg with 1.5mg weekly will increase after at the least 4 (4) weeks on the present dose if extra glycemic management is required. Don’t exceed the utmost dose of 4.5mg.
Pediatric advisable beginning dose: 0.75mg. If extra glycemic management is required, improve to the utmost dose of 1.5mg after at the least 4 (4) weeks on the 0.75mg dose. Don’t exceed 1.5mg.
Should be refrigerated.
|
| Medicine | Model Title | Why? |
| Semaglutide | Ozempic
Wegovy Rybelsus
|
Decrease danger of demise brought on by metabolic syndrome and well being problems brought on by kind 2 diabetes.
|
| Tirzepatide
|
Mounjaro
Zepbound |
Decrease danger of demise brought on by metabolic syndrome and well being problems brought on by kind 2 diabetes; to this point no FDA indication for lowering CV2. |
| Dulaglutide
|
Trulicity | Decrease danger of demise brought on by metabolic syndrome and well being problems brought on by kind 2 diabetes. |
Implications for Medical Follow: GLP-1s as Adjuncts to Weight loss plan and Train
Generally reported side effects of GLP-1 medicines embrace gastrointestinal occasions akin to bloating, nausea, vomiting, and diarrhea.9,10,11 To offset the negative effects and to make sure nutritionally wants are being met, supplementing sufferers’ diets with nutritionally designed meal replacements for sufferers prescribed GLP-1 medicines warrants consideration. Supplementing sufferers’ diets with nutritionally designed meal replacements can assist sufferers guarantee they’re consuming the RDA for nutritional vitamins, minerals, protein, and fiber whereas additionally serving to them handle the GI negative effects of GLP-1 medicines.
Along with the GI negative effects, sufferers can lose muscle mass rapidly when meals consumption is diminished. Lack of imply muscle mass can adversely have an effect on main organs of the physique; most significantly, muscle is metabolically lively, requiring vitality to maintain itself. When one has extra lean mass, their resting metabolic charge is elevated, which interprets into a rise within the variety of energy being burned. In brief, extra lean mass ends in increased vitality expenditure due to the elevated metabolic charge.
To make sure dietary wants are being met, pre-packaged, nutritionally designed shakes/drinks supply comfort and fulfill each day suggestions for nutritional vitamins and minerals. Nutritionally designed shakes/drinks have the additional benefit of lowering GI negative effects and needs to be thought of as a part of sufferers maintaining a healthy diet plan whereas on weight reduction medicines.
Sources:
1 Use of dulaglutide, semaglutide, and tirzepatide in diabetes and weight management
3 Tirzepatide once weekly for the treatment of obesity
4 FDA approves diabetes drug tirzepatide for chronic weight management
5 Integrating oral semaglutide into clinical practice: For whom, when, and how?
6 Pharmacological profile of once-weekly injectable semaglutide for chronic weight management
7 Semaglutide for the treatment of obesity
8 Dulaglutide: An evidence-based review of its potential in the treatment of type 2 diabetes
