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Sunday, June 4, 2023

Semaglutide, the (high-risk) antidiabetic race

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Fashion is born on social networks: one injection per week of a diabetes medication
, semaglutide and weight loss is quick and easy. Fast enough to leave a slightly sunken and haggard face, saggy skin with an aged appearance, but for influencers, stars and personalities like Elon Musk, who has admitted to using it, the possible negative consequences of its use are entirely secondary to the desired weight loss. It is a pity that the rush to misuse it, in those who do not have diabetes, contributes reduce inventories to the point that led the Italian Medicines Agency to warn that supply shortages will be possible throughout 2023. No small problem, because, as explained by Graziano Di Cianni, president of the Association of Diabetologists, «out of about four million diabetics in Italy, it is estimated that several thousand are treated with semaglutide and today they are forced to change therapy and use less effective or less tolerated products».

Increases the feeling of satiety

Semaglutide is a GLP-1 receptor agonist, which stimulates insulin production after meals or only when carbohydrates are introduced; because of this does not cause a sudden drop in blood sugar
Further slows gastric emptying by increasing the feeling of satiety and by acting on the appetite centers in the central nervous system, it reduces hunger. It is administered orally once a week or daily by subcutaneous injection and shares these effects with other drugs of the same class, such as dulaglutide and liraglutidebut it is especially effective for losing kilograms: in adults it is possible to lose even 20% of the weight and the result is maintained as long as the treatment is followed. «Slimming, which contributes to the positive effect on blood sugar levels and the protection of the cardiovascular system (thanks to the reduction of parameters such as blood pressure, blood fat and abdominal circumference, ed), is a beneficial “side effect” of semaglutide because people with type 2 diabetes in whom it is used are often obese» notes Di Cianni.

Disorder of metabolism

Also for this reason, the US FDA approved its use against obesity, but then there was a “head start” of those who had only a few extra pounds and began to receive injections. document everything on social networks like Instagram and TikTok. A risky drift for many reasons, as indicated by Angelo Avogaro, President of the Italian Society of Diabetology: «The improper use and resulting deficiency endangers people with diabetes, who can lose their metabolic compensation and, by stopping the drug, a dangerous weight “rebound”.; on the other hand, use by people who are healthy can lead to excessive weight losswith loss of muscle mass and disruption of metabolism that can lead to serious metabolic changes in the long run ».

Contraindications and side effects

Even if I want to ignore that, like all drugs, semaglutide has contraindications (for example, it should not be used during pregnancy or breastfeeding or if you have pancreas or kidney problems) and that it can have side effects such as diarrhea and vomiting, headache, drowsiness, confusion and so on, it is dangerous to use it to lose a bounty because there are no data on use in healthy humans; even its use in obese patients is currently off labelie outside the permitted indications, because to protect people with diabetes Aifa allows the prescription only in case of uncontrolled type 2 diabetesas an adjunct to diet, exercise, and possibly other medications. «Semaglutide is prescribed in some regions off label paid for by the obese patient, in the recent past, but now it is no longer possible and can only be provided by the National Health Service in the case of type 2 diabetes – notes Di Cianni -. This should suffice if deterrent to abuse, which was probably quite limited in our country; however, it should be discouraged by all means, because this drug is an important first choice for treating people with type 2 diabetes with a high cardiovascular risk and it is essential to prevent shortages in supplies,” concludes the diabetologist.

A therapy for obesity

A “close relative” of semaglutide, liraglutide with daily subcutaneous injection, it is already approved in Italy for the treatment of obesity; the US has also given the green light to semaglutide in a higher dose formulation, currently not available in Italy. Probably, when the collective mania for the drug will have been consumed by those who do not have weight problems or diabetes and who use it in a completely inappropriate way it can also be used in our country with the real obese. As Renato Cozzi, president of the Association of Endocrinologists, underlines: «deficiency should not become a tool to stigmatize obese patients and their need for health, because early intervention can prevent complications such as diabetes itself». Meanwhile, research continues and, as Enzo Nisoli of the University of Milan explained at the last congress of the Italian Society of Pharmacology, «there are promising prospects for other drugs».

Source: Corriere

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