Getting a weekly injection that results in marked weight reduction without major adverse effects might seem too good to be true. And yet several medications that were initially designed to manage type 2 diabetes can really help people lose up to 20% of their body weight. These drugs are known as incretin mimetics and they have also been found to improve blood pressure and cholesterol levels.
So it doesn’t come as a surprise that these diabetes drugs are highly sought after, particularly semaglutide. This demand has caused shortages and is one of the challenges for those looking to use these drugs, which are expensive btw costing around $1,000 to $1,500 per month—and not covered by Medicare for obesity.
Diabetes Drugs That Make You Lose Weight
Venomous reptiles known as Gila monsters possess a unique capability to maintain consistent blood sugar levels even after long periods of fasting. The venom from this vibrant creature inspired the creation of exenatide (Byetta) which was the first drug classified under incretin mimetics.
Today, more potent drugs that mimic an incretin called GLP-1 are available. These injectable drugs include dulaglutide (Trulicity), semaglutide (Ozempic) and liraglutide (Victoza). Semaglutide is also available as an oral pill named Rybelsus. Meanwhile, both semaglutide and liraglutide are approved for weight loss under the brand names Wegovy and Saxenda, respectively. Just recently a new addition to this drug class combines GLP-1 with another incretin mimic, GIP. Tirzepatide (Mounjaro) was approved for type 2 diabetes treatment in May 2022 and last November 2023 was approved for obesity treatment with the brand name Zepbound.
Overlapping Risks
Up to half of all newly diagnosed diabetes cases in this country are associated with obesity, a condition that now affects over 40% of Americans. Both conditions are closely tied to cardiovascular disease. “Many cardiologists now recognize that addressing obesity is the best way to manage heart disease,” says Dr. Caroline Apovian, co-director of the Center for Weight Management and Wellness at Harvard-affiliated Brigham and Women’s Hospital.
Other anti-obesity medications help people lose only about 5% to 8% of their body weight. However, incretin mimics, which are similar to hormones naturally produced by the brain and gut, have multiple effects – stimulate the pancreas to release insulin when blood sugar becomes too high, target brain receptors to reduce appetite and slow down stomach emptying.
The newest drugs, tirzepatide and semaglutide, can lead to impressive weight loss and also reduce HbA1c levels (a three-month average measure of blood sugar) by up to two percentage points. Studies also found that semaglutide and liraglutide lower the risk of severe cardiovascular events, such as stroke and heart attack in people with obesity and diabetes.
Who Should Consider These Drugs?
Those who have been diagnosed with diabetes who are overweight are prime candidates for semaglutide or tirzepatide, especially those at high risk for heart disease. For those without diabetes, the official criteria for prescribing these medications are the same as for other anti-obesity drugs: a body mass index (BMI) of 30 or above, or a BMI of 27 or higher with at least one weight-related health issue.
Taking these drugs involves self-injecting in the thigh or abdomen using a pen-like device with a very thin needle. Side effects like diarrhea, nausea and constipation are common but usually don’t last longer than a week, particularly if the dosage is started low.
Which Diabetes Medications Promote Weight Loss?
There are a handful of diabetes medications known to promote weight loss including:
- Ozempic (active compound: semaglutide)
- Mounjaro (active compound: tirzepatide)
- Rybelsus (active compound: semaglutide)
- Trulicity (active compound: dulaglutide)
- Victoza (active compound: liraglutide)
- Canagliflozin (generic name for Invokana)
- Metformin (generic names include Fortmeza and Glutmeza)
- Empagliflozin (generic name for Jardiance)
- Dapagliflozin (generic name for Farxiga)
These medications differ from each other in their administration methods and recommended usage times. I will discuss each one below.
Injectable Diabetes Medications
Ozempic and Other GLP-1 Agonists
Glucagon-like peptide-1 (GLP-1) receptor agonists are perhaps the most well-known class of injectable diabetes treatments that cause weight loss. Ozempic is a weekly injectable medication designed to help individuals with Type 2 diabetes manage their blood sugar levels. It’s commonly referred to by its generic name, semaglutide, and was approved in 2017 for diabetes treatment.
Dr. W. Scott Butsch, Director of Obesity Medicine in the Bariatric and Metabolic Institute at Cleveland Clinic explains that Ozempic is identical to Wegovy, which received U.S. Food and Drug Administration (FDA) approval in 2021 as an anti-obesity medication. Wegovy, containing a higher dose of semaglutide, became the most effective obesity treatment – 15% weight loss in a year-long randomized controlled trial.
Although prescribing Ozempic for weight loss is considered “off-label,” the primary difference between the two brand-name medications is the dosage.
Prescribing a medication “off-label” refers to its use for purposes other than those officially approved. This practice is widespread in medicine. For instance, beta-blockers, typically used for heart conditions, may be prescribed for situational anxiety, or anti-seizure medications might be used to manage migraines.
Ozempic is administered through a weekly injection into the thigh, abdomen, or upper arm. “We’ve been utilizing GLP-1 receptor agonists for nearly two decades to treat diabetes and obesity,” Dr. Butsch states.
When you take Ozempic or other GLP-1 medications, your body increases its production of GLP-1, which naturally suppresses your appetite and makes you feel more satiated. However, Ozempic isn’t just an appetite suppressant, as Dr. Butsch clarifies. Like other anti-obesity drugs, Ozempic not only alters how your body responds to weight loss but may also have effects that extend beyond shedding pounds.
Ozempic and similar medications work not just by curbing appetite and reducing food intake but by influencing the communication between your gut and brain, fundamentally altering how your body reacts to food.
Mounjaro
Manufactured by Eli Lilly, Mounjaro contains tirzepatide, an active ingredient classified as a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist. It’s administered through a weekly injection.
Studies reveal that patients using Mounjaro experienced an average weight reduction of 41 pounds over 72 weeks. Without insurance, Mounjaro’s starting price is approximately $1,135 for a 28-day supply.
Victoza
Victoza is a prescription injectable medication that healthcare professionals use to regulate blood sugar levels in people who have Type 2 diabetes mellitus. It is produced by Novo Nordisk, the same pharmaceutical company that manufactures related drugs like Ozempic, Wegovy, and Saxenda.
It was approved by the FDA in 2010 for the treatment of Type 2 diabetes in adults and was later authorized to reduce the risk of certain major cardiovascular events—such as heart attacks and strokes in patients with heart disease and Type 2 diabetes.
It’s important to note that Victoza is FDA-approved for managing Type 2 diabetes in adults and children over the age of 10. It is not specifically approved for weight management, although some patients may experience weight loss while taking it.
Liraglutide, the active ingredient in Victoza, plays a vital role in regulating blood sugar levels. Liraglutide stimulates the pancreas to release insulin, a hormone that facilitates the transfer of glucose (sugar) from the bloodstream into cells, where it’s used for energy. This insulin-mediated process helps maintain stable blood sugar levels, reducing the likelihood of sudden energy spikes and crashes that often lead to cravings for high-calorie foods.
Trulicity
Trulicity (dulaglutide) is FDA-approved to treat Type 2 diabetes when used in conjunction with diet and exercise. It’s also approved to lower the risk of heart complications in people with Type 2 diabetes and either established heart disease or risk factors for it.
Research has demonstrated that Trulicity can lead to greater weight loss than metformin alone. It has also been shown to result in more weight loss than sitagliptin (Januvia), another popular diabetes medication, when used alongside metformin.
The amount of weight lost with Trulicity may depend on the dosage. In 2020, a large-scale randomized controlled trial (the gold standard for clinical research) studied the effects of Trulicity on weight loss. The study found that participants who received the maximum dose of 4.5 mg experienced the greatest weight loss, with an average reduction of 10 pounds, compared to a placebo group. While Trulicity is not approved as a weight loss drug, its weight-loss effects are well-documented. If you’re considering Trulicity for weight loss, consult your healthcare provider to discuss the potential benefits and risks.
Oral Diabetes Medications
If you dislike needles, then oral medications could be more appealing.
Rybelsus (semaglutide)
GLP-1 receptor agonists have traditionally been available only as injectable drugs, requiring either daily or weekly administration. That changed in 2019 when the FDA approved Rybelsus, the first GLP-1 receptor agonist available in tablet form. Novo Nordisk accomplished this by altering the semaglutide formulation to withstand stomach acid and facilitate absorption into the bloodstream.
Since it’s easier to take than an injection, Rybelsus may appeal to those seeking the benefits of a GLP-1 receptor agonist without the need for needles. Rybelsus is currently available in three doses (3 mg, 7 mg, and 14 mg). Patients typically start on a low dose of 3 mg for the first month, increasing to 7 mg after 30 days.
Because Rybelsus was only recently approved, it remains costly. As with other GLP-1 receptor agonists, the out-of-pocket cost for a 30-day supply can be more than $900 without insurance. A combination of Rybelsus and metformin may be a more cost-effective solution for some patients.
SGLT2 Inhibitors
SGLT2 inhibitors work by blocking glucose absorption in the kidneys, so any excess glucose will be excreted in the urine. This not only reduces blood sugar levels but can also lead to weight loss. The three primary SGLT2 inhibitors are:
- Canagliflozin (Invokana)
- Dapagliflozin (Farxiga)
- Empagliflozin (Jardiance)
While these medications are primarily prescribed to manage blood sugar levels, their weight-loss effects are well-documented. However, they are associated with an increased risk of urinary tract infections and genital infections.
Metformin
Metformin is perhaps the most commonly prescribed diabetes medication. Although it is primarily used to regulate blood sugar levels, it is also associated with modest weight loss.
Metformin works by decreasing glucose production in the liver, improving insulin sensitivity, and enhancing glucose uptake in cells. While it’s not typically considered a weight-loss drug, some patients may experience a reduction in appetite, which can contribute to weight loss.
Concerns Surrounding Diabetes Shots That Make You Lose Weight
The introduction of GLP-1 receptor agonists for managing type 2 diabetes has been life saving for countless individuals. However, these drugs also contribute to weight reduction, which make them appealing to those without diabetes. Doctors have noticed an increase in requests from individuals without diabetes or serious weight issues, seeking these medications thus resulting in shortages.
Across the country, people with diabetes often report difficulties in obtaining their semaglutide prescriptions. Medical professionals receive inquiries from patients all the time because they are unable to refill their medications. This shortage has forced healthcare providers to reduce dosages or switch patients to other drugs within the same class.
Type 2 diabetes is characterized by improper sugar metabolism, often leading to elevated blood sugar levels and damage to various organs and tissues. Semaglutide helps the body release insulin to lower blood sugar and influences brain chemicals that regulate hunger. Medical professionals highlight that this drug not only aids in diabetes management but also reduces the risk of other diabetes-related complications, such as cardiovascular, kidney disease and obesity.