Type-2 diabetes: The prevalence of type-2 diabetes and obesity are increasing at a fast rate world-wide and are referred to as the twin epidemics of the 21st century. Both disorders are complex combining epigenetics, genetics, lifestyle as well as socioeconomic and environmental impacts. Obesity increases a person’s risk of diabetes, high blood pressure, heart disease, cholesterol, cancer, asthma and so on. Type-2 diabetes has quadrupled in number of cases in the last 30 years with a 5% increase in premature mortality in the last 10 years.

Last year, over 540 million adults were reported to suffer from type-2 diabetes globally, and it is estimated to reach almost 800 million by 2045. Currently, 1 in 10 people suffer from type-2 diabetes and the number is increasing at pandemic rates. Type-2 diabetes is when cells in the pancreas, called beta cells, which produce insulin, become non-functional, resulting in high blood glucose levels. Long term, high blood glucose levels results in low-grade chronic inflammation which can result in kidney failure, loss of vision, heart disease, neuropathy, poor blood circulation in the feet which can result in diabetic ulcers and gangrene.

Treatments: Type-2 diabetes can be reversed at early stages, progression can be slowed, and those who are type-2 diabetic can keep it under control by various lifestyle modifications, to include changes in diet, use of nutraceuticals and increasing physical activity. As a first line of treatment/management type-2 diabetic patients are prescribed metformin. In addition, there are several synthetic drugs and herbal preparations to manage glucose levels and suppress harmful long-term inflammation. However, these are often associated with side effects such as dizziness, anxiety, depression, nervousness, and diarrhea. Metformin often leads to gastrointestinal upset, and repaglinide (another type-2 diabetic drug) leads to hypoglycemia (low blood glucose levels). Current treatments include insulin (via injection), or its analogs, such as insulin aspart, insulin lispro, and oral medications which include glimepride, acarbose, saxagliptin, glipizide, metformin, pioglitazone. In 2006 the FDA approved a short-acting drug called Exubera which can be taken just prior to consuming a meal.

Professor Vasso Apostolopoulos. Photo: Supplied

Tirzepatide a new era to treat and manage type-2 diabetes with the added benefit to control diabetes: Incretin hormones, are products which are made by the intestines of the human body, which help beta-cells to secrete insulin. The incretin hormones called GLP-1 and GIP are the main ones secreted by the intestine cells. In recent years, short synthetic peptides which mimic GLP-1/GIP have been made called tirzepatide, also known as ‘twincretin’. Tirzepatide is a first-in-class and the only dual mimicking drug, mimicking both GLP-1 and GIP. Tirzepatide has been shown to significantly reduce blood glucose levels in patients with type-2 diabetes. Interestingly, it has also been shown to decrease body weight by 20% and can also improve lipid metabolism.

This novel anti-diabetic drug is a purely synthetic drug and is injected once a week. Tirzepatide was developed by Eli Lilly, and approved, under the brand name Mounjaro, by the US FDA in May 2022. This has started the ‘twincretin’ era and it is highly appealing due to its dual actioning for both type-2 diabetes and obesity; under close monitoring by the doctor, it can also be beneficial in cardiometabolic settings. Type-2 diabetes, obesity, and heart disease are the leaders in morbidity, disability, and mortality worldwide.

For further reading on tirzepatide, its evolution, clinical development, and outcomes, see link: https://doi.org/10.3390/molecules27134315