Disclaimer: This article is for general health information only and is not an advertisement for, or recommendation of, any medicine. GLP-1 medicines are prescription medicines and may not be suitable for everyone. Speak to your doctor or pharmacist for advice.
GLP-1s (glucagon-like peptide-1) and GLP/GIPs (glucose-dependent insulinotropic polypeptide) were initially approved to treat type 2 diabetes but quickly gained recognition for weight loss.
“By mimicking the body’s naturally occurring incretin gut hormones, these incretin analogues suppress appetite and decrease the rate at which the stomach empties, so people feel full longer,” says Dr Angela Murphy, a specialist physician in Gauteng with a particular interest in endocrinology, diabetes and obesity.
Three are currently registered for weight loss in South Africa. The two GLP-1s are liraglutide and semaglutide; and the dual agonist GLP-1/GIP is tirzepatide.
The same class of medications are registered for Type 2 diabetes and known as liraglutide, semaglutide, dulaglutide and tirzepatide.
Who can take GLP-1s?
To be a candidate for GLP-1s to treat diabetes, you would have an HbA1c (a blood test measuring average blood sugar levels over the past 2–3 months) of >7.5% (indicating poor diabetes control) despite using a minimum of two oral medications and following a healthy lifestyle, explains Dr Murphy. “It is particularly desirable diabetes medication for people who are also living with obesity and/or have a high risk of, or established, cardiovascular disease.”
To qualify for GLP-1s for weight loss, you would need to meet the criteria for obesity, with a body mass index (BMI) of 30 kg/m2 or above. You could also qualify with a BMI of 27 kg/m2 or higher, if you have risk factors for cardiovascular disease such as hypertension (high blood pressure), high cholesterol, hyperlipidaemia (high levels of fats in the blood), fatty liver disease or obstructive sleep apnoea. Research has shown people with these conditions not only shed weight on GLP-1s, but have an improvement in overall health, particularly in managing their blood sugar levels and lowering their cardiovascular risk, Dr Murphy says.
Other considerations before GLP-1s are prescribed for either diabetes or weight loss would include your medical history, and it is essential to have a comprehensive medical evaluation.
Who should not take GLP-1s?
Certain medical conditions, such as gastrointestinal issues (including gastroparesis) or pancreatitis, can be exacerbated by GLP-1s. If you or anyone in your family have a history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 (a rare inherited disorder), this rules out GLP-1s use as there is a possible risk of thyroid tumours. GLP-s are also not recommended for pregnant or breastfeeding women, or those planning to become pregnant. Mental health conditions such as depression or eating disorders should also be considered in the decision-making process.
Making an informed decision based on medical advice
“It’s vital to consult with a qualified medical practitioner to determine if GLP-1s are appropriate for you,” says Dr Murphy. “These are not miracle drugs, and diabetes and obesity require lifestyle changes, with a healthy, calorie-controlled diet and regular exercise, as well as addressing any psychosocial concerns. Medical monitoring is essential to track progress, address possible side-effects early, and make any necessary adjustments.”
Side effects are possible when starting GLP-1 medication, and can include nausea, diarrhoea and constipation. There may also be dizziness, headache, increased heart rate and upper respiratory symptoms. Severe side effects are possible but rare, says Dr Murphy, and include pancreatitis, bowel obstruction, and gall bladder issues.
GLP-1s are not a one-size-fits-all solution to weight loss or diabetes, and careful assessment is needed to decide if they are right for you.
Clicks Clinic Service: Personalised Support for Weight Management & Diabetes Care
Selected Clicks Clinics now offer Weight Management Support consultations, including clinically supervised weight management support, and ongoing monitoring of weight, blood pressure and other markers. Find out more and book an appointment.