Diabetes is a condition characterized by high blood glucose (or commonly referred to as sugar) levels. Glucose comes from the food we eat. It is also produced by our liver and is the main source of energy for the body’s cells and is transported through the bloodstream.

There are different types of diabetes:

1. Type 1 diabetes happens when the body is unable to produce insulin and can occur at any age, although it typically presents more commonly in children and young adults.

2. Type 2 diabetes happens when the body does not produce enough insulin or when the insulin produced does not work properly. Type 2 diabetes is the most common form of diabetes in the world, accounting for over 90% of all diabetes cases.

Then there is also gestational diabetes, which occurs when hormones produced during pregnancy cause our cells to be more resistant to insulin; and pre-diabetes is a condition where your blood glucose (sugar) level is higher than normal, but it’s not high enough to be considered diabetes.

Type 2 diabetes is marked by the body’s inability to produce or effectively use insulin, which results in elevated blood glucose levels. As this condition progresses, managing blood sugar levels becomes increasingly challenging, and this poses serious health risks.

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There is a link between obesity and diabetes

Obesity increases a person’s risk for developing type 2 diabetes, but not every single person with obesity develops diabetes. Approximately 80 to 90% of people who are obese have type 2 diabetes, meaning that there are still some people who are significantly overweight but don’t have diabetes. Researchers are still working to understand exactly how this occurs, yet the current understanding is that excess fat tissue leads to a variety of metabolic changes in the body, which also include:

• Increased production of pro-inflammatory substances, leading to chronic inflammation throughout the body.

• Higher levels of fat in the blood.

• Changes in hormonal balance, because fat tissue produces hormones like estrogen.

All of these metabolic changes can result in the development of insulin resistance – meaning that your cells don’t respond normally to insulin. As insulin resistance becomes more severe, you can develop prediabetes or type 2 diabetes.

There are weight loss options.

For a person trying to lose weight, there are a few options: these include dietary changes, increased exercise, bariatric surgery, and medications. Currently, there are several different types of medications approved in Singapore for weight loss. These include semaglutide (Wegovy) and liraglutide (Saxenda). These are medications known as a GLP-1 receptor agonist, or GLP-1RAs. Other medication options include phentermine, orlistat, and naltrexone-buproprion.

GLP-1 RAs and how they work for weight loss

GLP-1 Receptor Agonists, often referred to as GLP-1 RAs, are a class of medications designed to mimic the action of glucagon-like peptide-1 (GLP-1), a hormone that regulates blood sugar levels. Semaglutide (in the form of Ozempic and Rybelsus) is one such GLP-1 RA that has been proven for its effectiveness. Initially, semaglutide was only approved in Singapore for treating diabetes. However, weight loss was known to be a common effect of this medication. So in 2021, a form of semaglutide called Wegovy was approved specifically for weight loss in the US.

In Singapore, we have two versions of semaglutide available for the treatment of diabetes: Ozempic (given by injection once per week), and Rybelsus (a tablet that’s taken daily). 

While for weight loss, we have Wegovy (semaglutide) and  Saxenda (liraglutide), with the effects on blood sugar control being seen as a beneficial side effect.

GLP-1RAs work by: 

• Slow down emptying of the stomach after a meal, helping you to feel full for longer.

• Reduce cravings and emotional eating.

• Stimulate the pancreas to secrete insulin.

• Reduce the release of sugar from the liver.

GLP-1RAs help to reduce the amount that you eat, which leads to weight loss.

The benefits of semaglutide

Two of the biggest benefits of semaglutide are:

1. Controlling blood sugar; and 

2. Stimulating weight loss; and

Hold on… is it safe?

Semaglutide is also considered to be a safe medication, with a low risk of serious side effects. Studies have shown that semaglutide is better tolerated than other options, including liraglutide and bupropion-naltrexone.

Blood glucose control

Weight loss effects

Clinical trials have demonstrated significant weight loss outcomes with semaglutide. A study published in 2022 showed that people taking semaglutide lost an average of 5.9% of their body weight at three months, and 10.9% at six months. If you currently weigh 100kg, this means that you can expect to lose approximately 11kg after six months on semaglutide.

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Now that we have established their effects, the question is, what will the long-term effects be, and would GLP-1 RAs, such as semaglutide, be as effective in the real world?

Real-world data: The long-term benefits of GLP-1 RAs (semaglutide)

Improving blood sugar control and sustained weight loss

GLP-1 RA (semaglutide) treatment proved to be effective in improving blood sugar control and weight loss in the long-term.

A real-world data presented at the European Association for the Study of Diabetes (EASD) showed that semaglutide (Ozempic, Novo Nordisk) significantly improved the A1c level and body weight for up to 3 years in a large cohort of adults with type 2 diabetes.

This real-world data is significant as people act differently in real life compared to trial settings. In the real-world, some people might adhere to the prescribed treatment, while others don’t. This shows that semaglutide is still effective whether people discontinue the treatment or adhere less.

Treatment with semaglutide was associated with reductions in both A1c (-0.77%; P < .001) and body weight (-4.7 kg; P < .001) at 6 months of treatment. These reductions were maintained for up to 3 years and, in particular, in those patients with higher adherence to the therapy.

Sustained weight loss in post-nonsurgical and post-bariatric treatments

In the case of all nonsurgical interventions and to an extent, even with bariatric surgery, it is common to regain weight after the initial weight loss. 

It was found that there was minimal weight regain over 2 years  when GLP-1 RA (semaglutide) was administered once-weekly.

Reducing cardiovascular risk by 20% in overweight and obese adults

Another study demonstrated that semaglutide 2.4 mg (Wegovy), may help prevent major adverse cardiovascular events (MACEs) such as cardiovascular death, non-fatal heart attack or non-fatal stroke. Those treated with Wegovy had a 20% lower risk of experiencing a MACE, contributing to an overall reduction in risk.

This trial studied the effects of Wegovy on adults who had cardiovascular disease, were overweight or obese, and who did not have diabetes. 

Are GLP-1 RAs (such as semaglutide) for me?

If you’re interested in considering GLP-1 RAs as part of your plan for diabetes control or weight loss, you will need to visit a doctor as these can only be obtained by prescription.

Further, not all clinics in Singapore carry GLP-1 RAs, so if this is a weight loss journey that you’d like to take, you should call the clinic to check before making an appointment.

NOVI offers some of these medications to certain patients – both injectable and oral semaglutide. This requires an appointment with one of our specialist doctors to evaluate whether a GLP-1 RA medication would be a good option for you. 

Since GLP-1 RAs such as semaglutide are most effective when it’s used alongside lifestyle changes, such as increased exercise and eating a healthy diet, we also believe that medication alone is not the best approach – a healthy lifestyle is also important. Our patients receive personalized nutrition and fitness advice from a dedicated health coach, to help them develop and stick to a healthy lifestyle plan.

NOVI Optimum Plus is our weight loss program centered on safe and proven weight loss medications supported by a healthy lifestyle for weight loss that lasts.

NOVI Optimum Plus: A Comprehensive GLP-1 RA Program

NOVI Optimum Plus includes:

• Doctor consultation

• Dietitian consultation

• Digital health coaching

• GLP-1 RA

A consultation with our doctor will be required to determine if GLP-1 RA would be appropriate for you.