From insulin to semaglutide: The evolution of diabetes treatments

Diabetes treatment has changed dramatically over the past 100 years. In 1921, researchers in Toronto discovered insulin, a breakthrough that remains life-saving for people with type 1 diabetes and is still used in some cases of type 2 diabetes. Since then, advances in pharmaceutical research have led to the development of new treatment options. Among them is semaglutide, a medication that has recently drawn significant attention.

What is type 2 diabetes?

Type 2 diabetes accounts for about 90% of all diabetes cases. It involves two main mechanisms: insulin resistance and reduced insulin production. Insulin is a hormone produced by the pancreas that lowers blood sugar levels. It allows sugar to enter cells, where it is used for energy.

In people with diabetes, or those at risk of developing it, cells become resistant to insulin and no longer respond properly. As a result, sugar builds up in the bloodstream and, over time, can damage organs such as the kidneys, heart and eyes. To compensate, the pancreas produces more insulin, eventually becoming overworked and less effective.

Current treatment approaches

Treatment for type 2 diabetes typically combines lifestyle changes with medication. Treatment often begins with a first medication, with others added gradually as the condition evolves.

Different medications target diabetes through various mechanisms, including improving insulin sensitivity, reducing glucose production by the body, increasing glucose excretion in urine, and stimulating insulin secretion.

One class of medications has been receiving particular attention lately: GLP-1 medications, which include semaglutide.

GLP-1, which is short for glucagon-like peptide-1, is a hormone naturally produced by the body and part of the incretin family. Incretins stimulate insulin secretion, slow gastric emptying, reduce blood sugar spikes and increase the feeling of fullness. They also decrease the release of glucagon, a hormone that raises blood sugar levels. Together, these effects help stabilize blood sugar and reduce appetite during meals.

Demystifying GLP-1

Medications known as GLP-1s are designed to mimic the action of this natural hormone. These are called agonists. Enhancing the incretin effect can be especially helpful for people with diabetes, as this natural response is often reduced in these patients.

Several medications fall into this category, including semaglutide, liraglutide and dulaglutide. Another molecule, tirzepatide, acts on both GLP-1 and GIP, another incretin hormone. These medications are available by prescription, either as injections or tablets. They are used to treat type 2 diabetes when first-line treatments are no longer sufficient. Some of them also offer protective benefits for the heart and kidneys, organs that are often affected by diabetes.

Semaglutide and GLP-1 medications can cause side effects, most commonly digestive issues such as nausea, diarrhea or constipation. There are also precautions to consider at the start of treatment, and some patients may have contraindications. Following the guidance of a healthcare professional is essential. 

A side effect that took the world by storm

Semaglutide and other GLP-1 or GIP agonists are now also used to treat obesity. Because of how they work, weight loss is a known side effect. This can be beneficial for people with type 2 diabetes who are overweight, as well as for individuals with obesity who do not have diabetes.

These medications require medical supervision and must be combined with healthy lifestyle habits, but they represent an important step forward in the treatment of obesity.

Beware of misleading advertizing

Because weight loss is a highly popular topic, many false products and misleading advertisements circulate about semaglutide and GLP-1 medications. It’s important to remember that these treatments are available by prescription only and should always be discussed with a healthcare professional before use.

The future of diabetes treatments

Treatment options for diabetes and obesity continue to evolve alongside scientific progress. New therapies, including GLP-1 agonists, are expanding the range of effective, patient-centred solutions. In this rapidly changing landscape, the role of healthcare professionals remains essential to ensure safe, appropriate and personalized care.