New gut hormone combinations could replace weight loss surgery for obese type 2 diabetic patients, according to Arab Health experts

• 2023 American Diabetes Association’s (ADA) guidelines for diabetes management recommend more aggressive weight loss
• Daily or weekly weight loss injections could help patients loose up to 15% of body weight without surgery
• Experts at the Internal Medicine Conference at Arab Health 2023 discuss the challenges of eradicating side effects, such as nausea, some patients experience when taking weight loss injectables

With obesity affecting approximately 650 million adults worldwide, constituting a major contributor to global diabetes rates, treatments that result in substantial weight reductions may improve outcomes for people living with diabetes and negates the need for weight loss (bariatric) surgery in the future.

With the American Diabetes Association’s (ADA) recently released 2023 guidelines for diabetes management recommending more aggressive weight loss (up to 15% of body weight), discussions at the Internal Medicine Conference at Arab Health 2023 centered around the use of new gut peptide agents, and their profound impact on both glycemic and weight management in individuals with type 2 diabetes.

Panelists from the UAE's top healthcare facilities, including Imperial College Diabetes Centre, Cleveland Clinic Abu Dhabi, and American Hospital Dubai, highlighted the transformative role of new gut peptide combinations, specifically combinations of Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) hormones, in the future of bariatric surgery. GLP-1, for example, is a peptide derived from differential processing of the precursor for the hormone glucagon. It is secreted predominantly by endocrine cells in the gut epithelium in response to food intake.

Speaking at the conference, Dr. Saf Naqvi, Imperial College Diabetes Centre, Abu Dhabi, UAE, said: “Typically, diabetes management has involved the non-disease modification medications such as Metformin, which wasn't addressing the core problem, which was weight management. And it is only recently, through bariatric surgery, that we have understood that there is something else; it is not just food restriction or transposition of the internal visceral that does the job. 

“Bariatric surgery leads to an average of 15% to 25% total weight loss, and the effects of weight loss in these patients are huge. Their diabetes reverses quickly, even before the weight loss happens. We knew that this happens due to changes in gut peptides and the effect of those peptides on satiety - the feeling of fullness that persists after eating - and weight.”

Presently, the peptides used for weight management include GLT-1 analogues, with Liraglutide coming onto the market first. However, the newer peptides are significantly more potent, resulting in weight loss of up to 15% of body weight. 

“For instance, the new combination analog Tirzapetide – a once-weekly subcutaneous injectable medication that activates both the GLP-1 and GIP receptors – is showing phenomenal results," Dr. Naqvi added.

According to Dr. Naqvi, the challenge now is to develop peptides that do not cause side effects such as nausea, as studies have shown that bariatric patients, who experience an increase in a combination of peptides after surgery, do not experience nausea. 

He said: “The newer peptides currently in preparation that use a combination of different peptides, such as GLP and GIP, not only normalise glucose very quickly but also give us the weight loss closer to what we see in patients that have bariatric surgery.”

A total of nine Continuing Medical Education (CME) conferences will take place during the four days of Arab Health 2023, welcoming an anticipated 3,200 delegates and more than 300 international speakers from 30 January to 2 February at the Dubai World Trade Centre. Internal Medicine, Paediatrics, and Anaesthesia and Pain Management are new additions to the conferences this year. In addition, popular returning tracks include Obs & Gyne, Orthopaedics, Total Radiology, Surgery, Emergency Medicine, and Quality Management.