GLP-1s will get more efficient

For years, diabetes treatment has been very “glucocentric” – with an intense focus on bringing the blood sugar down. This is certainly very important, both in terms of your everyday health, and also preventing long-term complications such as kidney, nerve or sight damage. Now though, there are some brilliant drugs coming through.

It’s easy to forget GLP-1s were originally developed for the treatment of T2, mimicking glucagon-like peptide-1 (or GLP-1), a hormone that’s naturally released by the gut after eating and which tells the pancreas to release insulin and help blood glucose levels return to normal. But these drugs are now also showing clear benefits outside of glucose control, for example in reducing the risk for having a heart attack or stroke.

I predict that GLP-1s are going to become even more efficient, the side effects will lessen, most injectable versions will be replaced by tablets and as drugs fall out of patent and prices drop, they will become more accessible.

There’s also a triple-hormone injection, Retatrutide (or triple-G), which is currently being trialled with results suggesting it can lower blood sugar levels in people with T2 diabetes. It contains pharma versions of not just GLP-1 and glucose-dependent insulinotropic polypeptide (GIP), which are both in Mounjaro, but also the hormone glucagon, which plays a role in revving up metabolism.

Meanwhile, there are SGLT2 inhibitors which are bringing huge benefits to people with T2 diabetes. They work to lower blood sugar by making the kidneys urinate excess sugar. They are not a silver bullet, as sugary urine can cause some people to experience recurrent UTIs or genital thrush, but they hold huge promise.

We’re also seeing advances in treating the side effects of living with diabetes. Certain diabetes medications and particularly insulin can cause a “hypo” (short for hypoglycaemia, when the level of glucose in your blood drops below normal limits after taking too much insulin or missing a meal) and they are incredibly frightening.

Historically, they’ve been treated with sweet food or gels to get the blood glucose up very quickly. But that doesn’t help with the “hypo hangover” – where, even after the blood glucose readings are back to normal, brain fog persists as it takes the brain a while to efficiently use glucose as a fuel. Hypo treatment drink Klario, a new product, contains glucose to raise blood sugar as well as an alternative ketone-based fuel source that the brain can use.

We can drive diabetes down and it’s vital we do

The T2 landscape has become unrecognisable in the 30 years since I was a medical student, and if we fast forward another three decades from here, there’s no reason to believe it won’t have transformed once more – but for the better.

Back in the late 1950s, when as many as 70 per cent of men smoked, it might have been inconceivable to imagine a world where people weren’t allowed to smoke in offices, hospitals, pubs, on trains and planes. But it has happened, and with it cases of lung cancer in men have fallen by almost 40 per cent since the early 1990s.

I believe we could find a world where supermarkets label UPFs with health warnings and they become highly taxed, just as cigarettes are now. I think incorporating movement into our days will start to be taken very seriously by schools and employers, and metabolic testing will be standard for anyone with any of the five signs of insulin resistance, from an increased waist size to high blood pressure.

It’s bold, but it’s vital, because we can’t be in a situation where we allow insulin resistance to become the norm. The message I reinforce with my patients who have prediabetes and T2 – particularly early on in the illness – is that this is a reversible condition. You really can stop it yourself through your lifestyle. And once insulin resistance melts away, and your body’s cells start hearing insulin again, good health will be yours.

As told to Amy Packer

Dr Saira Hameed is a consultant endocrinologist at Imperial College Healthcare NHS Trust and a senior tutor and honorary clinical senior lecturer at Imperial College London. She holds a PhD in neuroendocrinology. Her new book, Signals, The Inside Story of our Hormones (£20; Faber) is out now