A 55-year-old businessman with a family history of ischemic heart disease felt like he was sitting on a time bomb because he had high blood pressure and type 2 diabetes. When he came to see Dr Abhijit Bhograj, an endocrinologist at Manipal Hospital, Bengaluru, he was concerned because his diabetes remained out of control despite taking metformin and other supportive medications, including a drug for high blood pressure, for five years. The doctor asked if there was any other way to lower blood sugar levels.
The HbA1c number (average blood sugar over three months) was eight percent, which should be less than 5.7 percent. His body mass index (BMI) was 26.5 kg/m2 (normal range is less than 24.9 kg/m2) and his waist circumference was more than 40 inches. “Due to his family history of heart disease and risk factors for diabetes and high blood pressure, she put him on Rybelsus, an oral diabetes medication that belongs to a new class of GLP1 receptor agonists. In addition to blood sugar management, Rybelsus is also approved to reduce the risk of major cardiovascular events such as heart attack, stroke, or death in adults with type 2 diabetes who are at high risk for these events. It does this by reducing bad cholesterol, or protein Low-density lipoprotein (LDL) and even triglycerides, says Dr. Bhojraj.
Its active ingredient is semaglutide and it works by mimicking the hormone GLP-1, which slows stomach emptying, helps you feel full longer and reduces appetite, all of which can lead to lower calorie intake and weight loss. It signals the body to produce more insulin only when blood sugar is high, and regulates its levels. It reduces the liver’s production of glucagon, the hormone that raises blood sugar, which helps stabilize glucose levels and prevents hunger caused by blood sugar fluctuations.
But now the FDA has expanded its use based on new evidence from the SOUL trial, which showed the drug could reduce patients’ cardiovascular risks by about 14%.
How did Rebelsus reduce his weight too
At the end of the three months, there was a noticeable difference in the businessman’s HbA1c as it dropped from eight percent to seven percent. “This encouraged him and he made several lifestyle modifications, including maintaining regular exercise and a clean diet. At the end of six months, his HbA1c level had improved to six per cent. At the end of eight months, my patient had lost eight kilograms, from 80 kg to 72 kg. His BMI had dropped to 24.1 kg/m2. Metabolically, his body was not fighting it anymore,” says Dr Bhograj.
Not only that, but other risk factors that worried the doctor, such as blood pressure and abdominal or visceral fat, which is measured by waist circumference, decreased. “By delaying stomach emptying, improving insulin levels, thus preventing excess sugar buildup in the blood and reducing appetite by sending satiety signals to the brain, my patient lost some initial weight which could motivate him on his weight loss journey as well,” says Dr. Bhograj.
In fact, the new drug regimen got rid of very stubborn visceral fat. “Unlike fat around the skin, fat around the abdomen releases inflammatory substances that can damage blood vessels and promote fat deposition, a condition called atherosclerosis, in which the arteries harden and narrow. It can harden the arteries, making blood flow more difficult and leading to high blood pressure. Belly fat can interfere with insulin, leading to high blood sugar levels, which is one reason my patient had difficulty controlling it. Excess fat can lead to abnormalities in the structure and function of the heart, even before any Other diseases Dr. Bhojraj explains that having symptoms of heart failure can also increase the risk of arrhythmia and other heart problems.
How the businessman managed the side effects of Rebelsus
Story continues below this ad
Oral semaglutide like Repulsus showed a higher rate of gastrointestinal side effects, such as nausea and abdominal pain, compared to injectable versions. “That’s why I gradually upped my patient’s dose from 3mg onwards. He was experiencing some bloating and nausea, and the symptoms had to be treated. But what really made him cope better was the way he was preparing his body for sustainable weight loss and developing a maintainable lifestyle,” says Dr. Bhograj.
His patient no longer worried about snack breaks, focusing on a diet free of fatty and processed foods. It included non-starchy vegetables, fruits, whole grains, legumes, nuts, seeds and fish, with greater reliance on plant proteins. He did strength training two or three times a week with bodyweight exercises, resistance bands, or light weights. This gradually helped in building lean mass which resulted in shedding of body fat.
Should Repulsus be indefinite?
Repulsus is usually prescribed as a long-term treatment for the management of type 2 diabetes. “It is meant to be taken daily, along with a healthy diet and exercise, and possibly for years, provided it is safe and effective for the patient. The exact duration is determined by the healthcare provider based on the patient’s individual needs and response to medication. But as my patient explains, addressing metabolic risk factors early with lifestyle combined with GLP-1 therapy can reduce cardiovascular risk and move toward disease remission rather than simple management,” says Dr. Bhograj.
(tags for translation)heart disease
