AACE MENA 2025-What is in the Pipeline for Diabetes and Obesity Management

Video Transcription

Video Summary

The lecture focuses on the future of obesity and diabetes treatment, emphasizing multi-faceted approaches beyond lifestyle changes. For obesity, lifestyle programs achieve about 5% weight loss, but long-term adherence is challenging. Pharmacotherapy, particularly GLP-1 receptor agonists like liraglutide, semaglutide, and tercepatide, can induce significant weight loss (up to 15-20%) and reduce cardiovascular events by 20-25%. However, these drugs are costly and have high discontinuation rates, with weight often regained upon stopping. Emerging treatments include combination peptides like ritrutide and novel oral GLP-1 agonists, and approaches to preserve or increase lean muscle mass alongside fat loss, such as combining GLP-1 drugs with myostatin inhibitors (e.g., Biomagrubab). A novel, promising approach involves transcranial magnetic stimulation (TMS) targeting brain areas linked to hedonic eating and disrupted neurocircuitry, showing sustained weight loss one year post-treatment.<br /><br />For diabetes, the key message is that single drugs are insufficient due to multiple pathogenic mechanisms ("ominous octet"). Early combination therapy (e.g., GLP-1 receptor agonists plus SGLT2 inhibitors or pioglitazone) improves glycemic control, beta cell function, insulin sensitivity, cardiovascular and renal outcomes, and reduces mortality better than traditional stepwise treatments relying on metformin and sulfonylureas. The talk stresses re-evaluating misconceptions about drugs like pioglitazone, highlighting benefits despite weight gain and edema risks. Overall, integrated pharmacological strategies and addressing brain neurocircuitry dysfunction are essential for more effective, durable management of obesity and diabetes.

Keywords

obesity treatment

diabetes management

GLP-1 receptor agonists

pharmacotherapy

weight loss

transcranial magnetic stimulation

combination therapy

beta cell function