The misuse of injectable diabetes medications over the past two years has led pharmaceutical companies to develop alternative treatments for weight loss, addressing shortages that affected diabetic patients worldwide, including in Cyprus.
Drugs containing semaglutide and tirzepatide, marketed as Ozempic, Wegovy and Mounjaro, have been at the centre of this trend. Ozempic has long been prescribed for diabetes management in Cyprus, while the newer medications developed in response to Ozempic misuse specifically target weight loss and obesity treatment.
Countless analyses have been conducted on semaglutide’s benefits, risks and potential side effects when used incorrectly by individuals seeking weight loss rather than diabetes treatment.
Tirzepatide, marketed as Mounjaro, has been added to doctors’ arsenal for both diabetes and obesity management. However, specialists emphasise that injectable treatments are not suitable for everyone, are not completely harmless as they remain pharmaceutical products, and certainly should not be used merely for cosmetic weight loss.
Dr Angelos Kyriacou, specialist in endocrinology, diabetes and metabolism, explains: “Obesity is a common health problem to the extent that we now talk about a pandemic of obesity. The first line of treatment remains lifestyle changes, including dietary management and exercise.”
These lifestyle changes are unconditionally recommended, but Dr Kyriacou notes: “In many cases, these changes alone are not sufficient to reduce body weight to desired levels. The introduction of injectable medications for weight loss has changed the landscape.”
Examining Mounjaro’s advantages and disadvantages, Dr Kyriacou first clarifies: “Not all cases of obesity or weight gain are the same. Before considering medication, one should undergo thorough examination by an endocrinologist or other doctor specialising in obesity to exclude underlying conditions and determine the best management approach.”
How the new medication works
“Mounjaro, containing tirzepatide, is a new medication approved for use in obesity and Type 2 diabetes,” explains Dr Kyriacou. “Tirzepatide is an agonist of two hormone receptors called GLP1 and GIP. It acts on the brain’s hypothalamus to reduce appetite and slows gastric emptying, creating earlier feelings of fullness.”
The medication also stimulates post-meal insulin production from the pancreas, reducing blood glucose levels without risk of hypoglycaemia. Additionally, it increases white adipose tissue sensitivity to insulin, improving insulin action and further lowering blood sugar.
“Tirzepatide is administered subcutaneously using an easy-to-use prefilled pen-type device once weekly. It is perhaps the most effective preparation currently available for controlling blood sugar in Type 2 diabetes and reducing body weight,” explains Dr Kyriacou.
Regarding weight reduction, “Most of the weight lost using this preparation is adipose tissue, with minimal impact on muscle tissue. It significantly reduces visceral fat, which is directly linked to cardiovascular risk.”
The medication also “reduces other risk factors such as blood pressure and cholesterol, including triglycerides. We already have data showing a favourable impact on metabolic-associated steatotic liver disease (also known as ‘non-alcoholic liver disease’ or ‘fatty liver’) and obstructive sleep apnoea, conditions directly related to metabolic syndrome.”
Among its disadvantages, it is an expensive medication and “considering obesity is a chronic condition, this implies treatment must also be chronic.”
Regarding side effects, “some patients will experience gastrointestinal disturbances, with nausea being the most common. Other digestive system disorders include vomiting, diarrhoea, constipation and dyspepsia.” Additionally, “tirzepatide causes a slight increase in the risk of gallstones, although this side effect applies to anything causing rapid weight loss, even after strict dieting.”
Comparison with semaglutide
“Semaglutide is available under the brand name Ozempic in Cyprus. Semaglutide is indicated for obesity and Type 2 diabetes, while Ozempic is only licensed for Type 2 diabetes.”
Ozempic has been well-known in Cyprus for years “as it has been extensively used off-label for obesity.”
Wegovy “is another commercial semaglutide preparation at a higher dose, which is licensed for both conditions (diabetes and obesity) but is not available in Cyprus. Although both preparations are very effective in managing Type 2 diabetes, tirzepatide has comparatively greater effectiveness regarding glycaemic control.”
“Although both preparations are highly effective in managing Type 2 diabetes, tirzepatide has comparatively greater effectiveness regarding glycaemic control, reducing glycosylated haemoglobin by 1.6-2.4% versus 1.5-1.8% for semaglutide.”
Furthermore, “it causes greater weight loss, approximately 15-22% versus 12-15% with semaglutide. About 91% of patients will lose at least 5% of their body weight with tirzepatide, versus 86% with semaglutide.” In summary, “both preparations are quite effective in controlling diabetes and body weight, with tirzepatide showing a moderate advantage.”
Although both drugs are expensive (and unavailable through Cyprus’s national health system), “there is research abroad showing tirzepatide has a better cost/benefit ratio.”
However, semaglutide “also has some advantages such as slightly less likelihood of side effects, especially in the initial stages of treatment. Semaglutide has research evidence for reducing cardiovascular diseases, while for tirzepatide we are still awaiting research regarding cardiovascular endpoints.”
The role of tirzepatide in treatment
“The official indication for the medication is for individuals with a body mass index (BMI) greater than or equal to 30 kg/m² or 27 kg/m² with obesity-related co-morbidities.”
“For individuals with morbid obesity (BMI > 50 kg/m²), we generally consider bariatric surgeries superior as they cause more weight loss and may have a better cost/benefit ratio.”
For people with slightly excess weight and without co-morbidities (who do not have an indication for tirzepatide or semaglutide), “it is preferable to intensify weight loss efforts through dietary and other means.”
At the same time, “the exact place of tirzepatide in treating individuals with BMI 30-50 or 27-30 kg/m² with co-morbidities has not been clarified, e.g., whether it should be given as a first-line treatment or alternatively as a second-line treatment after using semaglutide or other medications.”
“Until there is expert consensus and relevant guidelines, treatment should be individualised taking into account BMI, co-morbidities (e.g., Type 2 diabetes), the cost of these medications, and the priorities, concerns and expectations of patients.”
“In conclusion, tirzepatide (Mounjaro) is a welcome addition to our arsenal for combating obesity and Type 2 diabetes, but like all medications, it should be administered carefully and individually alongside good nutrition and a healthy lifestyle.”
