Tirzepatide vs Semaglutide in Patients with Type 2 Diabetes

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Tirzepatide vs Semaglutide in Patients with Type 2 Diabetes

22 Sep, 2:30 PM

welcome good evening everyone and I welcome you all to uh the new um session that we have started this month is the first debate that goes live on Netflix and we have topic of the zip tag versus thermocol tidal patients uh with type 2 diabetes so for this uh we have with us tonight the two speakers um Dr om lakhani and Dr mayor agarwa and the moderator for this nation is where we need an instruction uh which is his name is anonymous to a divertologist with the experience that's deeper than an option and knowledge that's an info and that's an insight to begin itself uh Dr panchi Sabu is truly a name to reacting with when it comes to um library's care and so for me believes that diabetes is just Amendment which any one of us can fight again if we maintain a proper lifestyle um so I'll take this forward and um introduction and um then we'll get started so first of all thanks madiflex for giving me an opportunity and I am really pleasure to have uh you know it's my pleasure to chair the situation where my two of my close friend mayur as well as om who are going to discuss on a very important topic and I think that's really when I am here from Stockholm and here ESD everything is moving around glp1 so I think it's very very important topic for all of us to listen also Mom is a a consultant endocrinologist from Jairus multi-specialty Hospital one of the biggest Hospital of our city of Ahmedabad Gujarat Dr mayur is from City of Bhopal endocrineologist so I'm not talking much about them because what we are more interested to know about the debate which is very important and I would not like to put any remark before they start talking with each other and they deliberate that points in favor of it was ever died with this if you can have poles in advance and then we will be requesting arm and mayur to talk about it yes it's a very short um just to get an idea on which side of the management are you are you on the tourism or are you with some of your type uh so you see it on your screens you can choose the option and hit submit and it's an open-ended question and we'll just do it once again so 62 Fords are there and this appetite is 43 is it like that 27 people have vote for that is appetite is it like that so one disclaimer which is very important because if both are not available in our country in a oral form is available so many of our colleagues have used hemoglutite as it is slightly older molecule and some of you must have heard the Sima gluten data also till the appetite is comparatively newer molecule but those who have attended the Ada asked one year any meeting we must have seen a lot of data I will be not talking much about the data which is discussed here in ESD but this is one disclaimer which is very important because many of Physicians and some of the even the diabetologists and endocrinologist colleague also not heard much about which is appetite all the data which is there so now I request for the debate which we are going to have uh um who is going to talk first arm is going to talk first yes so now I request Dr om to start thank you so much uh so thank you to uh Netflix for this uh very interesting debate and thank you to Dr banshi Sabu for joining from all the way from Stockholm uh and I think you know I'm I'm sure you know uh for him to spend his time for this uh interesting session I think you know thanks so much so uh we're going to discuss the reciprocite versus versus [Music] right and to my complete surprise uh you know the pre-core actually won in favor of symmetry which I think makes my job easier uh so I don't have to climb against the hill uh so I'm going to talking favor of SEMA blue type but you know one thing uh I I absolutely adore debates but one thing is very clear that you know sometimes when you have a clinical trial where you have a head-to-head comparison of two drugs I think that sometimes ends the debate for good uh you know I mean I I say this but there has been times where you know for example uh there is there is a debate going on between uh you know you uh large in u300 versus uh you know your your uh uh you know at receiver and I think that that debate has still not ended you know because you have one trial which says one thing and the other trial say something else so uh what exactly is this right so like Dr banshi Sabo sir said uh not many people would have heard about this agent it is relatively a new truck I think I'm really uh it's commendable job from uh you know uh from from Netflix to uh talk about a futuristic molecule uh which is very important idea having a debate before uh the drug is really in the market which makes it a very interesting debate so this appetite is a dual uh glucose dependent Gip uh insular topic peptide Gip and glucagon like peptide receptor economists so you know conventionally you have TLP one receptor iconis but this is something which is a dual Economist so it utilizes uh if your eyes is two different hormones you have the GNP and Gip it's available as once weekly injection in the doses of 5 10 and 15 million and like Dr banshi Sabu sir said it is not currently available in India so this is the introduction to principle and what is SEMA group right now cimaglutite is a long-acting glp1 receptor icons it's a pure glp1 to subject what is it does not include Gip it's available in oral and injectable form the oral form is available in India it's available in the strengths of 3 7 and 14 milligram whereas the injectable form which is again once a weak injection is not available in the doses of 3 7 and 14 million Okay so moving on like I said when you have a debate in medicine I think when you have a well-conducted clinical trial which is published in a reputation that ends the debate right so even though the pre-port was in my favor as of now the data is in favor of my right completely I think I have to uh you know concede this point because you know once you do a head-to-head clinical trial and you find one drug is better than the other you know the debate does not that kind of in terms of scientific terms intensity so you have the Surplus to tribe uh which was published in any GM in August 2022 uh yeah 21 sorry uh and the trial concluded that the patients with type 2 diabetes this recipient was non-inferior and Superior to schematotype in terms of mean change in glycated uh the H prevention from Baseline it to 40 weeks and the hplc reduction was greater with recipient and the weight reduction was also creativities right I think this is again needless to say because here you are combining two molecules instead of one molecule so instead of having glp alone you are having glp with Gip and naturally when you are combining two molecules uh the effect of the two molecules is going to pay better it's like compare you know let's say you are having a debate between depakly Flossin versus emparkly Flossin with metformin combination naturally impact influences metformin combination will work better than depakly inclusion because of the fact that it's a combination model right so it's same way uh you know I think that debate kind of ends because you already have two drugs in combination you know I try to look up the literature about how Gip works and I you know initially my thought was that perhaps tap should increase the risk of hypoglycemia but to my surprise actually Gip reduces the risk of hypoglycemia because Gip is a very interesting hormone uh you know when it it is both insulinotropic as well as it is so in when you have hypoglycemia the glucagon levels increase with response to Gip and when you have higher sugar levels the insulin increases with the geosc so Gip tends to play a dual role when you have high sugar it increases the insulin production when you have low sugar it enhances the glucose very interestingly you we have all been using DPP foreign and hence you know uh keeps the blood sugar in a tight good range so Gip does not increase risk of hypoglycemia despite being an additional drug added to this compilation so I'll completely concede to this and I'm sure you know uh mayur will give you more details of this trial and we'll give you more data from this trial but my job is to tell you that this trial exists and since this trial exists I think I am again fighting a perhaps a losing bet that's it so there are clear advantages of physical product it has better weight loss it has better HPS reduction and perhaps similar side effect profile as far as the data is concerned from the Surplus treatment however there is a big part right is it available in India right answer is no it's not available in India it's definitely available is speeded where Dr bhaji sahu sir is there it's available in the United States it's available in Europe uh I believe it's also available in Australia but it's not available in India so what is the use of a drug which is not available at all and the concern is not that it is not available in India the concern is it is probably not going to be available in India very soon we don't know this right but remember this truck was uh you know uh manufactured and promoted by Ally Lily and we all know that Allah really currently has shut up its operations in India perhaps that another company would like to take a chance and bring this truck to our country it's a it's a wonderful molecule it should be brought to our country but as of now it's not available so as of now the drug which is available in India is our oral simultane remember injectable simulated is also not available in India but according to the company known orders it is going to be available next year very soon but as of now the only drug available in India is oral right and that again that we paid deals in my favor because you know what's the point of debating a drug which does not exist in our country right so then then there is no question about it right also remember that when a drug is not available uh but then the challenge with this drug is that unless you start using this molecule uh you are you do not know how it really works you do not know there could be some Hidden Side effect which makes it makes the truck you know uh less usable for the patient maybe maybe not we don't know right so in a sense grossly a drug which is not available it is or only speculation and it is only Based on data that you can uh predict right again this comes to the oral versus injectable debate right now remember SEMA gluten is available in both oral and once weekly injectable form but very interestingly a big company like known artist which manufactures insulin which is injectable decided to bring the oral drug in India first before the injectable so this appetite unfortunately when it comes it will only be available injectable and we know for sure this is proven Beyond doubt that Indian patients prefer oral drug to India and it is unlikely that if zip but I will ever be available in an oral form because remember again no notice has taken a lead over there perhaps you will have a drug from lower orders which is a glpg combination which might be an oral pop but as of now at least in the near future it only looks like that oral silver glutath is the only glp which will be available in order for at least in India and the recipient is unlikely to be available in an Indian patients always prefer oral uh too injectable and this comes see don't take my word for it this comes there are people who are geniuses in marketing there are people who you know invest a lot of money in companies like no notice and their products and these people decided to bring a oral drug to India not an injectable drug and the market actually proved their point right now it's a huge Market there is a huge Market it's become a very popular and a blockbuster truck in a very short period of time always remember injectable because I was available for a long time in India and did not take the market by storm despite having cardiovascular safety occurred despite having a lot of other benefits uh this truck did not take the World by storm but oral srimacite even though it is expensive drug it has still taken the market by storm and it clearly proves that oral drugs are Blockbuster compared to injectable and Indian patients prefer oral drugs compared right now the other debate which which is a scientific argument which I you know would say is clearly in my favor is that the recipient currently does not have a CV outcome right now this perhaps comes from the fact that you know these mandatory CV outcome trials are now not required as per the usfda so the drug the company decided to do a head-to-head clinical trial in preference to cbot track but there is a c of T trial like I said in the pipeline and which will be uh results will be coming in 2024 this is actually planned to come earlier uh since we have been part of this trial you know this but there are a lot of pickups in the trial because of government and because of that there's a lot of delay in the trial and because of that you know perhaps you can expect the data 2024. C magnetite does have CV outcome right remember this trial you have both oral and injectable at a CV output though the results are slightly different so sustain 6 is a CV outcome trial for injectable C model right it showed clearly showed cardiovascular risk reduction and a benefit from cementite and the trial concludes in patients with type 2 diabetes who are high risk of cardiovascular disease the rate of cardiovascular death non-fatal Mi or non-fatal stroke was significantly lower in patients receiving semacrotide I am talking about injectable right then those patients are receiving Placebo which confirms superiority and non-impy radio right so what it means is that clearly a injectable type has cardiovascular benefit we do not have a cvot trial of irrespective so we don't know again maybe it is cardiovascular benefit maybe it doesn't we don't know right we can only speculate the other tribe which you have so you will you know I'm sure mayur will tell me that arrays but let me tell you that you have a CV safety trial of oral similar product also which is Pioneer system this is a small trial and this was mainly done uh to show cardiovascular non-interity or cardiovascular neutrality and it did too so oral symmetry type has proven that it is cardiovascular safe drug and it does not increase cardiovascular risk so there are there is an ongoing trial which perhaps he wants to see the cardiovascular superiority but as of now we do not have cardiovascular superiority uh from oral civil gluten we just have cardiovascular safety but you have cardiovascular CFT trial you don't have any cardiovascular safety trial with so maybe you know it could be the next Rosy glitter who knows right it could come like a storm and suddenly then go away vanish because perhaps you know you saw that it had increased cardiovascular disease we don't know I'm actually speculating right Stevie has a clinical trial we don't right so then comes the question will tell me tolerated right now this is a you know unless you have a first hand experience now Indian patients are very you know uh difficult to manage as Dr both Dr banshi saba and Dr Mayu know right it's it's a challenge right so which means you know will stop that right they'll you know uh you know uh constipation okay uh you know a pain injection stop the truck at the drop of the Hat the other weight loss right so we know that you know we don't know how this drug will really how patients will tolerate how patients will accept the drug we know oral signal group that is very well accepted by the uh population again in defense of mayur I'll tell you that there are papers from jca which have shown that contrary to building Gip actually reduces the glp-induced nausea and vomiting which is you know a problem to impact his zip attack may be better tolerated then then the currently available drugs but we don't know we can only speculate again till we have at least in the clinical trial the safety profile is similar and the tolerance also has been similar so this is it I'll conclude here right first take home messages clearly from a head-to-head clinical trial this is superior to Civil Right both in HP events reduction as well as weight reduction which is proven I concede completely conceive this point too but exhibited is not available right third CBO uh OT outcome trial is important we don't have cbot outcome priority zip has CV superiority with substances which is injectable and CV neutrality with oral simultane which is biod is extract so you have cardiovascular safety proven right and Indian patients always prefer oral to injectable and uh Sigma chlotide is available in oral pump so thank you for a patient listening I would now do here the arguments from Dr White thank you all the points where Dr om he talked very nicely that you know the data which he had shown and he had agreed that there is a data to support that is appetite is a better in terms of weight reduction and HBS reduction and then he had also shown the SEMA glutamide cbot data as we don't have for the trees at the time and unlucky it is appetite is not available at the same time Ally will be company who is the originator of this molecule are also shut off their business from India so we don't know whether it will come or it will not come so we don't know but on a scientific ground we are just discussing which could be the better so I would like to ask now uh Dr mayur to talk in favor of precipitide and then we will have a discussion is it okay start my work please thank you thank you sir thank you very much for that introduction and thank you Netflix for giving me this opportunity and also thank you Dr om lakhani for giving me the easier talk so obviously uh as I told I want to hear the argument there are no argument it's a discussion and obviously we have a strong data in favor of trj parathai so it's not an argument and both of us at present are actually using SEMA glue type because that is available in India and when this newer molecule will be available we both would be using the newer molecule so actually it's just a discussion so I am I'll be talking in favor of uh it is appetite okay so what is exactly as already told by Sr it's a dual Gip glp1 receptor Agonist and now as he told if you are using a dual thing that is obviously more powerful than a single thing there is no big signs of big logic you need to understand all those things right and the important thing here I would like to stress like SEMA glutide is just a glp1 receptor agonis where is this with this Gip also gone is it will act in a reverse way also it's like you can see uh the way paracetamol works so if you give paracetamolin the patient does not have fever it is not that it is going like temperature will go down right and in this molecule what will happen if the sugars are high it will lower down and vice versa if the sugars are low it can even raise that because it can even secrete the glucagon so that's a very beautiful thing right it is maintaining the balance so that is something really Innovative about this molecule now this is a peptide we know and most of the peptide except for Roland semen glutamide are to be given injectable so obviously it's an injectable molecule and the half-life is five days that is why you can give it weekly substitute injection the dose is started from 2.5 mg gradually titrated every four weekly 2.5 you have to increase and the maximum those you are allowed is 15 milligram per week subcute injection okay and no renal and hepatic dose modification as with the SEMA gluten so almost similar way like an injectable SEMA blue type is also weakly oral you have to give daily and there we have this 3 7 and 14 dosing now what is uh important is like four things I am going to discuss first is the co-acconist which I've already told you regarding the this glucose dependent insulin Tropic polypeptide and the glucose like polypeptide one it's a both dual receptor agonis it controls the glycemia better than any other molecule I would say highest HBC reduction I would say this SEMA glutide had actually changed the game the tagline was also the same uh Game Changer molecule because it was so potent and it has multiple effect it's like in the 20 years back mobile was just to talk but now mobile is not just to talk you need a camera also similarly initially the molecule was just the glycemic control but it's not now just the glycemic control obviously with the latest phone you talk but you have multiple things to do similarly with the newer molecule you not just only needs a glycemic control you need a cardio safety you need weight reduction you need that it does not cause hypoglycemia now we have a molecule which can even correct it so obviously it's a good molecule right now this is regarding the surpass trial already told by Sir regarding the surpass 2 but there are five surprise trial and many more surmount and all those are in Pipeline and P it's trial all those there are so uh so see like SEMA glue type because they were very confident they came with different trials which compare their molecule to different molecules usually what happens to meat uh if you need to Market any molecule you need phase trial and after this phase three it comes to the market and usually it is against Placebo but now these newer molecules they are so confident about their molecules that they are coming with different trial like Head to Head compare with different molecules not only different molecule the molecule from the same company with the same class of drug so that's like excellent you have for the SEMA glutide also versus the Lira glue type so similarly for this recipe type you have surpass one two three four five three uh three and four were uh against the insulin deglutic and large in whereas one against the placebo two was against the SEMA glue type and uh we have this cbot trial which is against the Dual glue type the results are still not out so I am basically as we are discussing against human protects have taken the data form Surplus 2 so almost 2000 patients included in this trial with a median age of 56 years with a median duration of 8.6 years with the HB and C of 8.2 all most all patients are obese here the B mean BMI is 34.2 okay so this is the Advanced Data as already told the hbnc reduction E1 E1 with the lowest dose of precipitide is much higher than the SEMA glutath optimal dose 1 mg that was injectable subcute so here you will see even the 5 mg reduces more obviously the 10 in 15 reduces much more the HB and C so first aim of your any OHA is to make your sugars good that is why it is the glycemic drug right so that is the hbmc reduction which was higher here if you see here the difference the mean difference was 1.6 with a 1 mg simulated whereas even with the five it was two and with the 5 and 10 and 15 it was much higher than as compared to five okay so again as I told you not just the glycemic control if you see you have the weight reduction that actually uh changes even at four weeks so this SEMA gluten molecule whenever we think that these patients are obese that is where we want to fit in the molecule that ok the patient will have weight loss and now all those with data of reversal remission and all those things going on so we want to control not only the sugar we want to control the blood pressure the lipids the again the uh all those weight everything we need and cardio safety renal safety all those things we want so here you will see even at the four weeks there is significant weight difference between even that is appetite 5 mg versus the SEMA glutamide 1mg neat loss need loss to say the 10 and 15 were obviously more significant weight loss were there with the these newer molecules so here you will see the weight in percentage difference was 6.2 percent with the Baseline 6.7 percent from the Baseline if you compare with 1 mg of SEMA glutamine and even the 5 mg reduce much more weight loss that is statistically significant that is what I am talking 8.5 percent and now we have e even we have the data recently two three months back we have data for surmount 1 which is the recipient in non-diabetic patients so here you will see the weight reduction is in the tune of 20 and even with the 5 mg you have 15 percent with the 10 mg of 19 that is about the non-diabetic population so we have data for that also so this newer molecule is really good even used in non-diabetic patient as well so here the brand name also I'm telling you that's a munjaro only obviously one company is producing it and free now we have even further all those data are also trials are going on the summit trial for the reserved ejection fraction heart failure obesity that is going to come out in November 2023 then the surpass speeds that even trying in children that is 10 to 17 years that will be in 2027 you will get the data then surpass cbot since we don't have any dedicated cbot trial for this munjaro at present but obviously it will come in future and coming to the uh before summary I'll just uh tell few points which Dr om has told so sustain 6 obviously we know that it was a beneficial effect and then the Pioneer CA uh six trial which was for the overall schema blue type it was cardio neutrality that means it's not protective but there was almost 21 percent reduction which was non-statistically significant and that to involve it was mainly the stroke prevention and we know that all the glp1 have that benefits benefit of stroke prevention so obviously probably this molecule will also come with that because it's a glp1 and log as well so all those glp it's a group effect I would say now we have we are going to have data for the soul trial which is for the same oral SEMA glue type cbot trial and at present we don't have any real world evidence we and but I believe that they are going to launch in India also because they have multiple trial center for the this newer molecules in India also so probably it will come to India but again not only that injectable thing that is okay that's an important thing but I believe the most important thing would be cost so that we both cannot argue because anybody of us don't know the cost if the molecule is very very costly it will not work here because most of your population in these drugs are not like that you have to give one week one month it's not uh cold and cough you give and just uh you can stop it you have to give it these drugs continuously so cost will play a major role because both the molecules are really good and obviously the data at present is slightly more promising for this molecule but everything will burn down to cost so in summary it has demonstrated higher Advanced reduction than the SEMA glue type than the diluted then the clutching so you will be very surprised that even if you compare it against insulin or those patients who are in on insulin so we have this surpass 5 those who are already on insulin so they have compared with the placebo who are already on insulin so those patients receiving insulin or against insulin it has a better result in efficiency reduction and the weight reduction all those trials compared to the similar blue tight 1mg this has reduction in CV risk factors because we have now higher weight reduction higher efficiency reduction and if you compare the lipid profile there was no significant difference between the LDL but significant increase in the HDL in significant degrees in the triglyceride so probably it may have better cvot results than the SEMA blue type but at present we cannot say these are just an um what I'm taking is between the lines okay so this you cannot just quote it okay and again the side effect if you say they may be less or at present at least we can say from the data that they are similar to SEMA glutine because it was statistically non-significant and regarding the like during those trial actually it was a cubed era so all those who had death that was mainly because of the covet okay so if you will read all those supplementary data it was not due to either SEMA glue type or due to laser patite okay so with this I end my talk and it's a like a we cannot argue over this when the molecule become both of us will be using this and both of us are using at present SEMA glue type and data actually until this you have data in real world evidence also you cannot say and obviously at present the scientific data is in favor of the newer molecule so mayor nicely you have debated the molecule against the civil glutath and as you rightly said that this molecule is not available but one thing which I think I mean you could have shown because it is already available in U.S markets and there you can say that how whether it is now increasingly being used by diabetologist endocrinologist in comparison so I mean that data could favor you I mean this is just to show that and the data both of you had shown as far as superiority is concerned even seduction or the weight reduction is concerned there is a head-to-head trial but at the same time as we know it is not available no civility trial we don't have our direct experience other home is having because he is in clinical trials I'm sure he must have used in some of the patients who might not be unplaceable or was it a trial against a comparator or was it against a pleasant home so it's against uh dual aggregate so so that other patients were also yeah I think what mayur said is very important uh that you know these people are so much confidence that they are doing trials against existing molecules not just remarkable so you know to have that I think pre-clinical or maybe small pilot studies they would have amazing data otherwise they would not dare to you know use such an expensive trial against molecules itself but here the trial which had been shown you know the data directly with the SEMA gluten versus appetite you'll be surprised that you know even that SEMA glutamide also in that particular clinical trial had shown events reduction of 1.7 but this appetite has shown 2.2 which is like first a molecule which I am seeing a data to support that which is reducing A1C more than 2.2 and 50 percent of the patient because the Baseline A1C was 9 50 of the patients could achieve their A1C less than 6.5 and one third of the patient reduced their weight by 15 of the weight I mean that's a very very significant and remarkable while similar glutide averaged reducing the weight mean even since BP I mean weight reduction was around five percent or six percent only so I mean that's really uh remarkable as unique mechanism of action of Gip putting dual Agonist in a one molecule yes we know that there are some shortcomings like being an injectable we know that it is again maybe once it will come it will be very very costly we don't know the cost of this molecule where it is available is it costlier than SEMA glutide that data mayur could have shown and what is the usage in compared to the existing molecule in the U.S particularly and just I was sitting with some one from Middle East and it is available in Dubai so in Middle East people have already started using it this molecule also it is not available in UK and UK is not very you know the first line they don't come up with the glp1 injectable because still the type to diabetes to be treated by primary care physician so there is still on the cell phone and we have metformin in other molecules I just want to see whether it is the Siva glue tide or you talk of injectables we people use glp1 very often but still the uses of glp wire in our country is comparatively very very poor even the exoner type has been lost in India before 15 years so it never picked up was it injectable was it because of cost was it because of side effects now we have data to support that it is fantastic as far as weight reduction is concerned it is good molecule reduce the damage City good thing the newer and newer molecules are coming with a severity data also that come in the guideline also the way we are using sglt2 even in sgt2 also we know that 20 or even more than our patients develop generator mycotic infection and genital problems so what is your take home for this why it could not pick up you know you know so even it is in oral form or is it still the people are not auditing the molecule as you were saying already on that Indians are very fussy as far as years yeah and just to add one thing sir what you have told uh like uh even with the SEMA gluten we have one subgroup analysis that those who had hbmc more than nine percent their reduction was close to 2.5 percent similarly for this also we have a subgroup analysis which showed that if the hb1c Baseline agency is more than 8.5 percent the reduction in adjudance is 3.2 so it's probably more potential complete trial it was 2.5 and that was 1.7 that is a very significant interactions there are 25 or 30 of the patients whose h1c was below six I mean almost like a non-diabetes below 5.7 also they have taken as the end point and it was much higher with this uh type versus SEMA blue time uh the other thing I want to stress that I believe it is not the injectable in the oral thing because weekly injection I believe most of our patients do accept it's not a that big thing because um once a week is okay and it's almost painless I would say the main thing I believe is the cost and the sensitization of the doctors which is much less to use the newer molecules in the ways it is totally different they are even then OPD gets reimbursement they have health insurance in India we have very less health insurance and also at present the OPD treatment is not covered so that makes a huge huge difference yeah I agree and I think you know uh traditionally if you see some uh even if you take Noah knowledge which had their Blockbuster molecule Lira protide uh their promotion was still very subtle I think you know drug was promoted you know in only selected to selected doctors or selected reasons uh I think the company itself probably they would have done market research and all uh probably the company felt that the amount of money or efforts spent on Victoza may not be fruitful and perhaps the Lord give the output which was so desired but looking at How They are promoting oral simultane I think again there will be some market research that have shown that perhaps this Drug's acceptance is going to be much better and what I have seen before at least in the past few months there is tremendous response to overall simulator I mean there's a lot of there are patients who come and ask us show me the photo that sir apnea is foreign kg so they want to have I fully agree but I mean the way the glp one should take off in our country given it is the molecule before even the lifting has come in the market simultaneously exhilated was there I am witnessing that but still it had never picked up yeah I think combination of Sir cost and injectable I think and the promotion also I think it's triple thing right and I think one of the biggest challenges to uh this group of molecules because it came at the right hand just when you know glp era was coming you had sdnt2 which came and which completely took over the entire debate you know suddenly you had a drug which had a different unique mechanism of action and where also had very good cardiovascular data so I think uh perhaps if sglt2 had never come to the market glp1 would have been much better much better position because it could have been the only drug with a cardiovascular benefit or potent cardiovascular benefit as we can exercise only for the heart failure if you see the arthroscotic events are decreased only with the glp1 Dr Mohammed had made a comment that this appetite is Once in a week simulated once you know both injectable are once in a week only semiglotted oral is Once in a day and I think he is comparing confusing between 14 milligram of SEMA glutide which is an oral drug with 15 milligram of crazy appetite which is injectable the main drawback is a cost yes we all understand the availability is not this and they are the drugs for rich people I mean that's not the way or right way of telling because uh the cost and richness is very relative term how you explain in the patient some multi-millionaire may think that this is a costly drag and some routinely affording class of patient also May understand the importance of your health and importance of a molecule and they can afford to have it what is the maximum dose already SEMA gluten and Teresa appetite we had talked oral SEMA glutamide 14 milligram in injectable form it is 0.51 and 1.5 they are doing also the study for higher dose of Siva glutamide in obesity which has also been approved it is appetite is again to start with 2.5 with the highest is 15 milligram uh there are some questions again PDF of these talk I think there won't be any requirement it is already been discussed Seema glue tied in obesity yes without in blood sugar level not with hyperglycemia gluten can be used and it is already been studied and probably it will also get an indication to use in obesity also in our country also they are looking in a big way and the any other question or from the organizer if anything else to add for the audience uh for non-diabetic obesity the SEMA gluten approved is not the oral one it's the injectable one which yeah and at the higher dose so what is for diabetes is ozympic it comes by the name of Jose MP whereas for the Obesity is Vigo V which is 2.4 mg so it is much higher than what similarly like Lira glue type for diabetes is Victoza which you can give up to 1.8 mg whereas for the Obesity it is succeed which you can give up to 3 mg so it slightly different but the molecule is same yeah and interestingly we go is going to be available in India next year so you will have the ability pure obesity in the education injectable simulator available in India and also remember only for obesity indication only for obesity indication which is very interesting yes and and what is interesting is now you have you have a recent uh Trials of Peace appetite for weight loss in non-diabetic interviews weight which is very interesting yeah so so there is now we are going in the range of bariatric services yeah can we have coal again yeah so I think it again we have poles again uh yes sir I still believe future of diabetes management is yeah please so I think you know only I think three drugs on a long run three drugs will survive one is your sdn T2 other is glp and or Tapp in whatever form injectable oral and third metformin probably will survive test of time now these three drugs will probably survive probably will have a guideline soon like metformin may be pushed slightly back I think that will be a challenge because again and if you see that even the exhibition also it is either around glp1 or on the monitoring and Technology I mean nothing else you will find technology are we doing polls um I'll just Spam the call now that we've heard the entire argument for both um let's run the poll again and see if I will stand now I only see the hole on the screen it's a very simple question and you can put in your or choose your drug of choice and hit submit slight change compared to the earlier uh one but not much I think still kind of standard 50 50. good it was really really interesting and we enjoyed I think I thought this was our first uh take on debate you'll have one going ahead every month I will have to go one year one more debate which is CGM against North CGM so I am slightly it is 5 15 here and I'm going okay bye bye thank you thank you uh thank you first for joining in and we hope to see you once again on Netflix uh either for another debate topic or individual sessions we have had Dr om come in plenty of times so we look forward to you as well so for having sessions with us and thank you so much everyone for joining in and if you all have any interesting topics for the date that you would like to hear uh please drop in your topics suggestions to us thank you so much sir thank you for having me thank you good night good night everyone good night


The incidence of obesity and diabetes, also known as the 'twin epidemics', is a rising global issue, particularly in developed nations. Therefore, cutting-edge therapeutic modalities are required. As the only dual glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) receptor agonist, tirzepatide, also referred to as a 'twincretin', can significantly lower glycemic levels, improve insulin sensitivity, as well as reduce body weight by more than 20% and improve lipid metabolism. On the other hand, we have the USFDA and the EMA approved Semaglutide, a novel second-generation long-acting GLP-1RA for once-weekly subcutaneous administration, as an adjunct to diet and exercise in individuals with type 2 diabetes that is not well controlled. Join us LIVE as renowned endocrinologists Dr. Om Lakhani and Dr. Mayur Agrawal square off to discuss the benefits and drawbacks of each treatment.


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