A to Z of 2024: Ozempic, the breakthrough drug for diabetes and weight loss

SINGAPORE – In 2024, Ozempic gained global attention as ground-breaking treatment not just for Type 2 diabetes

but also weight management,

leading to widespread demand and media coverage. 

Originally developed by Danish pharmaceutical company Novo Nordisk to manage blood sugar levels, Ozempic’s active ingredient, semaglutide, was found to cause significant weight loss. This led to its adoption as a popular off-label treatment for obesity.

Semaglutide mimics a natural hormone made in the small intestine called glucagon-like peptide-1.

Besides regulating blood sugar levels, semaglutide works in the brain to create a feeling of fullness, helping users eat less by curbing their appetite.

This double benefit led to Ozempic being hailed as a game-changer and fuelled a surge in its popularity, which has been driven by endorsements from celebrities and social media influencers, as well as online weight-loss success stories.

Tech mogul Elon Musk, media personality Sharon Osbourne and influencer and plus-size model Remi Bader have stated publicly that they have used Ozempic.

In Singapore, it was approved in 2021 by the Health Sciences Authority (HSA) to treat “adults with insufficiently controlled Type 2 diabetes mellitus, as an adjunct to diet and exercise”, says a spokesperson for the authority.  

“Any prescription and use of the medicine outside of the approved indication is considered as ‘off-label use’ and will depend on the professional judgment of the medical practitioners when managing their patients to ensure that it is in the patients’ best interests,” says the HSA spokesperson.

Dr Ben Ng, director of Arden Endocrinology Specialist Clinic, says his main concern with Ozempic, which is a prescription-only medicine, is that it is being marketed on social media as the “next miracle drug”.

“Though obesity is extremely prevalent and needs to be addressed, I don’t think this drug should be considered the solution to all problems related to obesity,” he says. 

Controlling one’s diet and making lifestyle changes should remain the primary approach for treating obesity and diabetes, he notes.

In patients with diabetes, Dr Ng says Ozempic can be considered for those with poorly controlled blood sugar. 

In overweight patients without diabetes, he adds, it may also be considered for those with a body mass index of 27.5 and above who have at least one health complication, such as high blood pressure or high cholesterol.

Dr Tan Kok Kuan, medical director at Dr Tan Medical Center, prescribes Ozempic mostly to patients with Type 2 diabetes who are also obese. In very select cases, he prescribes it to patients with obesity even if they do not have diabetes.

One of his patients, who came in with a fungal infection on the foreskin of his penis and was obese, tested positive for diabetes. After being prescribed Ozempic, his sugar levels were normal after a month. He also lost 17kg in three months – dropping from 105kg to 88kg, and reaching a healthy weight range.

Dr Tan says his patients typically see significant improvements in their sugar levels within the first two months of taking Ozempic.

Dr Ng says weight loss tends to be progressive and usually starts within three to four weeks, and can last for up to four months. “We expect patients to lose anywhere from 5 to 12 per cent of their total body weight,” he adds.

However, not all who have diabetes will be prescribed Ozempic, notes Dr Tan. 

As a first-line treatment for diabetes, he usually prescribes metformin, a more affordable and effective medication. In comparison, Dr Tan says, Ozempic can cost over 20 times more for a month’s supply. 

At Dr Ng’s clinic, for example, one month’s supply of metformin costs less than $30, while Ozempic can cost more than $400.

Dr Tan says Ozempic offers the convenience of a weekly injection, compared with other medications. It also provides end-organ protection, he adds, meaning it helps protect the kidneys and heart.

However, the main drawback is its high cost, and some patients are reluctant to use it due to the need for self-injections, he notes.

And, like any medication, Ozempic can have side effects.

Dr Ng says the most common ones tend to be related to the gastrointestinal tract. He advises patients to look out for symptoms such as nausea, constipation and gastric reflux. 

In some patients, the nausea can be so severe that they are unable to drink water, making them more prone to dehydration, he adds. Pancreatitis, which is the inflammation of the pancreas, can also occur in a small proportion of patients, he adds.

The HSA spokesperson says the authority has a post-market surveillance programme to monitor the safety of registered medicines. This includes a review of adverse events reported by healthcare professionals and safety concerns detected globally.

If safety concerns are detected, HSA will take appropriate action to safeguard public health, adds the spokesperson.

Dr Tan says: “I think one thing the medical community is very careful with is that we don’t want patients to think of Ozempic as some kind of weight-loss medicine that can simply be bought over the counter and used without supervision.

“Patients may have side effects, so we will reserve it for those who are suffering from obesity and its complications, and for whom other treatments have failed.”