Dr. Fernando Gómez Peralta, Coordinator of the Diabetes Knowledge Area in the Spanish Society of Endocrinology and Nutrition (SEEN).
Obesity and type 2 diabetes remain two of the main public health challenges worldwide. Advances in pharmacological therapies have proven to be effective, but most Current treatments require injectionswhat generates adhesion barriers For many patients. In this context, new oral medications represent a significant change, combining clinical efficacy with greater comfort and accessibility.
In this interview to Oxalud, he Dr. Peralta analyze the latest findings about Orforglipron (Lilly)an oral drug that has shown promising results in weight loss, glycemic control and reduction of cardiovascular risks. In addition, it addresses the impact of these advances in clinical practice, the potential improvement in patient’s quality of life and the relevance of expanding therapeutic options against Obesity and diabetes.
Question.- Why are advances in oral treatments so important against injectable therapies that already exist against obesity?
Answer.- Many people reject, by a psychological barrier, injections. Reaching this population group would increase the penetration of the LPG1 pharmacological class, which has demonstrated important metabolic, renal and cardiovascular benefits.
Q.- What does it represent for clinical practice to have an oral drug that shows similar results or even superior to the semaglutida?
A.- It is important to specify that the ACHIEVE-3 study is a study in front of the oral version of Semaglutida, not the injection. However, the oral version of Semaglutida also has restrictions for its administration (at least 30 minutes before intake, only with water, etc.) and access. Oral administration without food restriction must translate into greater comfort and, therefore, in better adhesion.
The study presented shows that Orforglipron achieves weight losses of up to 8.9 kg in people with type 2 diabetes. What does this data mean in terms of glycemic control and complications reduction?
The result is equivalent to a reduction in the weight of 9.2%, close to that obtained by the injectable LPG1 in this population. This translates into protection of renal and cardiovascular function. In addition, it implies relevant improvements for the quality of life in mechanical complications of obesity, such as osteoarthritis or sleep apnea.
Q.- How do these results compare with current medications, such as oral semaglutida?
A.- In this trial in people with type 2 diabetes, Orforglipron surpassed in the reduction of HBA1C at both doses of oral semaglutid, even in their lowest dose. The highest dose allowed almost triple participants to achieve levels close to normal against the highest dose of semaglutida.
In addition, the medicine showed an average loss of 12.4 kg in people with obesity or overweight and is administered orally once a day, which enhances its use as a key treatment.
Q.- Can we talk about a paradigm shift in obesity management?
A.- In this study it is population with diabetes and overweight or obesity. There are results of other specific studies in obesity with diabetes with also interesting results, such as the one presented last week at EASD Attain-1.
The prevalence of obesity in Europe is 30% of adults and will reach 40% in 2050 (GBD 2021 Adult BMI Collaborators. Lancet 2025; 405: 813–38). Human and economic implications are huge. However, there is great heterogeneity in the clinical presentation and in the complications associated with obesity.
These results place Orforglipron as an advantageous option to improve the results in DM2/obesity and increase access and adherence in pharmacological therapy. In addition, it could help reduce known cardiovascular risk markers associated with DM2 and support significant improvements in public health.
Q.- When do you think we could see this medicine available in daily practice, and what regulatory steps are missing?
R.- During the year 2026 it must be presented to the regulatory agencies: the European (EMA) and the American (FDA). This will open the door to the negotiation of its financing by national health systems.
Finally, Doctor, how do you see the future of the treatment of obesity and diabetes in the next decade with the emergence of this type of medicines?
Different pharmacological therapy options are necessary to adapt to the different profiles, the evolutionary situation and individual preferences. Additionally, sustainable and economically accessible options will be highly demanded for this huge and growing population worldwide.
