Semaglutide, a glucagon-like peptide (GLP-1) receptor agonist, has been used for the treatment of diabetes. It has been hitting headlines since its FDA approval in 2021 for chronic weight management. It works by enhancing insulin secretion in response to meals while also delaying gastric emptying, which delays the rate at which glucose enters the bloodstream. These mechanisms prevent spikes in blood sugar levels.
Alternatives include other GLP-1 receptor agonists such as liraglutide, exenatide, and dulaglutide. Similar medications, such as DPP-4 inhibitors and SGLT-2 inhibitors, may be considered in a patient's treatment plan based on the patient's tolerances and preferences, budget, medical history and candidacy, and the availability of these pharmaceutical agents.
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Pharmaceutical Alternatives to Ozempic
Other GLP-1 receptor agonists are available for treating diabetes and, in some cases, weight loss. These include:
- Victoza (liraglutide): A daily injectable used for the treatment of type 2 diabetes
- Saxenda (liraglutide): Approved for weight loss in conjunction with diet and exercise
- Trulicity (dulaglutide) and Bydureon (exenatide): Once-weekly injections used for the treatment of type 2 diabetes
- Rybelsus (semaglutide): An oral form of semaglutide
- Ozempic and Wegovy: Injectable formulations of semaglutide
Choosing a GLP-1 receptor agonist depends on a patient's medical history, preferences, lifestyle, and treatment goals. Semaglutide has demonstrated the largest weight loss efficacy of any obesity medication and has shown improvements in decreasing cardiovascular risk and improving physical functioning.
All GLP-1 agonists have similar side effects. Ozempic is particularly noted for its effective weight loss and potential cardiovascular benefits, and a higher likelihood of gastrointestinal issues.
Besides GLP-1 receptor agonists, other classes of diabetes medications include biguanides, sulfonylureas, DPP-4 inhibitors, and insulin therapy.
- Biguanides: Metformin comes in immediate and extended release formulations and may be combined with other antidiabetic agents.
- Sulfonylureas: Glipizide, glyburide, and glimepiride. These medications work by promoting insulin release from the pancreatic beta cells.
- DPP-4 inhibitors: Also known as gliptins, work by increasing incretin levels which inhibit glucagon release, increase insulin secretion, and decrease gastric emptying. DPP-4 inhibitors with FDA approval include sitagliptin, saxagliptin, linagliptin, and alogliptin.
Insulin is an essential hormone that helps turn food into energy and manages blood sugar levels. It comes in many forms, including short-acting (regular), rapid-acting (lispro, aspart), intermediate-acting (NPH), long-acting (glargine, detemir), and ultra-long-acting (degludec).
Depending on the duration of action, certain insulin options may be administered multiple times throughout the day. Each of these classes of diabetic medications may be utilized alone or combined based on patient-specific needs and therapy goals.
Natural and Holistic Alternatives to Ozempic
Using Nutrition
Optimizing metabolic health through a balanced diet is critical not only for maintaining a healthy weight and regulating blood sugar levels but also for obtaining adequate nutrition, promoting cardiovascular and gastrointestinal health, reducing inflammation, and preventing disease.
A balanced diet for metabolic health includes:
- Lean proteins such as lean meats, fish, legumes, and beans
- A variety of fruits and vegetables, think “colors of the rainbow.”
- Healthy fats such as nuts, seeds, avocados, and fish
- Whole grains that are rich in fiber, such as oats and barley
- Low-fat or non-dairy alternatives such as yogurt, soy milk, kefir
These principles are largely part of the Mediterranean diet, which is widely known for its health benefits and traditional lifestyle of those living in countries along the Mediterranean Sea.
A study revealed a 20% decrease in type 2 diabetes risk with adherence to a Mediterranean style diet. Findings from a 2023 meta-analysis showed that higher adherence to the Mediterranean diet was found to be associated with a reduced risk of overall mortality, both in the general population and in patients with previous cardiovascular disease events.
Using Exercise
The importance of exercise is no secret, with recommendations varying based on individual needs, health status, and goals. General guidelines in exercise for managing weight and blood sugar levels include 150-300 minutes per week of moderate-intensity aerobic exercise (brisk walking, jogging, swimming) combined with more vigorous intensity exercise of 75-150 minutes per week. Regular exercise has been shown to reduce weight and blood pressure, improve lipid disorders such as lowering triglycerides and raising HDL, improve insulin resistance, and reduce the risk of metabolic syndrome.
Studies have shown that stress, through bodily inflammation, is linked to metabolic syndrome. This suggests that relatively cheap and easily accessible stress management techniques, including exercise, yoga, and meditation, have a significantly positive impact on health outcomes.
Natural Supplements and Remedies
Natural supplements can offer benefits as alternative forms of therapy or be utilized in conjunction with pharmaceuticals. These include:
- Berberine: Berberine is a plant compound that works by improving insulin sensitivity and decreasing glucose production by the liver. It lowers blood sugar and hemoglobin A1c levels, and reduces cholesterol and triglyceride levels. Although less potent than semaglutide, it provides a natural alternative with a less potential side effect profile.
- Cinnamon: Cinnamon-based therapy can help regulate glucose and lipid levels to avoid the progression of type 2 diabetes.
- Alpha-Lipoic Acid: ALA is a powerful antioxidant that helps not only reduce oxidative stress and has a role in energy production, but also may improve insulin sensitivity and glucose uptake in cells, aiding in weight loss.
- Chromium: Chromium has been shown to be efficacious for weight loss by increasing insulin sensitivity.
It is essential to consult with a healthcare provider before starting supplements. Providers should opt for reputable supplement brands and observe the quality and safety of these supplements.
Traditional and Complementary Practices
Integrating holistic practices into a patient's weight management treatment plan may provide further benefits.
- Acupuncture: Widely known for its stress relief effects, and it may also be effective in weight loss.
- Green tea: Rich in catechins, which may help boost metabolism and increase fat burning.
- Ginger: Well-known for its aid in digestion and appetite reduction.
Natural remedies such as green tea and ginger may help with weight loss; however, it is important to consider these aids as complementary support. Healthy lifestyle habits such as a balanced diet, exercise, stress management, and obtaining high-quality sleep are not replaceable.
Lab Tests for Metabolic Health Assessment
The following lab tests are beneficial for assessing metabolic health:
Blood Sugar Monitoring
Standard, easy-to-obtain blood sugar tests are essential for diagnosing metabolic disorders. Blood testing provides comprehensive insights for providers in creating patients' treatment plans. It presents a picture of a person’s metabolism, insulin sensitivity, inflammatory status, thyroid and hormone function, and more.
- The most common tests include a fasting blood sugar test, typically requiring an overnight 8-hour fast. some text
- Normal fasting blood sugars are less than 100 mg/dL, with impaired fasting glucose or diabetes within 100 to 125 mg/dL, and diabetes at greater than 126 mg/dL or higher on two separate tests.
- A hemoglobin A1c (HbA1c) test provides providers with an estimate of average blood sugar levels for the past 3 months by measuring the amount of hemoglobin bound to glucose. some text
- Normal HbA1c levels are less than 5.7%, prediabetes is from 5.7% to 6.4%, and diabetes is considered at 6.5% or higher.
- An oral glucose tolerance test (OGTT) identifies the ability to metabolize glucose after consuming a standardized amount of glucose. Blood samples are drawn at specific times, typically fasting at 1 and 2-hour intervals. some text
- In a normal OGTT test, blood glucose levels return to normal after 2 hours. In prediabetes, blood glucose levels are higher than normal, and in diabetes, blood glucose levels remain elevated at 2 hours.
Other Helpful Bloodwork
- Assessing lipid profiles initially and with follow-up bloodwork is beneficial in management as it evaluates a person’s cardiovascular risk and monitors health progress.
- Testing a person’s fasting insulin level is valuable as it assesses their insulin sensitivity and aids in identifying metabolic dysfunction and insulin resistance. It may provide a clue as to why a person may struggle with weight loss.
- C-peptide is a by-product of insulin production, and blood levels reflect the amount the pancreas is producing and releasing into the bloodstream. It can help differentiate between type 1 and type 2 diabetes and evaluate for insulin resistance.
- A hepatic function panel and renal function panel can help monitor liver and kidney health throughout pharmaceutical interventions.
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Key Takeaways
- While there has been an uproar in Ozempic in type 2 diabetes management, providers may consider several pharmaceutical alternatives. Health practitioners should consider using supplements, natural remedies, and integrative care for treatment plans to improve metabolic health.
- Functional and integrative medicine practitioners can provide a more personalized and preventative approach to treatment plans for weight loss programs treatment for diabetes and metabolic syndrome.
- Regular lab tests are essential for assessing metabolic health and monitoring of disease progression.
- It’s important for patients to always consult with a healthcare provider before making any changes to their diabetes management plan and discuss the potential risks and benefits of different treatment options to ensure the best outcomes.
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