World diabetes: Could a daily pill narrow the treatment gap for millions?

A shift from injections to pills

GLP-1 receptor agonist therapy has been used since Exenatide received FDA approval in 2005. Liraglutide followed in 2009 and was regarded as a major alternative to insulin. Now, once-daily oral GLP medicines are being developed as an option alongside injections, which are generally taken weekly. The change could affect both treatment choices and access, particularly in emerging economies.

Cost and access vary widely

The article gives monthly Mounjaro prices of about $500 in the United States, 199 pounds ($264) in the UK and 1,261 riyals ($336) in Saudi Arabia. It lists 14,766 rupees ($157) in India for the locally manufactured brand.

In Pakistan, it reports imported Mounjaro at 220,000 rupees ($723), compared with 17,000 rupees ($61) for locally made tirzepatide from Getz Pharma. Locally manufactured oral semaglutide is cited at about $18 for a 30-day supply; the article says oral medicines could also reduce reliance on refrigeration and ease rural distribution.

Diabetes and obesity burden

One in nine people worldwide aged 20 to 79 lives with diabetes, while one in eight people globally is obese. Obesity alone was responsible for 3.7 million deaths worldwide in 2024.

Alavi described Pakistan as facing both childhood malnutrition and obesity, and said some obesity may be linked to maternal malnutrition and premature, underweight births. Alavi also said GLP medicines can help manage type 2 diabetes and obesity, and may improve cardiac and renal outcomes, liver disease, obstructive sleep apnea and osteoarthritis.

Research behind the medicines

The gut releases GLP-1 after eating; as blood sugar rises, the hormone signals the pancreas to release insulin. GIP is another gut hormone that also prompts insulin release in response to rising blood sugar.

Research by Holst and his team led to semaglutide, followed by tirzepatide. Retatrutide is undergoing trials, with a potential release in 2027. Holst said it became clear that the therapy could benefit millions when its value in treating diabetes emerged.