GLP-1 Drugs and India's Non Communicable Disease Crisis: A New Hope or a Distant Dream?

The Non Communicable Disease (NCD) crisis: More Than Just Numbers

India has the second-highest number of people with type 2 diabetes globally, Recent estimates show that nearly 350 million are overweight or obese and 101 million adults have diabetes and out of these 77 million adults have type 2 diabetes, The growing rates of diabetes and obesity -are linked to a higher chance of developing long-term health issues such as cardiovascular diseases (CVDs), and specific types of cancer. These conditions not only lead to higher mortalities rates but also impose a significant financial burden on millions of households, pushing many into poverty.

GLP-1 Drugs: Mechanism and Efficacy

In India, traditional medications like metformin are widely used for type 2 diabetes due to their affordability and effectiveness in lowering blood sugar levels and enhance insulin sensitivity. Glimepiride with metformin is also a cost-effective drug combination for obese patients. But Glucagon-like peptide-1 (GLP-1) receptor agonists are a promising therapies are a class of medicine helps with both diabetes and obesity, it helps lower the blood sugar levels by enhancing the insulin secretion and also help in promoting weight loss. This drug acts like a hormone GLP-1, which helps the body to release insulin, reduce the release of glucagon and slow down digestion.

Traditionally, GLP-1 drugs were only injectable with patient compliance limitations. In 2020, India's Drug Controller General of India (DCGI) approved the oral drug called semaglutide (Rybelsus), a type of GLP-1 drugs launched by Novo Nordisk India. Recent clinical trial of oral Semaglutide on 152 patients over an year from 8 health centres across India showed significant improvement in their blood sugar level by 1.5%-1.8%, helps in weight loss of 6 kgs -10 kgs without causing hypoglycemia and also lower the risk of cardiovascular events. Which has proved its efficacy and tolerability in India patients. Earlier study in 2014 on Indian patients with type 2 diabetes undergone clinical trial on two approved GLP-1 analogues (exenatide and liraglutide) approved in India, had also experienced similar benefits as global populations with 40% of patients achieve HbA1c <7.0% without weight gain or hypoglycemia, outperforming other therapies.

Photo by Matt C on Unsplash

GLP-1 Drugs: A Game Changer—But at a Price

GLP-1 receptor agonists—are globally recognized drugs for diabetes and obesity—are being positioned as a potential game changer due to their unique dual-action mechanism. These drugs also offer cardiovascular benefits, reducing the risk of heart disease in patient with Type 2 diabetes. GLP-1s can reduce all-cause hospitalisations for people with type 2 diabetes and CVD compared to non-GLP-1 therapies. These medications are superior to other drugs in improving glycaemic control, reducing weight and lowering blood pressure, and cardioprotective effects, making them ideal for high-risk populations. However, their high cost is a major barrier. Patients with these critical co-morbidities incur high healthcare cost due to costly branded medicines and hospitalization. The financial burden on Indian people is the highest in the world, with medicines being the largest contributor. Medicines account for 70% of OOPE in India, the highest globally, leading many households to financial distress.

Affordability and Access: The Indian Dilemma

GLP-1 treatments are legally available in India but its limited distribution and high cost has driven people to seek alternatives through informal channels. The annual cost for branded GLP-1 drugs for example Eli Lilly's Mounjaro (tirzepatide), and Novo Nordisk's Wegovy and Ozempic) cost between Rs 5000 to Rs 20000 per month, which will be largely restricted to higher-income groups. In a survey, of 300 patients with type 2 diabetes was selected from various healthcare centers across India revealed that awareness and adoption of GLP-1 receptor agonists are limited. Only 66.2% of patients were aware of these drugs, and just 17% had adopted them. High cost, limited awareness and distribution and side effects are the reasons for not adopting it.

The Metabolic Multimorbidity Opportunity

The Production-Linked Incentive scheme (PLI) by the government encourages the domestic manufacturing of GLP-1 drugs which are near patent expiry in January 2026. Taking advantage of the limited availability of the dual benefit anti-obesity and anti-diabetic drug therapy, the Indian manufactures such as Lupin, Torrent, Zydus Cadila and Sun Pharma are planning to make biosimilars or generics which will increase the demand, competition among manufacturers that drastically reduce the cost of drugs to make it accessible to a broader population. The patent expiration will not only reduce the prices of drugs but also improve medical adherence in India by maintaining Indian’s global reputation as a pharma capital of the developing world. However, they are not a standalone solution. The fight against NCDs in India requires a comprehensive approach—one that combines innovative medicines like GLP-1s with prevention, GLP-1 drugs are a ray of hope for India, but we also require prevention programs for improved lifestyle, telemedicine for expanding services and education for side effects.

Conclusion

GLP-1 drugs represent a significant advance in the fight against multi comorbidities in India. The upcoming entry of GLP-1 drug to domestic market in the form of generics can be a new hope for millions of Indians but their full potential will only be realized if affordability and access are addressed.