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Diabetes has no cure, but the increasingly popular "slimming pens" have become an important weapon in controlling the disease and have transformed the lives of many living with the disease.
These medications help ensure a normal life for patients and, in some cases, lead to what experts call "remission" of diabetes, when symptoms disappear and the disease becomes temporarily inactive.
Businessman Felipe Inckot, 49 years old, is an example. A year and a half ago, he was diagnosed with type 2 diabetes, which was still in its early stages. Since then, he has adopted a set of measures that have led to a considerable weight loss, from 127 kg to the current 92 kg.
"I started taking Mounjaro [commercial name for tirzepatide] and underwent dietary re-education and lifestyle changes. I switched from water to wine", he reports. "I do exercises focused on bodybuilding and aerobics and I relearned how to eat, leaving aside my sedentary lifestyle. Today, I have a different disposition and all my exams are excellent."
Experts emphasize that the use of such medications needs to be monitored and provided with medical guidance, both in terms of necessity and the dosage required for each patient.
Brazil has the sixth largest diabetic population in the world — there are 16 million Brazilians diagnosed with the disease, and this number may still be underestimated (read more below). November 14th is considered World Diabetes Day.
Diabetes is not just one disease — there are several types. The most common are type 1, type 2 and gestational. The first is autoimmune.
"The immune system itself destroys the beta cells in the pancreas responsible for producing insulin", explains doctor Elson Paulozzi Nunes, specialist in metabolic diseases and author of A Dieta do Salgado.
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Type 2 diabetes represents the majority of cases and is the result of a combination of mechanisms. On the one hand, there is resistance to the action of insulin — often due to excess circulating glucose.
Initially, this forces the pancreas to produce larger amounts of the hormone, seeking to compensate the system. Over time, explains Nunes, "the progressive loss of the ability to maintain this high production" occurs.
"When the pancreas can no longer meet the body's demands, glucose begins to accumulate in the blood", adds the doctor.
"We are facing complex metabolic changes, often developed over many years, with a generally inadequate lifestyle, involving insulin resistance, visceral fat, pancreatic function and genetic predisposition."
Endocrinologist Bruno Geloneze Neto, coordinator of the Diabetes and Metabolism Research Laboratory at the State University of Campinas (Unicamp), explains that between 90% and 95% of cases are of this type. "The body develops resistance, as if the insulin no longer works properly, and the pancreas can fail."
Doctor Maria Augusta Karas Zella, professor at Faculdade Evangélica Mackenzie do Paraná, explains that type 2 diabetes begins silently, which makes it more difficult to detect.
"It often presents an increase in triglycerides and a reduction in HDL cholesterol. But type 2 diabetes is not a single disease and its presentation may require insulin at the beginning", says Kella.
This is the type of diabetes for which contemporary treatments have worked best, says biologist Alex Rafacho, coordinator of the Chronic Disease Research Laboratory at the Federal University of Santa Catarina (UFSC).
"In type 2 diabetes, the earlier we seek remission, the greater the chances of achieving it tend to be, because the pancreas generally still preserves greater functional capacity", says Rafacho.
"This reinforces the importance of early diagnosis and timely interventions."
Gestational diabetes, as the name suggests, appears during pregnancy — and, in many cases, disappears afterwards. Geloneze explains that its development occurs as a result of weight gain, in addition to genetic predisposition.
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The impact of weight loss pens
Weight loss pens have been efficient tools as they have a metabolic impact on the feeling of satiety and consequent insulin production — in addition to the fact that the patient drastically reduces the intake of excess food and has a significant weight loss.
Geloneze also highlights that "weight loss improves insulin sensitivity." "There is an anxiety about using the word cure, but in current medicine what we use for these cases is, at most, the term remission", ponders the doctor.
Rafacho explains that it is difficult to achieve a total cure for diabetes due to the "complexity of the mechanisms involved".
"In type 1 diabetes, it is not enough to restore insulin production. It would also be necessary to prevent the immune system from continuing to destroy the cells responsible for producing it", he explains.
"In type 2 diabetes, the challenge is different. It is necessary to reverse metabolic changes that affect several organs and preserve or recover the pancreas' ability to produce insulin adequately."
Nunes says that medications such as semaglutide and tirzepatide represent "an extraordinary advance" against diabetes.
"In addition to improving glucose control, they promote significant weight loss, reduce visceral fat and improve insulin resistance, acting on mechanisms involved in the development of type 2 diabetes," says Nunes.
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One of the most important findings is perhaps its preventive potential, says the doctor. He cites a study of people with obesity and pre-diabetes — a stage in which high blood sugar levels are a warning sign that the person is developing insulin resistance, which can still be reversed at this point with lifestyle changes.
In this study, only 1.3% of participants treated with tirzepatide developed diabetes after approximately three years, compared to 13.3% in the placebo group.
Melo adds that these medications "act directly at the root of the problem" and "improve insulin production in a very safe way, only increasing if glucose rises."
"They lead to a dramatic improvement in glycemic control. These are medications that have revolutionized treatment."
12% of Brazilian adults are diabetic
At least 16 million Brazilians are diabetic. This is a conservative number, because, according to an estimate from the International Diabetes Federation (IDF), 5 million people in the country live with diabetes, but have not yet been diagnosed.
Considering only the cases already diagnosed, Brazil has the sixth largest population of diabetics in the world, behind China (141 million), India (74 million), Pakistan (33 million), the United States (32 million) and Indonesia (19 million).
"There are around 530 million in the world. In Brazil, 12% of the adult population", says Geloneze Neto.
To raise awareness about the disease, its risks and the importance of diagnosis, for 35 years, November 14th has been considered World Diabetes Day by the IDF. Twenty years ago, the date was recognized and endorsed by the United Nations (UN).
The day was not chosen randomly. On November 14, 1891, Canadian doctor Frederick Grant Banting (1891-1941) was born. His research represented a leap in the quality of life of people with diabetes, a disease whose oldest record dates back to 1500 BC.
Banting was one of the discoverers of insulin, a hormone produced by pancreas cells that regulate the metabolization of carbohydrates, fats and proteins, promoting the absorption of glucose. The discovery earned him and his team the 1923 Nobel Prize in Medicine.
The scientists involved in the research decided to transfer the patent for the symbolic value of US$1 to the University of Toronto — the idea was to make treatments for the disease accessible to as many people as possible.
Credit, Louis Schmidt/University of Toronto/Public domain
What causes diabetes
Diabetes can have several causes. “In type 1, there is genetic predisposition and environmental triggers such as viral infection and many other factors that have been studied and have little evidence,” says Zella.
"In type 2 diabetes there is a genetic interaction associated with environmental triggers such as obesity, physical inactivity, use of certain medications and personal factors such as age, family history of type 2 diabetes, previous gestational diabetes, among others."
The disease is often associated with genetic predisposition, excess body fat, especially abdominal fat, and metabolic changes, says Nunes.
Endocrinologist Maria Edna de Melo, researcher at the Obesity and Metabolic Syndrome Group at the Hospital das Clínicas of the University of São Paulo (USP), comments that, in 80% of diabetes cases, obesity is a predisposing factor.
Nunes remembers, however, that thin people can also develop the disease — and not everyone who is obese necessarily develops it. "This demonstrates the importance of individual predisposition and the way each organism responds to the environment", he comments.
“Basically what happens is a meeting between genetics and environment”, summarizes Geloneze.
Most effective treatments
Experts agree that current treatments offer good prospects for quality of life for diabetics. But there is no cure. What do exist are ways of controlling the disease. And some induce prolonged remission, points out Zella.
"In type 1 diabetes, immunological therapies are managing to preserve beta cell functions [in the pancreas], but not permanently", explains the doctor.
Nunes points out that one of the most promising prospects for the eventual discovery of a cure for type 1 diabetes comes from stem cell research.
A study published in 2025 in the New England Journal of Medicine demonstrated that, after transplantation of cells derived from stem cells capable of producing insulin, 10 of 12 patients who received the full dose became insulin independent after one year.
"It is an extraordinary result, because it represents the possibility of restoring the production of the hormone, and not just replacing it", assesses the doctor.
"However, it is still an experimental treatment, which requires larger studies to assess its long-term safety and effectiveness."
Rafacho also adds that a challenge with this alternative is the immune system's rejection of the treatment.
Zella says that, in type 2 diabetes, remission is possible, but it depends on the reserve of beta cells, which synthesize, store and secrete insulin, in response to increased blood glucose, and sustained weight loss over time.
"The longer the duration of diabetes, the greater the irreversible loss of beta cells, reducing the chance of remission", says the doctor.
A diabetes patient is considered to be in remission when their glycemic index remains within normal limits for at least three months without using medication to control glucose.
"It's achievable and can last for years with sustainable weight loss," says Zella. "But it remains reversible."
This means that the disease and its symptoms can become active again if health care and lifestyle are abandoned.
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Remission x cure
There is an essential distinction between cure and remission, defines Nunes. "In a cure, we hope that the disease has been definitively eliminated. In remission, the parameters that characterize diabetes are no longer present, even without the use of medications to reduce glucose, but the predisposition to the return of the disease remains."
Geloneze talks about "diabetes management" as a more contemporary approach, combined with existing treatments today. Everything so that the person "seeks a different lifestyle" and does not regain weight and present symptoms again.
Nunes' assessment is that type 2 diabetes has had a change in perspective in recent years: what was a "condition of definitive progressive worsening", is now a disease that can "go into remission, in some patients, for a long time".
Nunes has a personal story of overcoming the symptoms of diabetes, in fact. 15 years ago, I was obese, had hypertension and pre-diabetes.
"With changes in diet, physical activity and lifestyle, I managed to lose a significant amount of weight and normalize my glucose and insulin levels", he says.
He defines his case as an early "reversal of pre-diabetes" altering the route to preventing its progression. Nunes remembers that remission should not be seen as a possible goal for every diabetes patient.
"This does not represent failure of him or of the treatment. A person who keeps their diabetes under control, preserves their kidney function, avoids a heart attack, remains physically active and lives with quality is achieving extremely important results, even if they continue to use medications", he highlights.
"The greatest advance in medicine is not understanding the mechanisms of the disease and offering people the possibility of living longer and better, with fewer complications and, when possible, achieving remission", he continues.
"Remission is an important achievement. But protecting the patient's life and health remains our highest goal."
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