Medication that has been a lifeline for patients with uncontrollable diabetes is now slowly shifting from injections to pills, a move that could fundamentally alter treatment for the disease – and who can access it.
This shift could also affect the treatment of obesity, a long misunderstood condition once associated with overeating and laziness, rather than the metabolic disorder it is now recognised as.
GLP-1 (glucagon-like peptide-1) receptor agonists therapy isn't new. The first FDA-approved drug, Exenatide, hit the market in 2005 and was followed by Liraglutide in 2009, which was seen as a revolutionary alternative to insulin.
But the market has until recently been dominated by weekly injections like Ozempic and Wegovy (semaglutide), and Mounjaro (tirzepatide). These drugs have also proved successful for weight loss.
Now, once-daily oral GLP pills are emerging as an alternative, especially for the diabetes-stricken Global South.
Oral once-daily pills of the same wonder drug could make access more affordable, and less reliant on the cold chain that GLP-1 injections and insulin depend on – and that are harder to secure in emerging economies.
Why this matters
One in nine people in the world between the ages of 20-79 lives with diabetes, and one in eight people globally is obese.
The GLP injections come with a high price tag and are often not covered by insurance companies, which treat them as an elective drug.
In the United States, Eli Lily's Mounjaro costs about $500 for a month's worth of doses; in the UK, about 199 pounds ($264); and in Saudi Arabia, 1,261 riyals ($336). In India, the brand is locally manufactured and available at 14,766 rupees ($157). In Pakistan, the imported Mounjaro is a whopping 220,000 rupees ($723), while the locally manufactured Tirzepatide from Getz Pharma costs 17,000 rupees ($61).
While pills are usually taken once a day, injections are once per week.
Pakistan has the highest diabetes prevalence in the world – 31.4 percent of its population suffer from the disease – followed by the Marshall Islands (25.7 percent) and Kuwait (25.6 percent).
Many other Middle Eastern countries rank among nations with the highest diabetes prevalence.
Pakistan 31.4 percent.
Marshall Islands 25.7 percent.
Kuwait 25.6 percent.
Samoa 25.4 percent.
Qatar 24.6 percent.
Kiribati 24.6 percent.
Saudi Arabia 23.1 percent.
French Polynesia 22.8 percent.
Egypt 22.4 percent.
Bahrain 22.1 percent.
For many countries in the Global South, the relative affordability of oral GLP drugs, where the locally manufactured oral semaglutide is about $18 for a 30-day supply, could make them more accessible for diabetes and obesity patients, remove the need for refrigeration and make rural distribution easier.
Dr Zakir Alavi is an endocrinologist in Karachi, Pakistan and has been treating patients with diabetes and obesity for nearly 30 years.
"Pakistan is a country of contrast. We have, on one hand, childhood malnutrition, underweight, and stunted growth. On the other hand, we have childhood and adult obesity," said Alavi. "And surprisingly, there is at least some element in the adult and childhood obesity which can be linked to a malnourished mother, and an underweight, premature baby."
Malnutrition during pregnancy can lead to low birth weight, and babies born small who gain weight rapidly in infancy face a higher risk of childhood obesity, according to doctors.
Alavi said GLP drugs – whether the injectables or pills – have revolutionised the management of type 2 diabetes and obesity. They not only help type 2 diabetes patients manage their weight, but can also help non-diabetics tackle obesity, improving cardiac and renal outcomes, liver disease, obstructive sleep apnea and osteoarthritis.
"They can be used for management of all these things when weight reduction is important, or sugar control is important, or both," he said.
Rayaz Malik is a professor of medicine at Weill Cornell Medica College Qatar, and a senior consultant at Hamad Medical Corporation in Doha. Malik has been at the front line of helping patients with diabetes and obesity, and he echoed Alavi's views.
"We looked at how much weight you need to lose to cure diabetes, the magic number seemed to come in at around 15kg, at least," he said, speaking of research on the subject.
With the wider availability of GLP medication in oral pill form, a cure for diabetes is closer than ever for many more people.
How was GLP therapy discovered?
Jens Juul Holst is one of the central scientists behind the GLP revolution that has given millions around the world a way to live with diabetes and, for those struggling with obesity, a chance to reclaim their bodies.
A professor, physician and physiologist, Holst lives in Copenhagen and began his journey with gut hormones in the 1970s.
"When we discovered this, what we found was an insulin-releasing peptide from the gut," Holst told Al Jazeera. "We were interested in what regulates insulin secretion, and that was as a physiological mechanism because we had some people who were developing too low blood glucose levels, [which is called] hypoglycemia, and we were looking for a peptide that could create insulin release stimulation and then be responsible for the low glucose levels."
He says reactive hypoglycemia, which patients experience after certain operations like bariatric surgery, explains how the GLP molecule works.
Eventually, his team discovered that the molecule plays a role not only in insulin release and secretion, but also helps regulate appetite and food intake.
"The discovery of that was actually perhaps even more exciting than the discovery of its insulin-releasing activities," Holst said, the excitement in his voice rising. "And then, the big day really was when we were able to infuse people with diabetes with this new peptide and see what happened."
They found that an intravenous infusion of GLP-1 "would normalise blood glucose levels completely in people with long-standing, problematic type 2 diabetes and this happened in the course of four hours," he said. "From then on, we knew that we were really onto something big."
Holst and his team's discovery led to what is now known as semaglutide, which paved the way for another drug, tirzepatide, and a third drug called retatrutide that is currently undergoing trials with a potential release in 2027.
Eli Lilly and Novo Nordisk, two of the primary manufacturers, expect the GLP market to jump from $80bn per year to $135bn by 2030.
Obesity alone was responsible for 3.7 million deaths worldwide in 2024.
In December 2025, the World Health Organization issued guidelines recommending GLP-1 medicines as a long-term treatment for obesity, which affects more than 1 billion people globally.
"As we realised that it was a very good anti-diabetic therapy, it was obvious that millions could benefit from this," Holst said.
"Because now you have a population which is 40 percent of the globe who would be interested in regulating body weight and the amount of interest would be huge," he said, referring to the WHO's 2016 estimate that 39 percent of adults worldwide are overweight. In 2024, WHO revised this estimate to 45 percent.
How do GLP drugs work?
Injectable GLP medicines, particularly tirzepatide and semaglutide, remain the most effective treatments because they provide the strongest evidence for long-term weight loss and cardiovascular benefits.
The human gut releases a hormone called GLP-1 when we eat. As blood sugar rises, GLP-1 instructs your pancreas to release insulin. GIP is a gut hormone also released when we eat. Like GLP-1, it tells the pancreas to release insulin as blood sugar rises.
GLP-1 also slows how quickly food leaves your stomach, helping you feel full. GLP-1 medicines, therefore, mimic the hormone's effects to lower blood sugar and reduce appetite.
Imagine a six-way traffic light when the lights aren't working, leading to chaos over who can pass the intersection and who can't.
Semaglutide, a GLP-1 drug, works on one receptor. This is like having a single-lane underpass at this intersection, meaning there is a guaranteed flow of traffic, albeit limited.
Tirzepatide is a GLP and a GIP, meaning it works on two receptors. That's like having a signal-free overhead bridge, traffic lights at the intersection and an underpass making traffic much smoother. In effect, the organs and cells are rerouted to work the way they are supposed to.
Will oral GLP drugs work as well as the injections?
Oral GLP-1 medicines promise the convenience of a pill without sacrificing much of the weight-loss effect, but they still face one major hurdle: the stomach.
Unlike injections, which deliver the drug directly into the body, oral semaglutide must survive digestion before a small fraction is absorbed.
That is why it must be taken on an empty stomach and at a higher dose.
Newer oral GLP-1 drugs such as orforglipron, however, are designed to overcome those limits and can be taken without fasting.
While oral drugs appear capable of delivering similar results for many patients, there are still few head-to-head trials comparing pills directly with injections, experts say.
Who stands to benefit most?
The biggest winners may be people in countries already carrying the world's heaviest diabetes burden.
If future versions become available as tablets and prices fall after patent expiry, the impact in South Asia and the Middle East could be enormous.
Malik said once-a-week GLP oral medication isn't that far from being a reality.
Meanwhile, he added, efforts are also under way to develop formulations of the current drugs that are much longer-acting – once-a-month doses might work.
What makes the GLP-1 drugs work is their ability to mimic what the body naturally does, Malik said.
"The clever way for treatment is to do what your human body is doing," he said. "And it's transforming people's lives."
