Written by Rinku GhoshNew Delhi | November 4, 2025 07:22 AM IST 5 min readA 55-year-old entrepreneur, with a family history of ischemic heart disease, felt he was sitting on a ticking time bomb as he had hypertension and Type 2 diabetes. When he came to see Dr Abhijit Bhograj, endocrinologist at Manipal Hospital, Bengaluru, he was worried because his diabetes remained uncontrolled despite being on metformin and other supportive medications, including one for high blood pressure, for five years. He asked the doctor if there was any other way he could get his blood sugar levels down.His HbA1c count (average blood sugar over three months) was eight per cent, which should be ideally below 5.7 per cent. His body mass index (BMI) was 26.5 kg/m² (the normal range being below 24.9 kg/m²) and his waist circumference was over 40 inches. “Given his family history of heart disease and two risk factors in diabetes and high blood pressure, I put him on Rybelsus, the oral diabetes drug belonging to the new class of GLP1 receptor agonists. In addition to managing blood sugar, Rybelsus is also approved to reduce the risk of major cardiovascular events such as heart attack, stroke, or death in adults with Type 2 diabetes who are at high risk of these events. It does so by reducing the bad cholesterol or low density lipoprotein (LDL) and even triglycerides,” says Dr Bhograj.Its active ingredient is semaglutide and it works by mimicking the hormone GLP-1, which slows down stomach emptying, helps you feel full longer and decreases appetite, all of which can lead to reduced calorie intake and weight loss. It signals the body to produce more insulin only when blood sugar is high, regulating its levels. It reduces the liver’s production of glucagon, a hormone that raises blood sugar, which helps stabilize glucose levels and prevents hunger caused by blood sugar swings.But now the FDA has expanded its use based on new evidence from the SOUL trial, which showed the drug can reduce cardiovascular risks in patients by almost 14 per cent.How Rybelsus lowered weight tooAt the end of three months, there was a perceptible difference in the businessman’s HbA1c as it came down from eight per cent to seven per cent. “This encouraged him and he made several lifestyle adjustments, including maintaining a regular exercise and clean diet regime. At the end of six months, his HbA1c improved to six per cent. At the end of eight months, my patient lost eight kilograms, from 80 kg to 72 kg. His BMI is down to 24.1 kg/m². So metabolically speaking, his body was not fighting against him anymore,” says Dr Bhograj.Not only that, the other risk factors that worried the doctor, like blood pressure and belly fat or visceral fat, which is measured by waistline, went down. “By delaying emptying of the stomach, optimising insulin levels, thereby preventing excess buildup of blood sugar and reducing appetite by sending satiety signals to the brain, my patient lost some initial weight that could motivate him towards a weight loss journey too,” says Dr Bhograj.In fact, the new drug regime got rid of the very stubborn visceral fat. “Unlike the fat around the skin, the fat around the belly releases inflammatory substances that can damage blood vessels and promote fat deposition, a condition called atherosclerosis, where arteries harden and narrow. It can stiffen up the arteries, making it harder for blood to flow and leading to high blood pressure. Belly fat can interfere with insulin, and lead to high blood sugar levels, one of the reasons that my patient had difficulty managing them. Excess fat can lead to heart structure and function abnormalities, even before other symptoms of heart failure appear. It can also increase the risk of heart arrhythmias and other cardiac problems,” explains Dr Bhojraj.How the businessman managed side effects of RybelsusStory continues below this adOral semaglutide like Rybelsus has shown a higher rate of gastro-intestinal side effects, such as nausea and abdominal pain, than injectable versions. “That’s why I graded my patient’s dose gradually from 3 mg onwards. He did have some bloating and nausea, which had to be treated symptomatically. But what really made him adjust better was the way he was preparing his body for sustained weight loss and evolving a maintainable lifestyle discipline,” says Dr Bhograj.No more troubled by snack breaks, his patient focussed on a clen diet free of fatty and processed foods. He included non-starchy vegetables, fruits, whole grains, legumes, nuts, seeds and fish, relying more on plant proteins. He took up strength training twice or thrice a week with bodyweight exercises, resistance bands or light weights. This gradually helped build lean mass which eliminated the body fat.Should Rybelsus be had indefinitely?Rybelsus is typically prescribed as a long-term treatment for managing type 2 diabetes. “It is intended to be taken every day, along with a healthy diet and exercise, potentially for years, provided it is safe and effective for the patient. The exact duration is determined by a healthcare provider based on the individual patient’s needs and response to the medication. But as my patient shows, addressing metabolic risk factors early with lifestyle alongside GLP-1 therapy can reduce cardiovascular risks and move toward disease remission rather than simple management,” says Dr Bhograj.© The Indian Express Pvt LtdTags:Heart diseaseweight loss