Eli Lilly's weight loss drug slashes the risk of diabetes in long-term trial

https://www.cnbc.com/2024/08/20/eli-lilly-weight-loss-drug-cuts-risk-of-developing-diabetes-in-trial.html

by paulpauper • 2 years ago

88 150 2 years ago

daft_pink• 2 years ago

I use it. It’s amazing. If your insurance will cover it and you have these symptoms, you should get it!

paulpauper3• 2 years ago

This is the closet thing to a wonder drug for the 21st century. You can see the transformation ...people who used to be obese seeing the fat melt off, when nothing else seemed to work.

tyrefd5• 2 years ago

The wonder here is effective brain manipulation rather than fat melting.

These drugs are chemically induced intermittent fasting.

I’m okay with people saying “these drugs force people into healthy eating habits” but the weight loss itself is merely a symptom of the healthy eating habits that would be healthier on the body when done with discipline rather than chemically altering your digestion.

raincom• 2 years ago

Humans are biochemical machines. Hormones (chemicals) regulate many systems in humans. So, you want people to eat less and work out more, when hormones, or biochemical subsystems, are messed up?

djur14• 2 years ago

Anecdotally, the people I know who have been taking GLP-1 agonists have not been following eating patterns consistent with "intermittent fasting". They're just eating less (especially snacking).

teqsun• 2 years ago

I see it as a replacement for invasive surgical methods like lap-band surgery.

ctoth• 2 years ago

when done with discipline

I suppose that the drug also cures people with Parkinson's [0] through ... Discipline, right?

0: GLP-1 Receptor Agonists: A New Treatment in Parkinson’s Disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11011817/

petesergeant5• 2 years ago

The wonder here is effective brain manipulation rather than fat melting.

Yes

These drugs are chemically induced intermittent fasting.

No, they're a type of calorie restriction, as is intermittent fasting.

leovander• 2 years ago

Hopefully they reduce the cost overall. As soon as people are taken off it, whether that be because they finished their trial or they get out priced, appetite shoots right back to what it was before and the weight comes back with it unless the person changed their habits.

ryandrake• 2 years ago

This seems to be a great outcome if you're the drugmaker. You don't want your medicine to cure the patient, otherwise they'll stop buying it. I bet if they found an alternate drug that worked permanently after N doses, they'd bury it and never productize it.

flakiness2• 2 years ago

Long term the patent expires and it becomes a generic. That's I think when the real transformation starts.

standardUser• 2 years ago

Gabapentin may be a wonder drug, helping with heretofore barely-treatable conditions and the ravages of addiction.

Weight lose drugs are just a shortcut for something that is possibly for the vast majority of people without any drugs. Don't get me wrong, they seem great! But a drug that can help with seizures, nerve pain, alcoholism and anxiety sounds a little more "wondery" to me.

meany2• 2 years ago

I don’t think the data supports that it is possible for the majority of people. On traditional diets, Between 80 and 85 percent of those who lose a large amount of weight regain it. Source: https://stanfordhealthcare.org/medical-conditions/healthy-li....

ribosometronome3• 2 years ago

Gabapentin is 20th century medicine. It's from 1993.

toephu22• 2 years ago

But what are the long-term side effects? You don't get something for nothing. There is no such thing as a magic pill that makes you magically lose weight without any consequences.

davikr• 2 years ago

Why couldn't there be? There are magic pills that lower your blood pressure without any consequence.

GavinMcG• 2 years ago

You don’t get something for nothing

If that were true about the human condition in the same way that it’s true for conservation of mass, we wouldn't be living longer and healthier lives than our forebears. Yet here we are.

Of course we should be aware of side-effects. But there’s no law of nature that says there have to be any serious ones.

__MatrixMan__• 2 years ago

There's some concern about how it affects the retina: https://www.aao.org/eyenet/article/update-on-semaglutide-ris...

petesergeant5• 2 years ago

You don't get something for nothing

This is medicine, not witchcraft.

semaglp17• 2 years ago

There's some evidence of bone density being affected negatively, which could be prevented with exercise: https://jamanetwork.com/journals/jamanetworkopen/fullarticle...

I've also read anecdotal reports of skin burning sensations from people that take it.

If people can take it to lose weight and curb food addiction while also beginning strength training for long term health, I think that's a positive.

panarky• 2 years ago

The long-term is a luxury that healthy people can worry about.

Obese people are also at much greater risk for diabetes, heart failure, kidney failure, liver failure, depression, anxiety and suicide.

If a drug can add 20 years to my lifespan, I'll take it and worry about long-term side effects later.

Because without the drug, there's a good chance I'd die from something else before reaching the long term.

paulmd• 2 years ago

GLP-1 drugs have been studied for decades and the side effects are incredibly low/small.

The bigger problem is frankly the reaction you display, that even if the side effects were actually zero that people feel that’s “unfair” and that others shouldn’t be taking a pill to do something their personal body chemistry doesn’t do properly.

Your thyroid medication is really a moral failing, you see. Just eat less and your weight will remain healthy.

drooby• 2 years ago

Any estimates on how much this will relieve our healthcare system.. aren't diabetes and CVD the biggest burdens?

Will insurance costs come down if the US becomes healthier?

warkdarrior• 2 years ago

Will insurance costs come down if the US becomes healthier?

Health insurance prices in US are not related to demand, but to how much the market can bear. It may even go the other way, if drug companies decide to increase prices to make up for reduced demand ("we still need to recoup our drug R&D costs, so fewer sales means higher prices").

lotsofpulp5• 2 years ago

ACA compliant health insurance premiums are only for healthcare for under 65 year olds. I’m sure there is quite a bit of spend in there for diabetes/CVD/and other obesity related health issues, but the bigger impact would be on Medicare spending (65+ year olds), which is a federal expense.

Edit: note that the weight loss drugs may not decrease healthcare spend. For example, if it leads to more people living longer and utilizing other more expensive healthcare such as dialysis or cancer treatments, then the net effect will be an increase. For example, 25% of all Medicare spend is just for dialysis or kidney related issues.

https://www.kidney.org/sites/default/files/fy2023_kidney_dis...

mensetmanusman2• 2 years ago

Costs are $10k annual for life, might not help.

lotsofpulp5• 2 years ago

The patent should expire in 20 years or so, and presumably there will be advancements in mechanisms to administer it/generics that bring down the price.

petesergeant5• 2 years ago

In the US only, it's much much cheaper in the UK, UAE, Canada.

sisk• 2 years ago

Price will come down and, in the meantime, compounding pharmacies are filling the gap in addressing stock shortages and high prices. Just be sure to use a reputable pharmacy if you decided to go that route.

NickC253• 2 years ago

Any estimates on how much this will relieve our healthcare system.. aren't diabetes and CVD the biggest burdens?

I know diabetes is up there, but I was also under the impression that cancer and cancer-adjacent issues were a much larger burden on the system than CVD or end-of-life care (or aging related problems like arthritis or dementia). Could be wrong though - I'd love to see numbers and statistics.

Will insurance costs come down if the US becomes healthier?

No. Insurers are public companies and need to increase profits every quarter. Lowering costs harms this ability tremendously.

lotsofpulp5• 2 years ago

No. Insurers are public companies and need to increase profits every quarter. Lowering costs harms this ability tremendously.

And selling their insurance at higher prices than their competitors harms their ability to sell their insurance to customers. Hopefully, you or your employer are shopping around, and not just for health insurance.

ribosometronome3• 2 years ago

Any estimates on how much this will relieve our healthcare system.. aren't diabetes and CVD the biggest burdens?

Long term, I don't think this will necessarily decrease healthcare costs or the burden on the system. Ignoring the cost of the drugs, people not having diabetes means they're going to live longer and develop all the complex conditions that come with getting to be 75+.

skrtskrt4• 2 years ago

sure but heart conditions from obesity and poor diet can start showing up as early as your 40s and ramp up quickly from there

sva_• 2 years ago

Damn, that molecule!

https://en.m.wikipedia.org/wiki/Tirzepatide#/media/File%3ATi...

This seems to work very similar to Ozempic?

sk110013• 2 years ago

Yes, semaglutide (made by Novo Nordisk, brand names Ozempic, Wegovy) is a GLP-1 agonist; tirzepatide (made by Eli Lilly, brand names Mounjaro, Zepbound) is a dual GLP-1 and GIP agonist. Tirzepatide is newer and more effective, otherwise they're very similar - once a week injection, significantly reduces appetite, the use cases are diabetes and weight loss. Eli Lilly also have retatrutide in their pipeline which is a triple (GLP-1, GIP, glucagon) agonist, and which will likely be even better and will be available in a couple of years.

astura• 2 years ago

This seems to work very similar to Ozempic?

Yes, both drugs are Glucagon-like peptide-1 (GLP-1) receptor agonists.

https://en.wikipedia.org/wiki/GLP-1_receptor_agonist

cm2012• 2 years ago

The same, both came from studying Gila Monster venom in the 90s!

tstrimple• 2 years ago

I had no idea! Fascinating.

https://www.genesislifestylemedicine.com/blog/the-science-be...

petesergeant5• 2 years ago

Anecdotally (and in studies) it's much more effective, though. Retatrutide is the next gen one you could look up.

Mistletoe• 2 years ago

They don't call it diabesity for nothing...

The accumulation of an excessive amount of body fat can cause type 2 diabetes, and the risk of type 2 diabetes increases linearly with an increase in body mass index. Accordingly, the worldwide increase in the prevalence of obesity has led to a concomitant increase in the prevalence of type 2 diabetes.

I'd love to see the math on how much the governement would save just handing this out for free to people vs. paying the lifetime of medical costs and burdens to the medicare system, etc. Seems this is $1000 a month without insurance now, I wonder how low it needs to go to be cost effective? It's really expensive to be obese, have diabetes, cancer, heart disease...

CamperBob2• 2 years ago

It's really expensive to be obese, have diabetes, cancer, heart disease...

From the insurance companies' perspective, what's really expensive is living too long, rather than dying early. My family has gold-plated health insurance by most standards, but it doesn't cover Ozempic.

You'd think they would hand out Ozempic like candy, but evidently they're afraid it will work too well.

ribosometronome3• 2 years ago

It's also a $12k a year medication that potentially half their customers would want and qualify for under if obesity is qualifying alone. I can understand why they'd quake in fear at the cost. It's a real shame as these drugs will course correct the obesity epidemic and give millions of people decades of life they probably would not have gotten.

Snoozle• 2 years ago

From reading about this and Ozempic it appears the main functionality is reducing appetite / blood sugar spikes which results in weight loss. I am curious for those who are using it who have traditionally had a relatively poor diet (refined carbs, sugars, etc), has it changed what foods are desirable or does it simply reduce the amount eaten? In addition, when using these products and switching to a healthy diet such as high protein, which already typically affects satiety, does it cause the inability to eat an adequate amount of calories to function properly?

sk110013• 2 years ago

The changes are in quantity and quality of food - it basically gives me self control around food which I've never experienced before.

joshstrange• 2 years ago

From what I understand about Ozempic and friends is that it's not meant for super long-term use (I can't remember the exact time, like months to a year at most). Do you feel like that's reasonable? As in, do you feel like this is letting you form better habits that will continue after you stop using it? Or do you even have a feel for that (probably hard to guess how you will feel when you are off it)?

petesergeant5• 2 years ago

I've had both a good diet and a bad diet...

has it changed what foods are desirable

No, although anecdotally some people find they can't eat high-fat foods any more. It has changed my reaction to hyperpalatable foods though, in that I don't really get the buzzing "just smoked a cigarette" effect from them any more.

when using these products and switching to a healthy diet such as high protein, which already typically affects satiety, does it cause the inability to eat an adequate amount of calories to function properly

Not if you don't ramp your dosage up too quickly, but if you were to overdo it, then I guess it would.

lr4444lr3• 2 years ago

does it cause the inability to eat an adequate amount of calories to function properly

IANAD, but anecdotally it has been seen that a substantial - and arguably worrisome - amount of the weight loss is in lean body mass[0], so probably. GLP-1 agonists are for many obese and at-risk diabetics a worthwhile trade-off. Losing that last pesky 10 lbs. because you don't want to give up your daily 500 calorie latte? Probably not.

[0] https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.157...

oarfish• 2 years ago

If you dont resistance train, any weight loss regimen will cause a loss of lean body mass, medications aren't different from an "organically" achieved caloric deficit. Training and size of the deficit as well as genetics heavily shift the proportion of adipose to lean tissue (which includes water) lost.

So far as i know, the signal that glp1 agonists are particularly worse for lean mass retention isn't strong enough to claim that they're worse for muscle mass retention than normal dieting.

nox101• 2 years ago

I am curious too. I'm not "obese" by the medical defs (84kg, 177cm, 50s) but I could eat forever and constantly and I find that every time I finish some small amount of work (need to switch to the next issue) I get up and walk to the refrigerator looking for a snack. I generally keep from overeating by just not having any junk food nearby (though that's harder at work) and almost no calorie laden drinks. I don't feel hungry, I just seem to love eating. So I wonder if Ozempic would have any affect if all it does is remove my appetite since it "feels" like I don't have one most of the time.

efitz2• 2 years ago

I just seem to love eating

Or it could be compulsive behavior, which can be diagnosed and treated either with counseling or medication.

Fire-Dragon-DoL2• 2 years ago

I'm 35, same weight and similar symptoms. I'm just always hungry.

I found some sort of balance where I go 5 times/week to the gym, increased muscles and eat very healthy (fruit, legumes, chicken, veggies). It still didn't solve the problem of being always hungry.

I could say it's psychological, but my son, 3, is the same: he is constantly looking for food. My daughter (6) is like my wife and she sometimes barely eats.

I'd love to lose weight though. I have been going to the gym a lot for the whole year, but my weight dropped only temporarily.

UI_at_80x242• 2 years ago

I was diagnosed with Diabetes 2 years ago. As soon as I found out I immediately changed my diet. 0 carbs My blood sugar would still go too high. My fasting blood sugar (first reading in the morning after waking up. "12+hr fasting") was often the highest of the day. I spent the next 14 months trying different drugs to mitigate my blood sugar levels. So one day out of desperation I asked my Doctor if i could try ozempic.

It worked INCREDIBLY well. I started adding carbs back into my diet. My blood sugar stayed in good shape. I started loosing weight too. Before Ozempic and going 0-carbs I lost ~20lbs over 14 months. After taking Ozempic I have lost ~80lbs.

I still STRONGLY desire sugar/sugary foods. My cravings for bread is really bad too.

Ozempic controlled my sugar so well that I have been able to add carbs back into my life.

talldatethrow4• 2 years ago

My dad was like you. At age 61 I finally got him to try 90 days of only fresh home squeezed/extracted vegetable juice. Technically all his calories those 3 months came from the sugars in the vegetables (celery, beets, carrots, cucumbers, tomato, orange).

All his markers improved, even diabetic markers, and blood pressure. He's off the 3 meds he was on.

ddorian437• 2 years ago

Did you measure 1 hour after wake up? At wakeup there's the "dawn effect" where glucose rises/ketones fall.

What diet did you really try? Keto diet is known to ~easily fix T2D. A good company that can do that is virtahealth.com.

The only way to quit drugs (sugar) is to no take drugs at all, not take less drugs.

Source: I do keto diet but for other reasons. I was addicted to carbs, but not fat, and am no more. I would end up as T2D in 10-20 years though. If I restart carbs I will get addicted again.

sfjailbird• 2 years ago

Is it even possible to have high blood sugar while eating zero carbs? You could be catabolising muscle mass but that would be a case of extreme malnutrition and/or type 1 diabetes.

These drugs fix symptoms only, and only for ad long as you keep using them. They have adverse effects, and probably well beyond the published ones. Most signs point to T2D being caused by insulin resistance, which builds up through bad diet and lifestyle. You can 'fix' symptoms by forcing the body to pump out more insulin, but science and common sense would indicate that this could end up worse off in the long run.

gumby• 2 years ago

I believe this class of drug also suppress glycogen emission from the liver when exercising or eating.

EasyMark3• 2 years ago

You answered your own question. “… reducing appetite…” . It’s all about CICO but also not about that. The real game-changer is the fact people don’t have to have the will power of a Zen guru to fight off the hunger pangs. That’s the 90% you should take away from this. It’s almost effortless, and that’s a huge deal. People have been proposing what you say for a 100 years and obesity only got worse. If a drug can fix it relatively safely more power to them.

darreninthenet• 2 years ago

Can non-diabetics use this? Even though I'm morbidly obese (by BMI) I don't have any related health conditions (eg diabetes, blood pressure etc) (yet), probably because I'm still fairly active.

But I do clearly have an eating issue, was wondering if I can use this to help control it... also what happens when people come off it..?

sk110013• 2 years ago

Yes, it's treatment for obesity too, not just diabetes. Many of the people who come off it gain back a significant amount of weight (good to keep in mind that most people regain weight regardless of the method of weight loss, this effect isn't specific to this medication).

lr4444lr3• 2 years ago

Yes, they aid in weight loss. Ozempic is the same class of drug. Long-term effects and discontinuation are your roulette wheel to spin. Ask your doctor.

paulpauper3• 2 years ago

Yes. Non-diabetics actually tend to lose more weight

jmull3• 2 years ago

Yes. Talk to your doctor. IMO, far better to address your weight before it causes health problems than after.

(My brother was in a similar situation as you. BMI out-of-control his whole life, really. No real health problems, though he felt it was just a matter of time. Tried all the things — and remains a very avid walker — but could not reduce his weight substantially until Ozempic. He’s looking good now, quality of life is higher, and I’ve got to believe he’ll live longer.)

istultus• 2 years ago

There's humor that a drug developed to treat diabetes, using a peptide we know physiologically to lower blood sugar, and secondarily found to also help drop weight is now getting headlines showing that it does its stated purpose.*

* Yes, I get that this is supposedly a preventive study - but if your metric for diabetes is blood glucose level, and you take a drug that lowers blood glucose level, it's not surprising that people on it are found to "fail" to reach the given threshold for diabetes on average

efitz2• 2 years ago

And the TFA is basically an interview with the CEO of the company that makes the drug, saying "it works".

jmull3• 2 years ago

This is kind of amazing.

We actually have the miracle “weight-loss pill” we’ve always dreamed of.

I get it, not actually a pill, but the point is there appears to be a straightforward way to attain a healthy weight that will work for a large proportion of people.

Some possible drawbacks…

affordability - if it’s $1K/mo, it’s actually not feasible for a large proportion of people.

maintaining - seems like you probably have to keep taking the drug forever to maintain the benefit. That is, if you stop, the weight comes back.

negative long-term consequences? - It’s great to hear about the positive consequences of this, but since it appears you have to take the drug long-term, what are the negative consequences to doing so?

Personally, I’m a couple months into a diet to get to a healthy weight (a light-weight form of calorie counting). It’s working (yay), but if I don’t do it just right I end up hungry for significant periods of time. That’s miserable, and if it happens too much I probably can’t maintain the diet.

A miracle weight-loss drug sure is looking attractive right now.

paulpauper3• 2 years ago

Yeah. This is what people have been hoping for decades. A safe and effective non-surgical weight loss treatment. This is it.

404mm• 2 years ago

safe

Have you read the drug label?

I actually just picked up my first dose today and I’m still not sure if I want to take it.

blackeyeblitzar2• 2 years ago

negative long-term consequences? - It’s great to hear about the positive consequences of this, but since it appears you have to take the drug long-term, what are the negative consequences to doing so?

The GLP drugs very commonly cause GI issues. It isn’t clear yet if those effects can be permanent but they do remain at least for a while after stopping treatment.

Nzen• 2 years ago

The npr segment I heard yesterday [0] called out nausea and muscle loss among actual users.

[0] https://www.northernpublicradio.org/2024-08-19/ozempic-takes...

ddorian437• 2 years ago

It is a weight loss drug, but you will lose muscle. And you will still eat bad food. And you still have cravings for bad food.

skrtskrt4• 2 years ago

if you have paid attention to any article in the last year, one of the primary functions of these drugs is reducing the cravings.

OptionOfT• 2 years ago

On the contrary, it stops the cravings. And you're full for longer as it slows down the passage of food in your system.

Of course, it is up to the user to 1) exercise and 2) eat healthy.

insane_dreamer7• 2 years ago

Or, we could change our lifestyle and stop eating so much of the highly processed foods that make most of us obese in the first place.

Again, we're trying to fix the symptom instead of dealing with the root cause -- because we don't want to give up our Mountain Dew and Frito Lay.

skrtskrt4• 2 years ago

you would have to fix the entire system of food availability. we are still programmed to pack on and store energy as soon as it's available.

it gets harder and hard to constantly make good choices as you go down the income ladder not just due to the food environment but also because people on the whole just cognitively cannot make these decisions optimally all the time when they are tired, stressed, and overworked.

rincebrain2• 2 years ago

The problem is that for some people, it's not just "make better choices" - there's various research that shows once you made those poor choices, or had them made for you when younger, some of the marks that leaves on your brain's expectations last. Various people have remarked on how they've tried avoiding large classes of food that might be "unhealthy" and exercised intensely, and nothing changed for them without this.

To say nothing of, as the other poster said, how much time+money it can be to avoid, particularly when you've not got much spare income, so the difference might mean not having to skip a meal this week to afford your medication, even if it might be lead-filled or the equivalent that'll harm you over time (and not just directly, in money saved - making your own rounded meals costs a bunch of time, and sometimes upfront costs, and if you're that low on resources, you might not have that time to spare.)

I would agree the correct way to mitigate this is to do things like ban HFCS, among other things, and start aggressively researching the harms of anything remotely sweetener or addictive behavior-forming in foods, because if you remove the thing that triggers an excessive "MORE" response in some people, you better believe you're starting whack-a-mole with food companies finding other addictives that secretly cause your toes to fall off in 20 years but taste 5000x as sweet, or something.

djur14• 2 years ago

"Availability of hyperpalatable foods" and "urge to eat hyperpalatable foods to excess" are both prior causes to "eating hyperpalatable foods to excess", even if neither of them are a root cause (and I don't think the root cause can be addressed). GLP-1 agonists address both symptoms and causes.

illiac7862• 2 years ago

It’s like saying “you could learn 12h a day Japanese and be fluent in months instead on relying on crap google translate”. Some can easily learn languages, for others it’s super hard. Same for changing eating habits. For these people ozempic is the achievable goal, far better that the status quo.

vharuck• 2 years ago

The prevalence of obesity has risen dramatically in the United States over the years. I find it hard to believe the average level of self control has fallen that much in so few generations. It's more likely to be a systemic problem, which is better solved collectively.

jmull3• 2 years ago

I guess I can’t blame you for this response.

Diet has psychological, social, evolutionary, physiological, hormonal, economic, aspects (and more). Not only does that make it difficult to eat on a rational basis, people don’t even seem to be able to think or talk about diet rationally.

I think if you examine your comment, you’ll probably be able to spot some rather unlikely explicit and implicit assumptions, which will lead you to reconsider. I say this under the presumption you want to be a help (because if you don’t, no one gives a fuck what you have to say).

You want to think about causes that could actually explain the problem so that you can think of solutions that could actually work.

IMO, “eat better” is a good place to start, but the “how” is completely missing (not to mention, avoiding chips and pop is barely getting started with good eating). I think you need to think a little deeper about this.

maxerickson• 2 years ago

It seems that part of the effect of the drugs is to make people more likely to give up their Mountain Dew and Frito Lay.

tiffanyh• 2 years ago

Is this "Correlation vs Causation"?

Seems like diabetes is strongly correlated to your weight.

If this pill suppresses hungry, causing you to lose weight, have healthier teeth because you're eating less, and since you lost weight - less likely to get diabetes ... what's Correlation vs Causation here?

flakiness2• 2 years ago

FYI There is a podcast series about this from WSJ. A good overview of this Ozempic phenomena if you have not been following. https://open.spotify.com/playlist/0qijsxLd9QvGe3cwWBNAwk

ThinkBeat• 2 years ago

You can keep eating shit, you don't need to exercise, just take a diet pill every day for the rest of your life. (Or regular injections or whatever means of delivery.

If you stop taking it you get fat again, that is what I have seen at least, but not with this drug in particular.

EasyMark3• 2 years ago

Or you know you can find a middle ground and learn to eat better while also losing weight and not having to fight the cravings every second of every day. It has been like a reset for some of the people I’ve know and the doctors weaned them off it after the weight loss. Mind you that’s only 2 people but I can’t think of anything that would make them “different” all that much from the general populous. They picked up better eating habits along the way as well.

ngcc_hk• 2 years ago

As this is temporary, a more important way to deal with diabetes II is to use a painless measurement device. You cannot manage without measurement. Once you have numbers, you can control the drug use and the food intake. Of course making your own bread helps. But making your own meals even better. As all these help to understand and control. But eaten outside you have to use measurements

Eli Lilly's weight loss drug slashes the risk of diabetes in long-term trial

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