Once-daily oral GLP-1 pills are emerging as a potential alternative to weekly injections such as Ozempic and Mounjaro, especially for diabetes-stricken countries in the Global South. The oral versions could make access more affordable and less reliant on the cold chain that injectable GLP-1 drugs and insulin depend on, which is harder to secure in emerging economies.
GLP-1 receptor agonists have been used since 2005, when the first drug, Exenatide, was approved by the US Food and Drug Administration. They work by mimicking the natural gut hormone GLP-1, which instructs the pancreas to release insulin as blood sugar rises, slows digestion and reduces appetite. Weekly injections such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro) dominated the market until recently and also proved successful for weight loss.
“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 Dr Zakir Alavi, an endocrinologist in Karachi, Pakistan, who has treated patients with diabetes and obesity for nearly 30 years. Alavi said GLP drugs have revolutionised the management of type 2 diabetes and obesity, and can help with cardiac and renal outcomes, liver disease, obstructive sleep apnea and osteoarthritis.
Rayaz Malik, a professor of medicine at Weill Cornell Medical College Qatar and a senior consultant at Hamad Medical Corporation in Doha, 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.
The relative affordability of oral semaglutide could make it more accessible. For many countries in the Global South, locally manufactured oral semaglutide is about $18 for a 30-day supply. In Pakistan, locally manufactured tirzepatide costs 17,000 rupees ($61), while imported Mounjaro costs 220,000 rupees ($723). Prices vary widely: in the United States, a month’s supply of Eli Lilly’s Mounjaro costs about $500; in the UK about 199 pounds ($264); in Saudi Arabia 1,261 riyals ($336); and in India 14,766 rupees ($157).
Pakistan has the highest diabetes prevalence in the world, at 31.4 percent of its population, followed by the Marshall Islands (25.7 percent) and Kuwait (25.6 percent). Many other Middle Eastern countries also rank among nations with the highest rates.
Jens Juul Holst, a professor, physician and physiologist who began his work with gut hormones in the 1970s, described the moment his team infused the peptide into people with diabetes. “From then on, we knew that we were really onto something big,” he said. Holst and his team’s discovery led to semaglutide, tirzepatide and a third drug, retatrutide, currently in trials with a potential release in 2027.
But oral GLP-1 medicines face a major hurdle: the stomach. Unlike injections, oral semaglutide must survive digestion before a small fraction is absorbed, meaning it must be taken on an empty stomach at a higher dose. Newer oral drugs such as orforglipron are designed to overcome that limit and can be taken without fasting. Experts note that there are still few head-to-head trials comparing pills directly with injections.
Malik said once-a-week oral GLP medication is not far from reality, and efforts are under way to develop longer-acting formulations, possibly once-a-month doses.
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.