Type-2 diabetes

Synthetic long-acting amylin analog being developed in combination with semaglutide (CagriSema). Phase 3 trials for obesity and type 2 diabetes are ongoing. No marketing approval yet.

CagriSema is a fixed-dose combination of the amylin analogue cagrilintide and the GLP-1 agonist semaglutide (Novo Nordisk), in late-stage development for obesity and type 2 diabetes.

GLP-1 receptor agonist designed as a fusion protein of two modified GLP-1(7-37) sequences covalently linked to a human IgG4-Fc fragment. FDA-approved 2014 (Trulicity) for type 2 diabetes; EMA approval 2014.

Ecnoglutide (XW003) is a long-acting, cAMP-signalling-biased GLP-1 analogue from Sciwind Biosciences. Derived from GLP-1(7-37) with an alanine-to-valine substitution at position 8, it activates the GLP-1 receptor selectively via the cAMP pathway over β-arrestin recruitment. Investigated for weight management and in type 2 diabetes.

Efinopegdutide (MK-6024, formerly JNJ-64565111 / HM12525A) is a once-weekly dual agonist at the GLP-1 and glucagon receptors, developed by Hanmi and Merck. It has been studied for obesity and notably for metabolic liver disease (MASH/NAFLD); a phase-2 trial showed greater liver-fat reduction than semaglutide. Investigational, not approved.

Synthetic version of exendin-4, originally isolated from the saliva of the Gila monster (Heloderma suspectum). First GLP-1 receptor agonist, FDA-approved 2005 as Byetta. Weekly depot form Bydureon approved 2012.

Glucagon is a 29-amino-acid pancreatic hormone produced by the alpha cells of the islets of Langerhans. It is the physiological counterpart to insulin and raises blood glucose via hepatic glycogenolysis and gluconeogenesis. It is approved as an emergency treatment for severe hypoglycaemia and as a diagnostic aid; its receptor is also a target of modern dual and triple incretin agonists.

GLP-1 receptor agonist with a half-life of about 13 hours. The first daily (not weekly) modern GLP-1 RA — approved as Victoza for type 2 diabetes (2010) and Saxenda for obesity (2014).

Synthetic exendin-4 analog with a C-terminal lysine extension. Prandial GLP-1 RA focused on postprandial glucose. FDA-approved 2016 as Adlyxin; EMA-approved 2013 as Lyxumia. Sanofi discontinued US distribution in 2023.

Synthetic oxyntomodulin analogue that simultaneously activates the GLP-1 and glucagon receptors (dual agonist). Developed by Innovent Biologics and Eli Lilly. In China the NMPA approved mazdutide on 27 June 2025 for chronic weight management; a further filing for type 2 diabetes is under review in China. Outside China the substance remains in clinical development.

MOTS-c is a 16-amino-acid mitochondrial-encoded peptide (mitochondrial-derived peptide, MDP) whose open reading frame lies within the 12S rRNA region of mitochondrial DNA. In basic research (including the laboratories of Changhan Lee and Pinchas Cohen) it is described as a regulator of metabolic homeostasis and an activator of the AMPK pathway, and is sometimes discussed as an 'exercise mimetic'. The evidence comes almost entirely from cell and animal models; controlled human trials of MOTS-c as a therapeutic are lacking. It is not approved as a medicine anywhere and is traded on the grey market as a research chemical.

Pramlintide is a synthetic analog of the hormone amylin. It is used as an adjunct to mealtime insulin therapy in type 1 and type 2 diabetes and, among other things, slows gastric emptying.

Synthetic triagonist peptide that simultaneously activates the GLP-1, GIP and glucagon receptors. Developed by Eli Lilly; in phase-3 trials for obesity (TRIUMPH programme) and type 2 diabetes. No marketing approval yet.

Long-acting GLP-1 receptor agonist. Approved as a medicinal product for type-2 diabetes (Ozempic, Rybelsus), chronic weight management (Wegovy) and cardiovascular risk in obesity. One of the best-studied substances on this platform — many large human RCTs.

Synthetic peptide that simultaneously activates the GLP-1 and glucagon receptors. Developed by Boehringer Ingelheim and Zealand Pharma; in phase-3 trials for obesity (SYNCHRONIZE) and MASH. No marketing approval yet.

Synthetic peptide that simultaneously activates the GLP-1 and GIP receptor (dual agonist). Approved in the US and EU for type 2 diabetes (Mounjaro) and obesity (Zepbound).