Every few years, a new diabetes drug arrives with results that seem almost too good to be true. Blood sugar falls. Weight drops. Headlines celebrate another breakthrough. Yet despite these advances, rates of obesity and type 2 diabetes continue to climb.

So are we winning the battle against metabolic disease, or simply getting better at managing its consequences?

A recent article published by The Guardian has sparked considerable discussion amongst the metabolic health and diabetes communities. The article reports on a new once-weekly injectable medication called retatrutide, which appears to significantly reduce blood sugar levels while also producing substantial weight loss in people living with type 2 diabetes.

The results have been described as promising, with participants experiencing significant reductions in HbA1c (a measure of long-term blood sugar control) and losing between 11% and 15% of their body weight during the study period.

The emergence of retatrutide invites us to consider a bigger question: are we making progress against metabolic disease itself, or primarily improving how we manage it? 

The Growing Burden of Metabolic Disease

Around the world, rates of obesity, type 2 diabetes, fatty liver disease, hypertension, and other metabolic conditions continue to rise. Healthcare systems are spending billions treating the consequences of metabolic disease, while many individuals find themselves taking multiple medications to manage symptoms and complications. 

At the same time, scientists and pharmaceutical companies are investing enormous resources into developing increasingly sophisticated treatments.

The success of medications such as Ozempic and Mounjaro has already transformed the conversation around obesity and diabetes treatment. Retatrutide may represent the next step in that evolution.

But despite these advances, an uncomfortable question remains: Why are so many people becoming metabolically unhealthy in the first place?

What Makes This New Medication Different?

What makes retatrutide particularly interesting is that it acts on three separate hormone receptors involved in appetite regulation, glucose control, and energy metabolism: GLP-1, GIP, and glucagon. Most current medications target only one or two of these pathways. Researchers hope this broader approach may explain the substantial weight loss and improvements in glucose control observed in early trials. 

For many people living with obesity and type 2 diabetes, these findings are encouraging. Losing weight and improving HbA1c can reduce the risk of complications and improve quality of life.

For some individuals, particularly those who have struggled for years despite repeated attempts at dietary and lifestyle change, medications like these may offer a valuable tool.

But Are We Asking the Right Questions?

While the headlines focus on weight loss and glucose control, many in the metabolic health community are asking a different set of questions.

If type 2 diabetes is fundamentally a disease of insulin resistance and metabolic dysfunction, should our primary focus be on treating elevated blood sugar?

Or should we focus on understanding and addressing the factors that contribute to insulin resistance in the first place?

Many researchers now acknowledge that type 2 diabetes is closely associated with excess body fat accumulation, chronic insulin resistance, poor dietary patterns, lack of physical activity, inadequate sleep, chronic stress, and other lifestyle factors.

If these factors remain unchanged, can medication alone truly solve the problem?

Or does long-term metabolic health require a deeper shift in how we eat, move, sleep, and live?

The Lifestyle Question

At The Noakes Foundation, we have long advocated for education around nutrition and metabolic health. Over the years, including through our work with Eat Better South Africa, participants have reported improvements in glucose control and overall well-being, alongside reductions in medication use, after adopting low-carbohydrate and ketogenic dietary approaches. For some, these changes have been transformative. For others, maintaining those changes can be difficult.

Lifestyle change is often presented as a simple matter of personal choice. In reality, people attempting to improve their metabolic health are navigating food environments, financial constraints, social pressures, stress, poor sleep, and, in some cases, decades of established habits. So perhaps the more useful question is not whether people should change their lifestyle, but how we can better support them to do so.

The prevention question

One aspect that receives far less attention is prevention. Imagine if we could achieve the same level of scientific innovation and investment in prevention that we currently devote to treatment.

What might happen if schools, workplaces, communities, and healthcare systems focused more attention on helping people avoid metabolic disease before it develops? While treatment will always be necessary for many people, prevention has the potential to reduce the burden of disease before medication becomes necessary.

A key part of prevention is education. Many people spend years navigating conflicting nutrition messages without ever developing the knowledge and confidence needed to make informed decisions about their health. Improving nutritional literacy may not generate the same headlines as a new medication, but it has the potential to help people understand the relationship between food, blood glucose, insulin resistance, and long-term metabolic health before disease develops.

This is one of the reasons The Noakes Foundation places such a strong emphasis on nutrition education. The goal is not simply to tell people what to eat, but to equip them with the knowledge and practical tools needed to make informed choices, improve metabolic health, and, where possible, reduce the risk of chronic disease before treatment becomes necessary.

The Cost Conversation

New diabetes and weight-loss medications are often expensive and may remain out of reach for many people, particularly in low- and middle-income countries. By contrast, lifestyle interventions, while not always easy to implement, have the potential to reach far larger populations.

As these medications become more widely available, healthcare systems may face difficult decisions about cost, accessibility, long-term use, and sustainability.

• If a person stops taking the medication, will the benefits remain?
• Will these medications need to be taken indefinitely?
• How will healthcare systems fund widespread access if millions of people become eligible?

These questions remain unanswered.

What Does Success Look Like?

• Perhaps the most important question is this: how should we define success in diabetes care?
• Is success lower blood sugar readings?
• Is it weight loss?
• Is it fewer medications?
• If a person’s HbA1c improves but they remain dependent on lifelong medication, is that success?
• If weight loss occurs but metabolic health remains fragile once treatment stops, is that success?

Or should success be measured by something deeper: improved metabolic flexibility, reduced disease risk, greater quality of life, and the ability to maintain health over the long term?

The answer may be different for different people. Some individuals may benefit greatly from medication. Others may prefer a lifestyle-first approach. Many may find success through a combination of both.

Let’s Start the Conversation

The emergence of powerful new metabolic medications like retatrutide represents an exciting development in medical science.

At the same time, it provides an opportunity to reflect on the broader picture of metabolic health. We are not interested in telling you what to think. Instead, we would like to hear your perspective.

After reading the article, consider the following:

• Is this a breakthrough in diabetes care?
• Are we addressing the root causes of metabolic disease?
• Can medications and lifestyle interventions work together?
• Should healthcare systems prioritise treatment, prevention, or both?
• How do we create a healthier society in the first place?

Read the article, make up your own mind, and join the discussion.

👉 Original article:
https://www.theguardian.com/society/2026/jun/07/weekly-diabetes-jab-reduce-blood-sugar-levels-body-weight

Retatrutide may prove to be an important advance in diabetes care. But whether it becomes part of the solution or merely another chapter in the story of rising metabolic disease may depend on something far less glamorous than pharmaceutical innovation: our willingness to confront the underlying drivers of metabolic disease in the first place.