The working assumption for most people with type 2 diabetes is that normal blood sugar is no longer the goal. The goal is to get close enough – managing the condition, not erasing it.
A trial that ended this year challenged this assumption. For many patients taking new once-daily oral pills, blood sugar dropped to levels far beyond what doctors typically target — to an area most consider out of reach.
Pills, not injections
The medication is orforglipron, sold under the name Foundayo. It belongs to the same family as those popular weekly doses – GLP-1 drugs that calm and stabilize appetite blood sugar. But it comes as a once-a-day tablet.
What sets it apart from other birth control pills is how easy it is to take. Oral semaglutide, the version already on the market, must be swallowed on an empty stomach.
A small sip of water – and nothing else by mouth for the next half hour. Orforglipron has none of that, and works at any time of the day.
It’s not brand new. The organizers have already agreed to this Weight lossyet separate He studies In obese adults, they found that the highest dose took off about 27 pounds (12.2 kilograms) per year. Diabetes outcomes can reach a much larger number of people.
Face to face trial
Several trials have pitted these drugs against placebo pills. A large study comparing two oral versions to each other has not been attempted before. Not even this one.
The trial, called ACHIEVE-3, was led by Julio Rosenstock, MD, a clinical professor of medicine at the University of Texas Southwestern Medical Center (UT Southwest).
His team enrolled about 1,700 adults whose type 2 diabetes was not well controlled with metformin, the first standard pill. The trial took place in six countries.
For a year, volunteers were divided into four methods: taking orforgliprone or semaglutide orally at either a lower or higher dose.
By the end, the newcomer had made clear progress in blood sugar and weight. The separation appeared during the first month.
Blood sugar and weight
Your blood sugar is tracked using a scale called A1C — which is the average of how high it has been over the past three months or so.
At the highest dose, orforgliliprone reduced this number by approximately 2.2 points, versus approximately 1.4 for oral semaglutide.
The weight change told a similar story. People who took the highest dose of orforgliprone lost approximately 20 pounds (9 kg) over the course of a year. Those who took the stronger dose of the other pill lost about 11 pounds (5 kg).
Where the pill really separated itself was at the strict end. More than a third of the upper dose reached a near-normal reading, the kind you might see in a non-diabetic person. On oral semaglutide, about one in eight.
None of this came out of nowhere. earlier Triato It showed that a pill can lower blood sugar versus a placebo, but beating an active competitor sets a higher bar.
Tested on more patients
The head-to-head was the headline, but it was juxtaposed with two other experiences that asked different questions. One of the drugs orforgliprone is pitted against common blood sugar pills. The other added it on top of insulin.
In the face of these competing pills, Orforglibron came out on top. Far more people reached their target blood sugar level – nearly seven in ten at the higher doses, versus about one in five. The weight loss was also deeper.
The insulin study made a different point. Adding the pill on top of the insulin caused the blood sugar to drop sharply. The placebo group, which also took insulin, gained a little weight instead of losing it.
Side effects and limitations
Medicine is not a free lunch. Most of the problems are in the gut – nausea, diarrhea, and the odd bouts of vomiting. The same complaints after injections.
These side effects came at a price in this trial. Nearly one in ten people taking orforgliprone stopped taking it because of those side effects – nearly double the dropout rate seen with oral semaglutide.
What trials can’t tell yet is how the pill holds up over many years. Nor how it measures up against the weekly injections that push blood sugar Bottom is harder.
The longest look here covers about a year. Bigger questions remain open.
What could change next?
This is what the year of data settled on. Once-daily pills with no food or water rules can outperform oral GLP-1 in terms of blood sugar and weight, and they do so in very different patients.
This changes the calculations of many doctors. Pills this effective could become the first choice in a regular clinic, where they are prescribed in the same way as blood pressure pills, without a needle or anything to keep them cool.
Drugmaker Lilly plans to file for U.S. approval to treat type 2 diabetes by the end of June 2026. If regulators approve, a newly diagnosed patient’s first prescription could be for pills rather than an injection.
The company prepares the case for daily use. “Fundayo has the potential to be an attractive first-line treatment option in primary care,” said Thomas Seck, MD, a senior executive at Lilly.
The study is published in The scalpel.
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