The incretin market is expanding rapidly, with both injectable and oral therapies expected to play important roles in the treatment of obesity and type 2 diabetes. Guest author Ian Thompson explores how the market is evolving, the next generation of incretin therapies in development, and the continued role of subcutaneous delivery alongside growing oral options.
The risk of type 2 diabetes rises with increasing body weight, physical inactivity and other lifestyle patterns, and the global prevalence of both obesity and type 2 diabetes has increased continuously since the 1980s. No more so than in the US, where over 40% of the adult population is obese with a BMI >30, while rates in Europe range between 10–25% depending on the country.
Globally, it is expected that by 2030 over 1.1 billion people will be obese (BMI ≥ 30). Obesity is recognised by the WHO as a complex, chronic condition that increases the likelihood of comorbidities, in addition to type 2 diabetes, such as liver disease, heart disease, hyperlipidaemia, hypertension, dementia, and cancer. The overall costs to healthcare systems of treating these conditions are significant, in some cases up to 2.4% of GDP. There is therefore substantial potential to reduce these burdens. To achieve these goals of both improving patient outcomes and reducing financial burden, incretins will remain an important group of molecules in the treatment landscape.
The rise of incretins
Incretins are peptide metabolic hormones that decrease blood glucose levels, including GLPs and GIPs. The commercialisation of GLP-1 receptor agonists ("GLP-1s") began over 20 years ago in type 2 diabetes treatment with the launch of AstraZeneca’s Byetta (exenatide) requiring twice daily injections. Weekly formulations followed, but it was the launches of liquid-stable weekly therapies such as Eli Lilly’s Trulicity (dulaglutide), Novo Nordisk’s Ozempic (semaglutide), and Lilly’s Mounjaro (tirzepatide) that significantly expanded the use of incretins. The incretin journey did not stop at treating type 2 diabetes and has increasingly expanded into obesity treatment, typically using higher dosing. Today, semaglutide and tirzepatide are at the forefront of obesity treatment and have driven substantial growth in the overall incretin market, with research suggesting that 25 million Americans will be on incretin treatment by 2030.
With the recent launches of oral incretin mimetics such as Novo Nordisk’s oral semaglutide and Eli Lilly’s orforglipron, interest in oral incretin therapies has increased significantly among patients, healthcare providers and investors alike. These launches represent an important expansion of the incretin treatment landscape and are expected to further fuel overall market growth. Importantly, many patients using oral therapies may not previously have considered injectable treatment, meaning that oral therapies have the potential to broaden overall patient access rather than simply replace injectable therapies.
The number of people with type 2 diabetes and obesity using incretins has increased from around 15 to 25 million over the last two years and this is likely to increase to around 100 million or more patients by 2035 and beyond. This equates to continued annual growth in excess of 15% over ten years.
The future of injectable and oral incretins
There is broad consensus among analysts that injectable incretins will continue to represent the majority share of the market for treating type 2 diabetes and obesity as the market matures through 2030–2035. While oral therapies currently account for a relatively small proportion of the market, their share is expected to increase steadily over the coming decade. At the same time, injectable therapies are also expected to continue growing in absolute patient numbers as the overall market expands.
Current clinical evidence suggests that injectable and oral therapies each have different characteristics and trade-offs. Injectable therapies tend to demonstrate advantages in several areas, including increased bioavailability and overall weight-loss outcomes, with studies showing weight loss in excess of 20% with injectable therapies. However, outcomes can vary significantly depending on the molecule, formulation, dosing regimen, and patient population.
Oral therapies offer convenience, and the familiarity of this administration route may be a driver in the expansion of the whole market, broadening access in general, but especially for patients reluctant to inject. Oral peptide-based therapies can, however, face absorption challenges within the digestive tract, while tolerability, persistence and adherence outcomes continue to be evaluated as real-world evidence evolves.
There are additional oral incretin mimetics in development, though many remain in early clinical stages. Oral semaglutide and orforglipron are therefore expected to lead the oral segment in the near term.
Overall, both modalities are likely to play important and complementary roles in the long-term treatment of obesity and type 2 diabetes, with injectable therapies likely to remain the key pillar of the incretins market, even as oral therapies build momentum. (Fig. 1)
Development of next-generation incretins
At the same time, a broad pipeline of next-generation injectable incretin mimetics is advancing, including dual and triple agonists such as Novo Nordisk’s CagriSema and amycretin and Eli Lilly’s retatrutide. Aside from the big two, a host of companies including Amgen, Boehringer Ingelheim, Pfizer, Roche, AstraZeneca, Regeneron, Zealand and Kailera are seeking to bring therapies to market. The continued investment by major pharmaceutical companies in these next-generation injectable therapies also reflects expectations that injectables will remain an important part of the long-term incretin treatment landscape.
In the medium term, there are expected to be more injectable incretins competing for market share than oral therapies, further reinforcing the likelihood that the future market will include both injectable and oral treatment options. There also remains a high unmet need for those who don’t respond to available incretins, or who still need additional weight loss even after treatment (Fig. 2).
Pen injectors and autoinjectors for incretin therapies
Many currently available injectable incretin therapies, including semaglutide and tirzepatide, are simple peptides formulated for self-administration using either pens or autoinjectors.
Though autoinjectors are convenient for weekly injections, multidose pen systems also offer advantages in terms of convenience, supply-chain efficiency and reduced device volume, all helping improve patient access. This was reflected in Eli Lilly’s February 2026 launch of a multidose pen for tirzepatide, designed to provide 28 days of treatment in a single device rather than four separate weekly autoinjectors.
As the incretin market continues to expand, a range of injection systems are likely to coexist alongside oral therapies, supporting different molecules, patient characteristics, patient preferences, and healthcare system needs. An emerging trend is weight maintenance, with Eli Lilly CEO Dave Ricks noting that "a lot of people want to graduate from injectables when they reach their goal", and here orals are expected to offer an option for those who have concluded injectable therapies.
Supporting the future growth of incretin therapies
The rapid growth of incretin therapies for type 2 diabetes and obesity is expected to continue over the coming decade, driven by rising global demand and continued innovation across both oral and injectable treatment modalities.
As the market evolves, delivery systems will remain an integral part of the overall treatment ecosystem, supporting patient convenience, adherence and access across a broad range of therapies.
Author
Ian Thompson
Ian Thompson is guest author and former Vice President, Account & Business Development at Ypsomed, joining the company in 1995 and working in various roles in key account management and business development, helping pharma companies to develop and bring to market innovative self-injection systems. He studied biochemistry and biotechnology in the UK and has worked in the medical device space since moving to Switzerland in 1990. Since 2003 his focus was business development and new product innovation.
Since September 2024 Ian is Consulting Business Owner at Pi Biomedical GmbH providing support to pharma, medical device and networking companies that are navigating the complex landscape of drug-device combination products.
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