GLP-1 Medications; The Rundown

In this blog post, I will discuss a class of drugs that I get many questions about. This class of drugs is called glucagon-like peptide-1 (GLP-1) agonists. These drugs treat type 2 diabetes and support chronic weight management. The chronic weight criteria are defined as a body mass index (BMI) of 27 or higher with at least one weight-related ailment, or 30 if there are no other conditions that the weight is making or making worse. GLP-1s improve blood sugar control but also lead to weight loss. GLP-1 mimics the hormone that targets the area of the brain that regulates appetite and food intake.

Approximately 70% of American adults are overweight or obese. Weight issues are serious and can lead to chronic diseases that are currently the leading causes of death: heart disease, stroke, diabetes, and certain cancers. If you have been hanging out in my community for any length of time, you know that I am passionate about using medications and other treatments to control pain and weight.

Weight loss can vary depending on which GLP-1 drug you use and your dose. Studies have found that all GLP-1 medicines can lead to a weight loss of about 10.5 to 15.8 pounds (4.8 to 7.2 kilograms) when using liraglutide, semaglutide and making lifestyle changes lost about 33.7 pounds (15.3 kilograms) versus 5.7 pounds if the patient did not use the medication.

GLP-1s appears to help curb hunger. They slow food movement from the stomach into the small intestine, so you eat less. People taking these drugs have seen their blood pressure and cholesterol levels improve. It's unclear whether these benefits are from the drug or weight loss.

The downside to GLP-1 drugs is that all but one has to be taken by a shot. And, like any drug, there is a risk of side effects, some serious. More common side effects often improve as you continue to take the medication for a while.

I do have some concerns that I would like to discuss. My biggest concern is the cost; if you do not have weight loss medication coverage, you will need to pay out of pocket. If we agree that extra weight causes life-threatening complications, why do more insurance companies not cover these medications? If we can decrease weight, ease the cost burden on our health establishment, and do something more proactive. Intervening at a BMI of 27 vs. 47 and diabetic, the outcome is better and more cost-effective. The other concern is if the medication is no longer affordable or if an allergic reaction or pancreatitis develops. Weight regain is possible, which makes it even more imperative that we continue to counsel and educate on lifestyle changes.

Some of the more common side effects include;
*Nausea
*Vomiting
*Diarrhea
*Constipation
*Stomach pain

Who should not use these medications;
*Personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 (MEN 2)
*History of pancreatitis
*Possible complications of these medications;
*Allergic reaction
*Pancreatitis
*Gallbladder problems (including gallstones)
*Acute kidney injury
*Diabetic retinopathy (damage to the eye's retina)
*Increased heart rate
*Suicidal behavior or thinking.

As quoted by Good Rx

Wegovy as low as $1,334
Wegovy (semaglutide) is an expensive drug to help people lose weight and maintain weight loss. It is used with a reduced-calorie diet and exercise. It is less popular than comparable drugs. There is currently no generic alternative to Wegovy. Most Medicare and insurance plans do not cover Wegovy, but manufacturer and pharmacy coupons can help offset the cost.

Saxenda as low as $1333
LIRAGLUTIDE promotes weight loss. It may also be used to maintain weight loss. It works by decreasing appetite. Changes to diet and exercise are often combined with this medication.

Ozempic as low as $883
Ozempic (semaglutide) improves blood sugar control in adults with type 2 diabetes. There are currently no generic alternatives for Ozempic. Most Medicare and insurance plans cover Ozempic, but some pharmacy coupons or cash prices could help offset the cost.

Mounjaro as low as $965
TIRZEPATIDE treats type 2 diabetes. It works by increasing insulin levels in your body, which decreases your blood sugar (glucose). Changes to diet and exercise are often combined with this medication.

The following is a list of all the current GLP-1s, generic names, brand names, and dosing.

Dulaglutide (Trulicity) (injection weekly)
Exenatide extended-release (Bydureon bcise) (injection weekly)
Exenatide (Byetta) (injection twice daily)
Semaglutide (Ozempic, Wegovy) (injection weekly)
Liraglutide (Victoza, Saxenda) (injection daily)
Lixisenatide (Adlyxin) (injection daily)
Tirzepatide (Mounjaro) (injection weekly)
Semaglutide (Rybelsus) (taken by mouth once daily)

The only two medications with a chronic weight management indication from the FDA.