Clinical Insight: The Use of GLP-1 Agonist Medications for Weight Loss

Over approximately the past 6 months, there has been a major shortage of GLP-1 antidiabetic medications. Diabetics are unable to access the medications that they need because they are in high demand for weight loss. There has been a recent series released by ABC News discussing this recent trend.

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“The Skinny Shot” on Hulu by IMPACT X Nightline goes into detail on the issues regarding drugs such as Ozempic, Mounjaro, and Wegovy, which have been touted as breakthrough treatments for patients seeking to lose weight. Many celebrities, such as Rosie O'Donnell, Chelsea Handler, Millionaire Matchmaker star Patti Stanger, as well as social media influencers have credited the use of these medications with changing their lives.¹

With an increase in the use of these drugs for weight loss, we must consider how this is affecting patients with diabetes who rely on these medications.  Patients with diabetes have reported rationing their doses to deal with the shortage.

“For instance, if they usually take 2 mg per week, they’ve reduced their dose to 1 mg per week, and if they were taking 1 mg per week, they’ve rationed their dose down to 0.5 mg,” stated an article published by DiaTribe.²

Patients are switching to insulin—which if they are obese as well as having diabetes—isn’t ideal because you can have weight gain when using insulin. Some patients have reported exercising more frequently and changing their diets, which is positive but does not control glucose levels.²

Type 2 diabetes medications Ozempic, Wegovy, Mounjaro, and Saxenda, which are part of a class called GLP-1 agonists, are being used for weight loss in patients without diabetes. These medications work by increasing glucose-dependent insulin secretion, decreasing inappropriate glucagon secretion, and slowing gastric emptying.³

They can also act in the areas of the brain that are involved in regulation appetite so you feel full faster and, therefore, will have less caloric intake. Only Wegovy and Saxenda are FDA-approved for use in weight loss; however, all these injectable medications are being prescribed by physicians for weight loss.^4,5

When indicated for weight loss, these medications are to be used as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with a BMI greater than or equal to 30 kg/m², or a BMI greater than or equal 27 kg/m² with at least 1 weight-related comorbidity (hypertension, type 2 diabetes, or dyslipidemia).⁶

The effect of semaglutide on weight loss was studied through the Semaglutide Treatment Effect in People with Obesity (STEP) program. These trials showed that once-weekly treatment with semaglutide 2.4 mg along with lifestyle modifications (diet and exercise) led to a substantial initial weight loss.⁷

However, this weight loss plateaus after approximately 1 year for most patients.⁸ The entire trial lasted 120 weeks, and if patients continued with treatment throughout the entirety of the trial, weight loss was sustained.⁸

However, if patients stopped treatment after 60 weeks, they regained approximately two-thirds of their weight loss.⁹ After 68 weeks of treatment, 86.4% of patients achieved weight loss of 5% or more from baseline. But after stopping the medication, only 48.2% of patients sustained weight loss of 5% from baseline.⁹

“Doctors say that, anecdotally, they’ve seen this kind of rebound in patients, too,” Dr. Andrew Kraftson, a clinical associate professor in the division of metabolism, endocrinology and diabetes at Michigan Medicine, told The New York Times.¹⁰

A subgroup analysis showed that patients who had greater weight loss during the first 68 weeks of treatment had greater weight gain after stopping treatment.⁹

These studies showed that semaglutide may cause substantial initial weight loss for patients, but the only way this weight stays off is to continue the medication long term.⁹ This may not be a viable option for most patients due to the cost of these medications, as well as the safety profile.

Because not all these medications have a labeled indication for weight loss, insurance companies won’t cover the cost of the medications, which could lead to a significant financial burden for those who are using them for weight loss. After doing some investigating within the pharmacy, it was found that patients use a coupon produced by the makers of Mounjaro, Eli Lilly, to get the medication for $25; however, they are only getting it for that price by saying that they are using it for diabetes instead of weight loss.

The average retail price of each medication for 1 month is listed below:¹¹

Average retail price of GLP-1 agonists for 1 month.

The adverse effects (AEs) of these medications are similar to those of others and they also have a few serious AEs:^3-5

Common adverse effects of GLP-1 agonists.

“The Skinny Shot” episode discussed how people are finding Groupons for weight loss clinics or to have semaglutide sent to them in the mail.¹ The bmiMD.com is one of these websites offering the antidiabetic medication for $197 for the first month.¹²

Although this might seem promising, it can be dangerous. Your physician will determine whether you need the medication, and because it is only available by prescription, you should not obtain it without a physician being involved. These sites are not a safe or reliable way to obtain semaglutide because there is no way to know whether that is the medication that is being distributed.

Over the past 6 months, there has been increased use of Ozempic and Mounjaro for weight loss and this, in turn, has been negatively affecting the diabetic patients who are reliant on these medications. Although these GLP-1 agonists have been effective in facilitating weight loss in obese patients, this is not a viable treatment option due to the fact that these medications have to be used long-term to sustain weight loss.

This is likely a financial barrier for most patients, which leads to inaccessibility for patients who have been prescribed GLP-1 agonists for FDA-approved indications.

References 

1. Robinson L, Muldofsky M, Pedersen C, et al. Popularity of Ozempic, Mounjaro, similar drugs may be driving shortages for people with diabetes, obesity. ABC News. 2023 Feb.
2. Fallabel C. How People With Diabetes Are Getting By During the Ozempic Shortage. diatribe Learn. 2023 Feb.
3. Lexi-Drugs Online™. Lexi-Comp Online™. Hudson (OH): Lexi-Comp, Inc.; 2023. Available from: http://online.lexi.com. Accessed: March 30, 2023.
4. (Semaglutide). In: MerativeTM Micromedex® DRUGDEX® (electronic version). Merative, Ann Arbor, Michigan, USA. Available at: https://www-micromedexsolutions-com.libproxy.uwyo.edu/ (cited: 3/30/2023).
5. (Liraglutide). In: MerativeTM Micromedex® DRUGDEX® (electronic version). Merative, Ann Arbor, Michigan, USA. Available at: https://www-micromedexsolutions-com.libproxy.uwyo.edu/ (cited: 3/30/2023).
6. Pi-Sunyer X, Astrup A, Fujioka K, et al. A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management. N Engl J Med. 2015 Jul 2;373(1):11-22.
7. Garvey WT, Batterham RL, Bhatta M, et al. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nat Med. 2022 Oct;28(10):2083-2091.
8. Rubino D, Abrahamsson N, Davies M, et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021 Apr 13;325(14):1414-1425.
9. Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022 Aug;24(8):1553-1564.
10. Blum D. Ozempic Can Cause Major Weight Loss. What Happens if You Stop Taking It? The New York Times. 4 Feb 2023
11. GoodRx. 8 March 2023. Goodrx.com
12. bmiMD.com. Groupon. https://www.groupon.com/deals/bmimd-com. Accessed: March 1, 2023.