As pharmacists, my wife and I have an in-depth understanding of the various medications used to manage type 2 diabetes. Also, we at RxHealthyHabits promote a program to effectively achieve weight loss and long-term health optimization.
Because of recent questions from our subscribers about the new class of medications for Type-2 diabetes also being promoted for weight loss, we decided we needed to create his blog to discuss these medications and their role in Type-2 diabetes and more specifically about weight loss. We hope it's informative and it serves you well.
GLP-1 Analogues (Glucagon-like Peptide-1 Receptor Agonists)
One class of medications that has gained popularity in recent years is GLP-1 analogues, which mimic the effects of a hormone called glucagon-like peptide-1 (GLP-1) to improve blood sugar control and promote weight loss.
GLP-1 analogues work by stimulating the release of insulin from the pancreas and reducing the production of glucose in the liver. They also slow down the emptying of the stomach, which helps to reduce appetite and promote feelings of fullness.
Here are some of the common name brands currently available on prescription-only status in the United States which are approved by the FDA for the treatment of Type-2 diabetes (with the "side effect" of weight loss)**
Byetta (exenatide): The average retail price of Byetta is around $750 for a 4-week supply.
Bydureon (exenatide extended-release): The average retail price of Bydureon is around $1,200 for a 4-week supply.
Victoza (liraglutide): The average retail price of Victoza is around $1,200 for a 4-week supply.
Ozempic (semaglutide): The average retail price of Ozempic is around $1,200 for a 4-week supply.
Trulicity (dulaglutide): The average retail price of Trulicity is around $1,200 for a 4-week supply.
Rybelsus (oral semaglutide): The average retail price of Rybelsus is around $1,400 for a 4-week supply.
Mounjaro (efpeglenatide): can vary depending on the dose, pharmacy, and insurance coverage. However, as a newer medication, it is likely to be more expensive than other GLP-1 receptor agonists. According to some estimates, the monthly cost of Monjoro can range from $1,400 to $1,500 per month.
Mounjaro and Wegovy are relatively new GLP-1 receptor agonists that have recently been approved by the FDA for the treatment of obesity in adults.**
Wegovy (semaglutide): Wegovy is a GLP-1 analogue used for the treatment of obesity in adults. The average monthly cost of Wegovy is estimated to be around $1,300 per month, although this may vary depending on factors such as dose, pharmacy, and insurance coverage.
The monthly cost of Mounjaro (efpeglenatide) can vary depending on the dose, pharmacy, and insurance coverage. However, as a newer medication, it is likely to be more expensive than other GLP-1 receptor agonists. According to some estimates, the monthly cost of Monjoro can range from $1,400 to $1,500 per month. However, it's important to note that the actual cost may vary depending on the individual's insurance coverage and other factors.
**Note on price see below
It's important to note that the cost of these medications may be covered in part or in full by insurance, and there may be manufacturer coupons or patient assistance programs available to help reduce the cost of these medications for eligible patients. Patients should check with their healthcare provider, pharmacist, or insurance provider to determine their specific out-of-pocket costs for these medications.
Let's look at 2 large clinical trial studies to see the results
LEADER Trial: The LEADER trial was a large, randomized controlled trial that evaluated the cardiovascular safety and efficacy of liraglutide in over 9,000 individuals with type 2 diabetes. The trial found that treatment with liraglutide significantly reduced the risk of major cardiovascular events, such as heart attack, stroke, and cardiovascular death, by 13%. The trial also found that treatment with liraglutide significantly reduced HbA1c levels and promoted weight loss, with an average weight loss of 4.3 kg (9.5 lbs) over a period of 3.5 years.
2. SUSTAIN-6 Trial: The SUSTAIN-6 trial was another large, randomized controlled trial that evaluated the cardiovascular safety and efficacy of semaglutide in over 3,000 individuals with type 2 diabetes. The trial found that treatment with semaglutide significantly reduced the risk of major cardiovascular events by 26%, and significantly reduced HbA1c levels and promoted weight loss, with an average weight loss of 4.6 kg (10.1 lbs) over a period of 2.1 years.
Here are some of the advantages and disadvantages of using GLP-1 analogues for the management of type 2 diabetes and weight loss:
Advantages:
Effective at lowering blood sugar: GLP-1 analogues have been shown to significantly lower HbA1c levels, which is a measure of average blood glucose levels over the previous 2-3 months.
Promote weight loss: GLP-1 analogues have been shown to promote weight loss in individuals with type 2 diabetes, with an average weight loss ranging from 3% to 10% of initial body weight.
Cardiovascular benefits: GLP-1 analogues may have cardiovascular benefits, such as reducing the risk of heart attack and stroke.
Well-tolerated: GLP-1 analogues are generally well-tolerated, and the most common side effects include nausea, vomiting, and diarrhea, which usually improve over time.
Diverse options available: There are several GLP-1 analogues available on the market, such as Byetta (exenatide), Victoza (liraglutide), Ozempic (semaglutide), Trulicity (dulaglutide), and Rybelsus (oral semaglutide), giving healthcare providers and patients multiple options for treatment.
Disadvantages:
Cost: GLP-1 analogues can be expensive, and insurance coverage may be limited, making them difficult for some people to access.
Injection site reactions: GLP-1 analogues are administered by injection, and injection site reactions, such as redness, swelling, or itching, can occur.
Nausea and vomiting: These are common side effects of GLP-1 analogues, especially when starting treatment, and can be severe enough to lead to treatment discontinuation.
Pancreatitis: Although rare, GLP-1 analogues have been associated with an increased risk of pancreatitis, a potentially serious condition.
Limited long-term data: While GLP-1 analogues have been extensively studied, there is limited long-term data on their safety and effectiveness for weight loss and glycemic control.
Prefer to watch instead of read?
Here's a YouTube video that I did to discuss this topic
Consult your doctor and "weigh" the pros and cons.
While GLP-1 analogues have demonstrated several advantages in the treatment of type 2 diabetes and the promotion of weight loss, there are also several disadvantages that should be considered when prescribing or taking these medications.
Pros
One of the most significant advantages of GLP-1 analogues is their ability to promote weight loss. A study published in the New England Journal of Medicine found that individuals with type 2 diabetes who were treated with liraglutide experienced an average weight loss of 8% of their body weight after 56 weeks of treatment.
This is significant, as weight loss is a key factor in the management of type 2 diabetes and can lead to improvements in blood sugar control, lipid levels, and overall cardiovascular health.
In addition to weight loss, GLP-1 analogues have also been shown to have cardiovascular benefits. The LEADER trial found that treatment with liraglutide significantly reduced the risk of major cardiovascular events by 13%, while the SUSTAIN-6 trial found that treatment with semaglutide significantly reduced the risk of major cardiovascular events by 26%.
These findings suggest that GLP-1 analogues may have an important role in the prevention of cardiovascular disease in individuals with type 2 diabetes.
Cons
However, there are also several disadvantages of GLP-1 analogues that should be considered. One of the most significant disadvantages is cost. GLP-1 analogues can be expensive, and insurance coverage may be limited, making them difficult for some people to access.
Additionally, GLP-1 analogues are administered by injection, which may be uncomfortable or inconvenient for some individuals. Injection site reactions, such as redness, swelling, or itching, can also occur.
Nausea and vomiting are common side effects of GLP-1 analogues, especially when starting treatment, and can be severe enough to lead to treatment discontinuation. In rare cases, GLP-1 analogues have been associated with an increased risk of pancreatitis, a potentially serious condition.
There is also limited long-term data on the safety and effectiveness of GLP-1 analogues, and more research is needed to fully understand the potential risks and benefits of these medications. In conclusion, GLP-1 analogues are a promising treatment option for individuals with type 2 diabetes who are struggling with weight loss and cardiovascular risk factors. While there are several advantages to using these medications, there are also important disadvantages to consider. Working closely with a healthcare provider, as well as a certified health coach or pharmacist, can help individuals make informed decisions about their treatment options and achieve the best possible outcomes for their health and well-being.
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