GLP-1 Medication is Changing the Face of Healthcare

Each day brings more news, in medical journals and the media, about the positive effects of medications known as GLP-1 agonists on weight loss and blood sugar levels, and how they’ve been shown to prevent or halt diabetes and cardiovascular disease.

The drugs’ names quickly became part of the lexicon - most commonly, Ozempic, Wegovy, Mounjaro, Zepbound and Trulicity. Their prohibitive cost in the U.S., from $1,000 to $1,400 a month for those who pay out of pocket, is another hot topic.

Patients with diabetes will find that their commercial insurance covers the cost, as does Medicare.

‌People who seek the medicines for significant weight loss, even if they are pre-diabetic, will generally get a ‘no.’  Most insurance firms say that because of the medicines’ high prices, it isn’t financially feasible for them to cover them for everyone who seeks significant weight loss, even if research shows that the risks of many diseases increase exponentially when BMI is over 30. Prices aren’t expected to decrease soon, as some patents don’t expire for at least a decade.

‌And then there’s the question, “Are these new drugs safe?”

‌That’s relatively easy to answer, because GLP-1 agonists are not all that new. Researchers and clinicians who worked with diabetic patients two decades ago were introduced to their power in attacking diabetes and driving weight loss, because of how they dramatically slow down digestion. The Food & Drug Administration approved the use of GLP-1 agonists for several conditions, including Type 2 diabetes, weight loss, and to reduce the risk of heart disease.

‌‌So nearly 20 years of experience have shown that these drugs are generally safe. However, there are some people for whom the side effects can be serious, including the development of pancreatitis and gall stones. And there can be unpleasant digestive side effects, though these can often be managed with changes in dosage, adjustments to smaller meals, and to foods that are exceptionally low in fat and sugar.

‌Studies and outcomes show powerful effects

Betul Hatipoglu, MD, Medical Director of the UH Diabetes & Metabolic Care Center and Mary B. Lee Chair in Adult Endocrinology, was first introduced to GLP-1s in 2005, when she was leading research on islet cell transplants for diabetes at another institution. The first such drug was called Exenatide. She remembers the excitement she felt when seeing that the Exenatide not only reduced patients’ blood sugar and led to weight loss, but created beneficial cardiovascular outcomes for people who already had a cardiac event, as well as for those who were at risk for one.

‌Because of the consistency of such outcomes, there is a strong possibility that these drugs will eventually create a ripple effect throughout healthcare –  not only at a system like ours, but also on healthcare as an industry.

‌At UH Harrington Heart & Vascular Institute, GLP-1 agonists have been incorporated into our CINEMA program, which was started in May 2020. CINEMA (Center for Integrated and Novel Approaches in Vascular-Metabolic Disease) was designed to supplement existing diabetes care with a team approach to keep patients with type 2 diabetes free from cardiovascular and kidney complications, through diet, activity, recreation, stress reduction techniques and medications targeted to normalize risk profile.

‌Ian Neeland, MD, Director of the CINEMA program, led a GLP-1 agonist clinical trial at another institution that concluded in 2021; his study, and many others in the U.S., have shown positive outcomes for a patient’s current and future health. So, GLP-1 agonists have been added to the treatment toolbox for many patients.

‌“GLP-1s are going to be approved in much greater volumes because of their effect on cardiovascular and kidney health,” says Dr. Neeland. The result? Cost savings for patients who might never need a variety of cardiac procedures, or dialysis and kidney transplants, will likely be significant, and seen within the next  decade.

‌Recent studies have also shown that the use of GLP-1s can have positive outcomes on such conditions as fatty liver disease, resolving the pain from osteoarthritis, preventing obesity-related cancers and possibly even Alzheimer’s.

Bariatric surgery remains a strong alternative

‌Interestingly, UH has seen little impact on the number of surgical weight loss procedures, despite the popularity of the medicines and a decrease in bariatric procedures nationwide. Here and elsewhere, GLP-1s may be used in conjunction with the surgery, says Leena Khaitan, MD, MPH, UH Division Chief of General & Gastrointestinal Surgery.  Medications are being used before and after to enhance the effects of the operation and to decrease perioperative complications.

‌Physicians and researchers say a drop in the level of obesity-based chronic diseases in the U.S. – currently affecting 40% of the population – could improve productivity of our country’s work force.

With fewer people compromised by serious health issues, immobility, and pain, we may reduce the need for other interventions, such as joint replacements and cardiac procedures, and decrease the cost of healthcare for all.

‌Then too, how does one put a price on a person’s avoidance of severe or fatal  consequences from health conditions? Many of these can now be mitigated in ways that were not previously possible.

‌There is one sector of UH physicians whose practices have already seen a striking impact because of the availability of these drugs – our primary care providers.

‌George Topalsky, MD, FACP, President, UH Medical Practices, says that so many patients want to discuss GLP-1 agonists with their doctor – and whether they qualify for insurance coverage, how they could benefit their health, and other details about them – that it has added hours to each work day. It’s not just the patients’ questions, but then checking on insurance, determining whether the medications are available, suitable, or necessary, and determining a patient’s ability to pay out of pocket.

‌Yet here’s the big picture: in 2022, the U.S. spent $413 billion on diagnosing and treating diabetes and recent estimates show that obesity and its related costs already consume more than 3% of the annual Gross Domestic Product (GDP.)

‌We can’t predict with certainty what will happen as a result of the rising use of GLP-1s, as many external factors affect the cost and availability of these drugs, and research on them is continuing.

But there is little doubt that the downstream effects might be dramatic – for individuals, healthcare providers, hospital systems and for our nation.