GLP-1 medications have become wildly popular to treat obesity. Professionals need to manage patient expectations, educate on safe usage, and leverage evidence-based resources to stay current with shortages and best practices.
The meteoric rise of GLP-1 medications for weight management
It is difficult to turn on the TV, open your phone, or engage in any kind of media today and not hear something about Glucagon-like peptide-1 receptor agonist medications (these will be referred to as “GLP-1 medications” or “GLP-1s” from here on). The social media frenzy over these drugs helped fuel a 2.082% increase in prescriptions from 2019 to 2022.
As a pharmacist specializing in endocrinology and diabetes management, like most in the field, I have been familiar with this drug class for many years. The drug class – now also including semaglutide, liraglutide, dulaglutide, and tirzepatide (technically a GLP-1-based medication that also works on glucose-dependent insulinotropic polypeptide receptors) – was initially only approved to treat type 2 diabetes, and part of the reason they work is because they reduce how much glucose gets released after a meal while also suppressing appetite. This made GLP-1s a safer option compared to a lot of the other drugs being used that were only causing patients to push more insulin out and causing weight gain without addressing many of the issues surrounding the core condition of diabetes.
Weight loss as an indication
GLP-1 medications were developed not only to reduce blood sugars, but also to help with weight loss, or at least not cause weight gain. Clinicians started to observe the weight management benefits of GLP-1s in addressing metabolic syndrome in patients with diabetes and in treating patients with cardiovascular disease and conditions that can be exacerbated by overweight and obesity.
Today, many of the GLP-1s are approved to treat weight loss, and it has practically become their primary indication. Injectable semaglutide also has an indication for cardiac risk reduction, and many presume approval for cardiac indications for other GLP-1 medications is only a few years away.
With the rise in the awareness of the weight-loss benefits, GLP-1s have become very popular very quickly. According to a recent KFF Health Tracking poll:
- 12% of U.S. adults say they have taken a GLP-1 medication at some point.
- In the past five years, the number of patients with diabetes taking GLP-1 medications has risen to 43%, and the number of patients diagnosed as overweight or having obesity taking the drugs has risen to 22%.
- In the past year, the percentage of adults who have heard “a little” about these drugs has risen from 70% to 82%, while the number who have heard “a lot” about them has increased from 19% to 32%.
With patient and media interest so firmly fixed on these medications, it is more important than ever that providers, pharmacists, and care management teams have the resources and tools they need to help safely guide patients through weight-loss treatment planning and crucial questions regarding GLP-1s, particularly if they are not specialists in the field.
Key patient counseling points for GLP-1 medications
Regardless of how they are classified by any given organization or formulary, I always think of GLP-1s as specialty drugs. They are self-injectable drugs for a chronic condition – and perhaps most notably, they are expensive. GLP-1s typically cost hundreds, if not over $1,000 a month in the U.S. for patients without insurance coverage. Currently, not all plans cover costs in full or at all for weight-loss indications.
For generalists or care professionals who are just starting to use GLP-1 medications on a more regular basis for weight-loss treatments, there is a lot more to know about the drugs and the drug class than might be readily available in labeling information, including how to handle perceived vs. actual side effects and navigating drug shortages.
I would highly encourage professionals to access an evidence-based and current clinical decision support solution just as a handy resource to familiarize themselves with recommendations regarding GLP-1 weight-loss indications and therapeutic uses.
It’s also helpful to review patient education materials to share with your patients and plan members. While there are seemingly unlimited things you can offer counseling on with these drugs, it’s best to avoid overwhelming the patient by focusing on the high points:
- Help them understand how they will feel if the drug is working correctly, as opposed to what is a harmful side effect.
- Make sure they’re comfortable with injections.
- Ensure they understand that overweight and obesity are chronic conditions. GLP-1 medications are not a quick fix and may potentially requires indefinite therapy.
- Impress that along with long-term medication therapy, there are other things that they need to be doing, like reducing calories and increasing physical activity.
- Help them understand that these drugs are in shortage, and because they are so expensive, insurance coverage is in flux. Discuss the development of an alternative treatment plan in case they are unable to obtain their medication at any point.
Side effects vs. correct effects: Helping patients understand GLP-1s
In my experience, it is important for clinicians and care managers to have an upfront conversation with patients about what they might experience on a GLP-1 medication.
Most notably, many patients will complain that they don't feel hungry anymore. Others say that they feel full more quickly while eating, or that they feel like they have something like a large dumpling sitting in their stomach after a meal.
That’s good. That’s the drug working exactly how it is supposed to.
But if it’s not something the patient is expecting to experience, they are often concerned that it is an adverse effect of the drug. So, making sure they understand the experience before they start taking it will help put them at ease.
It may also be helpful for them to understand that the first few months, many patients are consistently losing weight, some quite rapidly. But the pace slows and eventually plateaus. After some time on the drug, it will be assisting them to maintain a weight, rather than continue to lose, but that doesn’t mean the drug’s not working anymore.
Similarly, they should be aware of which symptoms are potentially harmful side effects of the medication. Many patients experience relatively benign side effects, like an upset stomach or nausea, when they first begin the medication, and that may subside over a few weeks. If the nausea becomes intolerable, it may be possible to reduce the dose or switch to a different GLP-1 to see if the nausea improves. It is important, however, that they are aware that severe vomiting or abdominal pain may be a sign of pancreatitis and will require immediate attention from their healthcare provider.
Because GLP-1 medications work by lowering blood sugar, concerns have been expressed that patients run the risk of their sugar dropping too low. This is rarely a concern when used alone. In patients with diabetes, some may find they require less of their other diabetes medications as they start losing weight with the GLP-1, and they may also notice improvement in other markers like blood pressure. The cases in which low sugar would be a concern would be in patients with pre-diabetes, or in patients taking other diabetes medications that do increase the risk of low blood sugar.
Concerns related to GLP-1 medications and pregnancy
Because people who have overweight or obesity may have trouble getting pregnant, providers will often encourage weight loss to help with infertility. While the drugs themselves haven’t shown that they improve fertility, they can help with weight loss, which will at least help remove that comorbidity.
But should a patient using a GLP-1 plan to become pregnant or become pregnant, they must be counseled to stop the medication as soon as possible because weight loss medications are not recommended during pregnancy according to the American College of Obstetricians and Gynecologists and other groups. Additionally, GLP-1 medications have not been routinely studied in pregnant people or for their effects on fetuses.
