The use of glucagon-like peptide-1 receptor agonists (GLP-1 agonists), primarily intended for managing type 2 diabetes, has surged in recent years, with an increasing number of people using these drugs solely for weight loss. This trend has sparked concerns about a global shortage of these essential medications for diabetic patients.
A new study, published in the Annals of Internal Medicine, highlights that out of 1 million new users of GLP-1 medications between 2011 and 2023, there has been a twofold increase in users who do not have type 2 diabetes. Researchers observed that the proportion of users without FDA-approved indications rose from 0.21% in 2019 to 0.37% in 2023.
Weight Loss Driving Demand
The popularity of GLP-1 drugs like Zepbound and Wegovy, which have FDA approval for weight loss in obese individuals, has contributed to this trend. Many individuals are also using other GLP-1 medications, such as Ozempic, off-label for weight loss, exacerbating the shortage for diabetic patients.
Study Findings
Researchers analyzed medical records of around 45 million people in the U.S. using the TriNetX real-time federated health research network. They found that while the percentage of new GLP-1 drug users with type 2 diabetes decreased, there was a significant rise in users with a body mass index (BMI) of 30 kg/m2 or greater, and those with a BMI of 27 to 30 kg/m2 and an obesity-related condition.
Kevin Sheng-Kai Ma, DDS, FRSPH, FRSM, international scholar at the University of Pennsylvania and lead author of the study, noted that these findings were anticipated due to the recent FDA approvals for obesity-related indications. However, he emphasized the need for clinicians to continue monitoring patients on GLP-1 medications.
Health Disparities in Access
The study also revealed gender and ethnic disparities in GLP-1 drug usage, with non-Hispanic white females being the largest user group. Dr. David Cutler, a family medicine physician at Providence Saint John’s Health Center, explained that the economics of supply and demand for GLP-1 medications contribute to these disparities. Insurance coverage variability further limits access, exacerbating racial, ethnic, and socioeconomic inequalities.
Addressing the Shortage
Solving the GLP-1 medication shortage is complex, involving pharmaceutical licensure, manufacturing, and distribution challenges. Dr. Cutler mentioned that while non-branded, non-FDA approved alternatives are available at lower costs, they lack the regulatory approval of branded drugs. Increasing production capacity is crucial, but current efforts may not be sufficient to meet the escalating demand.
Dr. Mir Ali, a bariatric surgeon and medical director at MemorialCare Surgical Weight Loss Center, emphasized the importance of insurance coverage in addressing the shortage. He suggested that broader insurance coverage would further increase demand, potentially worsening the shortage.
Future Prospects
Ongoing research into the benefits of GLP-1 medications for metabolic diseases, such as metabolic-associated steatohepatitis (MASH), may widen their indications and exacerbate shortages in the short term. However, the long-term health benefits could be substantial. Current studies comparing the safety and effectiveness of non-FDA approved alternatives to branded GLP-1 agonists may also improve access.
In summary, the rising use of GLP-1 drugs for weight loss is straining supplies needed for diabetes management, highlighting the need for increased production and equitable access policies. As research continues, balancing demand and supply will be critical to ensure that all patients who need these medications can obtain them.
