DiabetesDrugs & Medications


Six months ago I published two articles on the use and side effects of Glucagon-like peptide-1 (GLP-1) receptor drugs. GLP-1’s, and specifically semaglutide (Ozempic, Wegovy, and Rybelsus), are the drugs “of the moment.” In fact, they may be the drugs of the decade! They were developed for use in controlling blood sugar levels in diabetics, but were discovered to cause patients to have a 15% weight loss. After that revelation, there was no stopping the public demand for GLP-1’s. Since Americans are an obese lot, there was a huge market for the product, and demand exceeded supply.

In my first post, “Weight Loss A Different Way,” I wrote “The exact mechanism of action for weight loss with GLP-1’s is unclear….” Since then, more information has come to light and multiple body systems are now known to produce the effects patients have sought. The report on which this post is based also states that GLP-1’s “show promise for improving cardiovascular outcomes or neurologic conditions like Parkinson’s disease of Alzheimer’s disease.”

In addition to increasing the body’s release of insulin and decreasing the production of glucagon (increases blood sugar levels), GLP-1’s have effects on the brain, GI tract, liver, and kidneys. 

Brain effects: GLP-1’s work on the centers of the brain that control hunger, desire for food, and satisfaction (called the “satiety center”).

GI tract effects: GLP-1’s delay emptying of the stomach, slow the intestinal movement of food (peristalsis) so the patient feels full all the time. 

Liver, kidney effects: GLP-1’s improve kidney and liver function—how is unknown.

Weight loss and improved cardiovascular outcomes are benefits that weren’t expected when this drug class came to market for controlling diabetes. It does, indeed, help diabetes and cause weight loss, and in the future, they may have a role in reducing colorectal cancer risk and treating “alcohol use disorder.”

Glucagon-like peptide-1 receptor drugs have become a big deal. Because of the weight loss effect, they have been prescribed for millions of overweight Americans, diabetic or not. They do have a lot of upside, but are expensive—as much as $1000.00, or more, out-of-pocket per month. Not everyone can keep that up month after month. Researchers keep coming up with new benefits of the drug class, and that’s good, but I have the feeling that some adverse effect will emerge that discredits GLP-1’s more than regaining lost weight when the drug is stopped. 

Reference: McNamara D. Where GLP-1’s work Now—and what’s coming. Medscape Clinical Digest 2024 Apr 24.

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