Concerns arise over diabetes medications used for weight loss

Vital Signs Spring 2023 - Diabetes
Feet on a scale
Photo: iStock

The development of a class of drugs called GLP-1 receptor agonists to treat type 2 diabetes has been a significant benefit for millions of patients. But the medications also help with weight loss, which has made them attractive to people who don’t have diabetes. Physicians have reported a surge in people without diabetes, or even a serious weight problem, asking for the medications, such as the drug semaglutide, to help them shed a few pounds — a use that is considered “off label,” meaning the drug was not approved for that purpose. Consumer demand has occasionally created critical shortages of semaglutide.

UCLA health experts urge people who wish to lose weight to fully understand their treatment choices before seeking a prescription for semaglutide. “Many of our patients are seeing benefits from these drugs,” says Matthew Freeby, MD, director of the Gonda Diabetes Center at UCLA. “It’s great for people taking these medications for diabetes or obesity. But the shortages caused by the offlabel effect are problematic.”

Nationwide, patients with diabetes are routinely reporting difficulty filling their prescriptions for semaglutide. Dr. Freeby says he receives several e-mails a week from patients unable to fill their prescriptions. “The shortage has required us to lower dosing or switch to another medication in the same class,” Dr. Freeby says. “But then we see shortages in the other brands, as well. We’re having to do a lot of workarounds.”

Type 2 diabetes involves dysfunction in the way the body uses sugar, often resulting in too much sugar in the blood and subsequent damage to a number of organs and tissues. Semaglutide, an injectable drug, prompts the body to release insulin to reduce blood sugar. It also acts on chemicals in the brain that control appetite. People on the medication feel full faster. “We’ve seen benefits from this drug with not only diabetes control but in reducing the risk of other diabetes-related conditions, such as heart disease, kidney disease and obesity,” Dr. Freeby says.

Studies show people taking semaglutide lose an average of 15% of their body weight. Semaglutide has been available as a diabetes medication for many years. In 2021, the Food and Drug Administration approved it for weight loss — marketed under the brand name Wegovy. The drug is intended for people who are overweight (a body mass index greater than 27) with one or more obesity-related medical conditions or people with a BMI of 30 or greater. It is not intended for mildly overweight individuals who are simply looking to lose a few pounds.

Wegovy is rarely covered by insurance and costs about $1,300 a month, says Zhaoping Li, MD, director and division chief of clinical nutrition. Moreover, some evidence suggests patients regain weight after stopping the injections. For that reason, Dr. Li urges people who do not need semaglutide for diabetes to consider the range of options for weight loss, including medications, bariatric surgery, diet and exercise.

“I do prescribe semaglutide for some of my weight-loss patients, under specific circumstances,” Dr. Li says. “But when a patient comes to me and requests the drug, I tell them this a great opportunity to learn to eat right and have a healthy lifestyle to help them maintain weight loss. We can’t simply say, ‘Ah-ha! We have a drug! Now you don’t have to worry.’”

Semaglutide carries some side effects, Dr. Li adds, including pain and redness at the injection site and nausea.

Proper use of diabetes medications may continue to be an issue in the future, Dr. Freeby notes. Last year, the FDA approved another diabetes drug, tirzepatide, that combines two hormonal agonists. Studies show patients experience significant weight loss on the drug, but it’s only approved for diabetes, so far. “Longer term, I think we’ll see more medications for diabetes and weight loss,” Dr. Freeby says. “The challenge is to find that fine line between the most potential benefit in this class of medications and making sure we’re using them for the purpose they’re approved for.”