Managing a patient’s weight and diabetes can be challenging, and the introduction of glucagon-like peptide 1 (GLP-1) medications has provided many patients with new hope. These medications, widely advertised and increasingly prescribed, have gained popularity due to their effectiveness in promoting weight loss and improving blood sugar control. However, despite their promise, many patients discontinue GLP-1 therapy earlier than expected.
GLP-1 medications have transformed weight management and diabetes care for many, but their continued use may be influenced by several factors, including high out-of-pocket cost, limited insurance coverage, severe side effects, and medication availability. While these medications may be effective, they are not without challenges.
- Cost and Accessibility: Many patients struggle with the high price of these medications, especially if they do not have type 2 diabetes (T2D), as insurance coverage is often limited.
- Side Effects: Gastrointestinal symptoms such as nausea, vomiting, and constipation can make adherence difficult. Severe side effects may lead some patients to discontinue use altogether.
- Perception of Short-Term Use: Some individuals may view GLP-1 medications as a temporary solution for weight loss rather than a long-term commitment to managing obesity or diabetes. The medical implications of noncompliance have not been fully vetted and may provide their own level of healthcare risks.
- Medication Shortages: Compounded versions of GLP-1 medications have become an alternative during shortages, but these do not undergo the same rigorous FDA approval process as brand-name drugs.
A recent study found that discontinuation rates are notably high:
- Within a year, 64.8% of patients without T2D and 46.5% of those with T2D stopped taking their GLP-1 medication.
- Patients who experienced greater weight loss were slightly less likely to discontinue, but the difference was minimal.
- Higher-income patients with T2D were more likely to continue their medication regimen.
- Moderate or severe gastrointestinal side effects were strongly associated with discontinuation.
- Some patients who regained weight after stopping GLP-1 therapy restarted their medication, though this was not a frequent occurrence.
Despite these challenges, GLP-1 medications offer benefits beyond weight loss, including potential neuroprotective effects and reduced inflammation. Additionally, they may play a role in improving impulse control and reward signaling in the brain, which could have broader applications in treating substance use disorders and psychological conditions.
However, we must also acknowledge the risks. Patients should be aware of potential side effects, such as nausea, vomiting, low blood pressure, sleep disturbances, and even more serious concerns like pancreatitis and kidney inflammation.
To optimize the benefits of these medications while minimizing discomfort, the following may be considered:
- Gradually Increase Dosage: Staying on the lowest effective dose for an extended period allows the body to adjust and has the potential to reduce side effects.
- Monitor Side Effects Closely: Timing the medication correctly may help manage nausea, which often peaks around 36 hours afterwards.
- Provide Comprehensive Support: Regular follow-ups with a healthcare provider may help address concerns and encourage adherence.
Ultimately, the key to success with GLP-1 medications lies in a patient-centered approach. Open discussions between patients and healthcare providers can help individuals make informed decisions about their treatment. By fostering a supportive and well-monitored patient to physician experience, retention rates may be enhanced, patient outcomes improved, and the importance of long-term health management reinforced.