Friday, February 23, 2024

by David Kliff of the Diabetic Investor

Think about this just for a moment. When was the last time a patient walked into your office and practically demanded that you put them on a drug? When was the last time these same patients said, “cost be damned, I don’t care that it’s going to cost me over $1,000 a month. I want to be on this drug.” How often do these patients give you the I really don’t care look when you explain this is a diabetes drug, they don’t have diabetes, and as good as these drugs are, there are side effects, they need to be aware of.

Welcome to what we call The Ozempic Effect. Ozempic is one of three drugs that is currently taking the world by storm.  The other two are Wegovy also from Novo Nordisk (the makers of Ozempic) and Mounjaro from Eli Lilly. We might as well throw Rybelsus from Novo Nordisk into the mix; and currently the only oral GLP-1 on the market. Of these four, only Wegovy is FDA approved to treat obesity, with Lilly expected to get the same approval for Mounjaro anytime now. 

Now unless you have been on a secluded island with no communication to the outside world, it’s impossible to escape the Ozempic effect. Ozempic has gone from a diabetes therapy to a worldwide phenomenon. Ozempic and the others aren’t just making news in the medical community, they are making news in the mainstream media and all-over social media. Shortages of these therapies created by the insatiable demand have created a true black market. 

Authors have written extensive opinion pieces on feeling guilty using these drugs to lose weight when they themselves do not have diabetes. Others have opined about the inequities in the healthcare system as the patients who need these therapies cannot afford them. Wal-Mart has stated they have noticed a change in customer buying habits and airlines have talked about the future size of airline seats. Celebrities such as Lady Gaga who lose weight are being called out for using the drug. 

Shares in diabetes device companies such as Dexcom and Insulet have been hammered as analysts have the false impression that patients will no longer use CGM or insulin pumps. Not surprisingly shares of Lilly and Novo are hitting new highs. Novo is making so much money they cannot spend it fast enough. An entire subculture is developing to make money off these drugs some legit many not. 

So, let’s separate fact from fiction: 

1. This cannot be understated, NONE of these therapies are approved for patients with Type 1 diabetes.
2. Ozempic, Wegovy and Mounjaro are all once-weekly INJECTIONS.
3. Rybelsus the only oral in the category has strict dosing protocols which if not followed make the drug ineffective.
4. Like any therapy, there are possibilities of adverse events.
5. These therapies also may not work in every case.
6. All are very effective at weight loss however the patient MUST remain on the drug to keep the weight off.
7. No question, cost is a factor and will impact patients who are not financially equipped. Reimbursement is improving but still remains an issue and as of this writing these drugs are NOT covered by Medicare.
8. This also cannot be understated as the data is beyond compelling, besides the weight loss, patients are seeing corresponding improvements in comorbidities associated with obesity.
9. The injections are not painful, and each come with a very patient friendly delivery system, except for Rybelsus.
10. Yes, more than a few patients experience real guilt from using these therapies. While they enjoy the weight loss, many accuse them of “cheating.” Do not underestimate this fact and do your best to prepare patients for this very real dynamic.
11. There is empirical evidence that these therapies also help patients with Type 1 diabetes but as we stated when we began, they are not currently approved for Type 1 patients.

Typically, in case such as this we would advise having a frank discussion with the patient. But here too the Ozempic effect comes into play as patients are already well informed. Many physicians we have spoken with have noted that try as they might to discuss things their information falls on deaf ears. The bottom line is these people see these drugs as an easy path to weight loss and it’s hard to blame them. There is no behavior change, no going to the gym just one injection a week. 

We hate to oversimplify here but the drugs make the patient feel full, so they eat less. Talking with many patients using the therapies they literally say the drugs have changed their lives. Many could lose weight but couldn’t keep it off, others no matter how hard they tired couldn’t lose weight. More than one has called their therapy a miracle. Frankly it’s astonishing as I have been writing about and living with Type 1 diabetes for over 30 years and have never seen anything close to this. 

Here's the crazy part, as good as these therapies are Novo, Lilly and others have even better therapies under development. Thankfully perceptions are also changing as obesity is no longer seen as a character flaw that it’s a real disease just as diabetes is a very real disease. Heck, Weight Watchers, Noom, and others have thrown in the towel and are actively endorsing these drugs. Advocates of weight loss through behavior change are struggling to compete. 

There is no question The Ozempic Effect is very real and has forever changed the treatment paradigm.