Diabetes

Nearly 2/3 of Patients Quit GLP-1 Drugs within the First Year

Robert Cucin MD JD MBA Diabetes, metabolic syndrome, obesity , , ,

In a recent study published in JAMA Network Open, 65% of those without diabetes discontinued their semaglutide drug in less than one year.

The quit rates were not only for cost but for the side effects and complications. Those who trimmed more weight were more likely to persevere with the drugs and those that regained weight after stopping the medications were more likely to pursue a second course.

While health insurers widely cover this class of glucagon-like peptide (GLP-1) agonists for diabetes, most don’t pay for these drugs for weight loss. List prices often exceed $1,000 per month and insurance is spotty. Just 1% of Affordable Care Act marketplace plans last year covered these drugs for obesity according to KFF, a nonprofit health policy organization.

Medicare paid $5.6 Billion for semaglutides in 2022, demonstrating the immensity of the obesity problem.

As reports of complications and side effects of these drugs continue to accumulate as fast as articles on discontinuance rates, it is evident that even though patients prefer pills to surgery, the semaglutides are not miracle drugs. As with every single drug we use OTC or prescribe, a side effect is just really just one of the many effects of any drug other than the desired one. We consider Endoscopic Visceral Lipectomy both complementary to patients taking the GLP-1’s and suitable as an alternate modality to those patients who don’t start or stop taking them.

Cleveland Clinic Study Finds Weight Loss Surgery Decreases Risk of Heart Attack and Stroke

Robert Cucin MD JD MBA bariatric surgery, Diabetes, obesity

Dr. Steven Nissen and colleagues compared the impact of various types of bariatric surgery on almost 2,300 people to the usual medical care on more than 11,000 obese patients with similar symptoms treated between 1998 and 2017 at the Cleveland Clinic.

Those having bariatric surgery lost more weight and had fewer heart attacks, fewer strokes, a lower incidence of kidney and heart failure, a lower incidence of atrial fibrillation, lower blood sugar levels, and experienced a 41% lower over all morbidity during the study.  Additionally, those who had surgery used fewer medications for diabetes and other conditions.

The researchers concluded that many of the deleterious effects of obesity are potentially reversible.

Obesity Surgery Benefits May Be Greater For Teens Than Adults

Robert Cucin MD JD MBA bariatric surgery, Diabetes, metabolic syndrome, obesity , , ,
obese kids
 

Most obese teens remain obese as adults, and adults who were obese as teens are unhealthier than those who become obese later in life. 

A new study presented at the Combating Childhood Obesity Conference in Houston (Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents. Inge TH, Courcoulas AP, Jenkins TM, et al. N Engl J Med 2016; 374:113-123) suggests that teens may benefit more from early surgery than adults.  

The researchers compared results from two studies of gastric bypass surgery in 161 teens and 396 adults who had been obese since they were teens. Three years after their operations, both groups had lost between 26% to 29% of their weigh and Diabetes went into remission in 86% of teens and 53% of adults diagnosed with the disease before surgery. High blood pressure was also normalized in 68% of teens and 41% of adults.

Although a 2% mortality accompanied surgery in both groups, two of the teens died from drug overdoses, suggesting substance abuse and self harm may accompany teen obesity.

The researchers documented the durability of clinically meaningful weight loss and metabolic improvements and weight-related quality of life among adolescents who underwent gastric bypass surgery or sleeve gastrectomy. The benefits of these current bariatric surgical alternatives must be viewed in the context of the risks of nutritional deficiencies and the possibility that future surgical procedures will be needed in some patients.

It is this author’s hope that Endoscopic Visceral Lipectomy, which does not expose the patient to the nutritional and surgical risks inherent in bypass surgery or sleeve gastrectomy, may prove equally effective and a safer minimally invasive intervention for this younger population (Uncoiling the Tightening Obesity Spiral. Cucin RL Clin Res Diab Endocrinol:1(2):1-5 (2018)).