GLP-1s have revolutionized how we think about and treat obesity. But that wasn’t what they were originally intended for.
GLP-1s have revolutionized how we think about and treat obesity. But that wasn’t what they were originally intended for.
Mentioned in this episode:
American Diabetes Organization (diabetes.org)
National Institute of Diabetes, Digestive and Kidney Diseases (niddk.nih.gov)
For more Nutrition Diva content centered around Diabetes, check out this special Spotify playlist here!
Nutrition Diva is hosted by Monica Reinagel, MS, LDN. Transcripts are available at Simplecast.
Hello! I’m Monica Reinagel and you are listening to the Nutrition Diva podcast, a show where we take a closer look at the latest nutrition research, headlines and trends so that you can make more informed choices about what you eat.
There's been a lot of news this year about GLP-1 receptor agonists as a treatment for obesity. And to be sure, this new class of medications has in a very short period of time completely revolutionized not only how we treat obesity, but even how we think about it.
With all of the buzz, it’s easy to lose sight of the fact that these medications were originally developed as a treatment for Type 2 diabetes. So today, in recognition of Diabetes Awareness Month, I’d like to take a closer look at how these medications have impacted how we think about and treat Type 2 diabetes and the impact they have had on individuals with this condition.
Diabetes Awareness Month covers all forms of diabetes, by the way, including Type 1 diabetes (an auto-immune condition) and gestational diabetes (which affects pregnant women). We won’t be talking about those other types of diabetes today–GLPs have not been approved for use in these conditions. But you’ll find educational and advocacy resources for all types of diabetes at the American Diabetes Organization (diabetes.org) and the National Institute of Diabetes, Digestive and Kidney Diseases (niddk.nih.gov).
Before GLP-1 receptor agonists, metformin was generally the first-line treatment for Type 2 diabetes – and this is still the standard practice. Metformin works by reducing glucose production in the liver and improving insulin sensitivity. It's a very effective medication and quite inexpensive (often just a few dollars per month). The main side effects are gastrointestinal issues that usually resolve over time.
But, if metformin alone didn’t do the trick doctors would typically add sulfonylureas (like glipizide or glyburide). These work by stimulating the pancreas to release more insulin. While these medications are also inexpensive and effective at lowering blood sugar, they do have some drawbacks: Since they increase insulin secretion regardless of your actual blood sugar levels, they can lead to dangerously low blood sugar. They could also lead to weight gain, which is often a challenge for people managing Type 2 diabetes.
Lastly, there were thiazo-lidine-diones (TZDs), which increases the body’s sensitivity to insulin. Side effects for these meds include things like fluid retention and weight gain, and some were linked to heart issues and even bone fractures.
So, although these medications are effective, they each target just a single pathway (which means that you might have to layer on multiple medications). And they have side effects that can make other aspects of metabolic health worse. This is why GLP-1s have been such a breakthrough!
GLP-1 receptor agonists (such as Ozempic, Rybelsus, and Trulicity) mimic a hormone the body produces after eating, called GLP-1, which prompts the pancreas to release insulin when blood sugar is high and signals the liver to reduce glucose production. This dual action allows for steadier blood sugar levels without the ups and downs that can happen with other treatments. In studies, GLP-1s have shown a significant ability to lower HbA1c—a key marker of long-term blood sugar control—making them highly effective for managing diabetes.
But we now know that GLP-1 receptor agonists have benefits that go beyond blood sugar. One of the most notable "side effects" is weight loss. Unlike some older diabetes medications that often lead to weight gain, GLP-1s tend to reduce appetite, helping many patients lose a meaningful amount of weight. This is a big plus for people with Type 2 diabetes, as managing weight can play a crucial role in controlling the condition.
Over time, longer-term studies revealed that these medications also protect the heart and kidneys, which is particularly valuable since diabetes often puts these organs at risk. GLP-1s reduce the likelihood of serious cardiovascular events like heart attacks or strokes in patients at high risk. And most recently, GLP-1s were shown to help slow kidney damage.
In other words, GLP-1s are more than just blood sugar meds—they’re now seen as a powerful, all-around tool for diabetes care, which will likely transform how we think about managing this common disease.
As exciting as all of this is, however, this remarkable breakthrough in diabetes care has been largely overshadowed by the discovery that these same medications could provide a powerful solution to the so-called obesity epidemic, upending long-standing assumptions, narratives, and even biases around obesity. And the surge in demand for these drugs as obesity treatments has made it even more difficult for people with Type 2 diabetes to access them.
These medications are generally more expensive than older diabetes drugs, leading to high out-of-pocket costs for many patients–if your insurance even covers them. Medicare and other insurance plans often impose restrictions, such as prior authorization or requiring you to try all the other options first. In addition, biologic medications like GLP-1 receptor agonists are complex to manufacture, and this has led to some supply issues.
But even as we struggle to cope with all of these challenges, there are more breakthroughs in the pipeline. The next generation of GLP-1-based treatments includes dual-action (and even triple-action) drugs designed to target multiple metabolic pathways for an even greater effect on blood sugar control, weight management, and overall metabolic health.
One example is tirzepatide, a medication that activates both the GLP-1 receptor and a second receptor called GIP. By activating both receptors, tirzepatide has shown even more significant impacts on both glucose control and weight loss than GLP-1 receptor agonists alone.
We are clearly at the threshold of an exciting future in which treatments for diabetes (and obesity) will be more comprehensive, tackling multiple aspects of these conditions with a single therapy. But, as with the original GLP-1 medications, widespread access to these more advanced therapies will also depend on both manufacturing capabilities and policy changes to improve insurance coverage.
In the meantime, Diabetes Awareness Month gives us an opportunity to refocus on just how transformative these advancements have been for diabetes care, offering benefits that older diabetes treatments simply couldn’t offer.
And there is still a huge need for basic education and awareness around Type 2 Diabetes.An estimated 1 in 5 people with diabetes aren’t aware they have it, and more than 8 in 10 adults with prediabetes remain undiagnosed. This means millions of people at risk for serious health complications are missing the chance to benefit from early intervention and effective treatment.
One of the goals of this awareness campaign is to encourage people who are at risk to get screened. Early treatment can make all the difference in limiting the impact and harms of this condition. Please check the show notes for more resources.
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Nutrition Diva is a Quick and Dirty Tips podcast. Our team includes Brannan Goetschius, Nathan Semes, Davina Tomlin, Holly Hutchings, and Morgan Christianson.and Nathaniel Hoopes.