Diabetes drug semaglutide is surging in popularity. Is it safe?

Diabetes drug semaglutide is surging in popularity. Is it safe?

A new-ish diabetes and obesity drug that can help users shed pounds is making big waves on social media and rippling through celebrity gossip echo chambers — but its popularity is also driving a supply shortage for the people who most need the medication.

It’s called semaglutide, often sold under the brand names Wegovy or Ozempic. Typically injected under the skin, the drug lowers appetite, slows digestion and increases insulin levels, causing blood sugar levels to drop. It’s very useful for managing type 2 diabetes, but it also drives weight loss, with some patients in clinical trials with the drug having lost 12 percent of their weight by 28 weeks.

Ozempic was first approved by the Food and Drug Administration (FDA) in 2017 for type 2 diabetes, but a new formulation, Wegovy, was approved in 2021 for obesity. Danish biotech giant Novo Nordisk makes both drugs and has funded much of the research into its effectiveness. A recent industry-funded study in the New England Journal of Medicine found that young people prescribed the drug experienced a “substantial reduction” in body mass index (BMI), an imperfect metric for determining if someone is overweight.

But outside of doctor’s offices, the drug has increasingly attracted the attention of Hollywood A-listers and billionaires like Elon Musk, who claim that semaglutide has helped them lose weight. Meanwhile, users on social media hubs are raving about its effects, with the hashtag generating around 45 million views on TikTok alone.

A combination of this sudden attention, increased demand from patients and supply chain disruptions has made semaglutide difficult to find. All Wegovy prescriptions are currently on backorder, with limited supplies of Ozempic. Novo Nordisk anticipates the shortage will be addressed by the end of the year. The company did not respond to Salon’s request for comment, but we’ll update this story if we hear back.

Dr. W. Timothy Garvey, an endocrinologist and professor at the University of Alabama at Birmingham, warned people not to use the drug unless prescribed by a doctor. Semaglutide can require specialized dosing and have side effects that can require monitoring.

“They need a health care professional, they can’t just use this drug willy nilly or nonchalantly,” Garvey told Salon. “I would not prescribe it to somebody who wanted to lose five pounds or whatever to get into a wedding dress. Now, if they met two criteria: a BMI of 27 or above and had obesity complications, I’d use it right away.”

It’s fair to say Garvey is one of semaglutide’s earliest fans, at least from a clinical standpoint. “I became familiar with semaglutide way before it was approved,” he says, describing how he worked on early clinical trials with other diabetes and weight loss drugs like liraglutide and Qsymia.

“I just saw patients losing weight all over the place [with Qsymia] and I hadn’t seen this before in American medicine,” Garvey says, noting that semaglutide is even more effective for weight loss. “I just realized we could help so many people with this level of weight loss. And so I became kind of passionate about developing models of care for obesity that are evidence-based.”

Four in ten American adults have obesity, according to a 2020 report from Trust for America’s Health, while 37.3 million Americans have diabetes, according to the Centers for Disease Control and Prevention. Garvey says patients deeply need to realize that this is not their fault.

“Whenever they lose weight, they’re fighting against a lot of maladaptive responses, biochemical pathways that are hardwired into this as a disease process, that are driving weight regain,” Garvey explains. “That’s why it’s hard to maintain weight loss. It’s not their fault. They’re fighting against some powerful forces. And sometimes they just need help to deal with that and these medications counteract those very processes that are driving that weight regain.”

Garvey also pointed to inherent bias in the medical system that has deprioritized treating obesity. “There’s a lot of shaming that goes on, with discrimination in social media in particular, but across our society,” he says. “It pervades healthcare systems as well, [the idea] that obesity is not a real disease, it’s not worth your time and effort. Patients internalize all of this.”

Semaglutide can help with obesity and diabetes because it works on GLP-1 receptors, which control blood sugar. When semaglutide agonizes these receptors, it tells the body to make more insulin. But it also blocks the production of glucagon, a hormone that can raise blood sugar back up. “It also interacts with feeding centers in the brain, the hypothalamus, the brainstem, and then these higher central nervous system centers that suppress appetite,” Garvey says.

Semaglutide is a peptide, which means under normal circumstances, you can’t take it as a pill or the stomach will dissolve it pretty quick. So the drug is typically injected subcutaneously, just under the skin, although oral formulations designed to withstand stomach acid also exist. Patients usually start with a low dose that is slowly raised over the course of several weeks. This is why a doctor should carefully monitor how the drug is interacting with the body.

Some of the most common side effects, which occur in around five percent of patients, are nausea, vomiting, diarrhea, abdominal pain and constipation. More serious issues include the formation of gallstones and kidney problems.

Less is known about the long-term effects of semaglutide, however Garvey and his colleagues recently published the results of a two-year trial funded by Novo Nordisk in Nature Medicine. They reported that, out of 152 patients prescribed semaglutide, 12 reported serious adverse effects and nine discontinued the trial. But the others experienced “substantial weight losses” averaging 15 percent or more. All of this points to why the drug should be prescribed under careful medical supervision.

“This should be prescribed by a health care professional that’s aware of the pharmacology and knows how to treat this disease. It’s not an easy disease to treat,” Garvey says, referring to obesity. He says that obesity is a topic glossed over in medical school and residency programs.

“That’s changing a little bit, but a lot of healthcare professionals don’t have a lot of experience with obesity, actually. Not that they don’t see a lot of patients with it,” Garvey explains. “But we’re kind of in a transition in American medicine, realizing now that we have the tools, we’re learning more about it and more people are getting trained, there’s greater interest.”

Yet, even if there wasn’t a shortage of the drug, many patients still don’t have access to semaglutide because of its high price, which is rarely covered by insurance and can cost between $900 and $1300 out of pocket. “That just goes along with the bias a lot of folks have throughout our society about obesity being a lifestyle choice and not really worthy of medical treatment, like other diseases,” Garvey says.

While semaglutide works remarkably well, Novo Nordisk and other companies are working on the next generation of GLP-1 receptor agonists, such as tirzepatide, which recently received a “Fast Track designation” from the FDA. That means it could hit pharmacy shelves sooner rather than later. Eli Lilly and Company, the biotech firm developing tirzepatide, reported last year that the drug was superior to semaglutide in reducing weight for patients with type 2 diabetes.

But even if new drugs can improve the clinical outcomes for patients, it does little to address the underlying issues in our society that promote bias and discrimination against people with obesity or diabetes — not to mention the ability to access these expensive medications, aside from the rich and privileged. Semaglutide is anything but a miracle drug, despite its remarkable potential for helping patients. But medications can only go so far in fixing the real issues people are facing.

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