How GLP-1 medications are transforming diabetes and weight loss treatment

Approximately 15.5 million Americans have been or currently are on injectable diabetes or weight loss medications known as GLP-1 receptor agonists, including the popular name brands Ozempic, Wegovy, Mounjaro and Zepbound. As obesity rates rise, eligibility expands and curiosity about these medications grows, more people are exploring their potential benefits.

Andrew Tenpas, PharmD, RPh, clinical assistant professor at the Texas A&M University Irma Lerma Rangel College of Pharmacy, explains the medications, their benefits and a few drawbacks.

What are GLP-1 medications?

Two examples of GLP-1 medications currently on the market include semaglutide and tirzepatide. Semaglutide, also known by the brand name Ozempic, first saw widespread use after trial data showed it to be far more potent than another popular GLP-1 agent at the time called dulaglutide (Trulicity). In addition, Ozempic skyrocketed in popularity about three years ago with the help of social media platforms. Tirzepatide, also known by the brand name Mounjaro, is a newer, even more potent cousin. Both drugs were originally developed and approved to treat type 2 diabetes but gained traction when patients reported significant weight loss. As a result, the makers of Ozempic created the brand name Wegovy, containing the active ingredient semaglutide, for weight loss. Similarly, Zepbound is Mounjaro’s weight-loss counterpart, containing the ingredient tirzepatide.

Tenpas, who sees patients at a VA clinic in South Texas, said many of his patients report life-changing weight loss while on GLP-1 medications.

“I have some veterans who have lost 70 to 100 pounds, and it’s completely changed their entire quality of life,” Tenpas said. “You can imagine when you lose 70 pounds, not only does it help with blood sugar control but also blood pressure, cholesterol and mobility—it can completely change people’s lives around.”

How do they work?

GLP-1 receptor agonists stimulate the body to release insulin after eating. They also decrease glucagon release — preventing the body from mobilizing extra sugars — and slow stomach emptying. This not only leaves the body feeling satiated for longer, acting as an appetite suppressant, but also tells the pancreas to release more insulin, bringing blood sugar down further, Tenpas explained.

Older GLP-1 medications like Victoza, Trulicity and even Ozempic possess one underlying mechanism. As “GLP-1 receptor agonists,” they mimic a naturally occurring hormone, GLP-1, released in the body after someone eats. For reasons that remain unclear, many patients that struggle with diabetes and/or obesity release less GLP-1 over time, or the GLP-1 that is released doesn’t work as it should. In essence, a synthetic analog like Ozempic helps to supplement that hormone. Newer, even more potent GLP-1 drugs like tirzepatide combine GLP-1 with yet another hormone called glucose-dependent insulinotropic polypeptide (GIP). Research suggests this combination reduces side effects and vastly improves outcomes, including weight loss, compared to GLP-1 alone.

Is it right for you?

“These medications are tools, not magic solutions,” Tenpas said. “They’re meant to help reshape your relationship with food and portion sizes and give you a leg up with weight loss so that maybe you can start exercising more.”

Patients often ask whether they’ll need to stay on the medication forever, and Tenpas’s short answer is usually no, if they are willing to continue doing the work they did to lose the weight in the first place. Once a patient has achieved their goals and adopted sustainable lifestyle changes to keep the weight off, their medical provider can help them gradually decrease the dosage until the medication is no longer needed. However, Tenpas said that when used responsibly and at recommended doses, GLP-1 medications are relatively safe to take long-term.

It should be noted that GLP-1 drugs may cause short-term side effects like nausea, vomiting and diarrhea, which tend to be dose-related or triggered by certain foods. Those side effects are more likely to arise if you have a history of certain conditions, such as gastrointestinal issues (e.g. gastroparesis, gastritis) or significant kidney disease.

GLP-1 medications are also not currently approved for women who are pregnant, and they might interact with some medications. For example, if used with glipizide or insulin, it can increase your risk of hypoglycemia, or low blood sugars.

The best way to know if a medication is right for you is to consult your preferred medical provider.

Tenpas cautions against using compounded versions of GLP-1 medications that are not approved by the Food and Drug Administration (FDA), since they may lack rigorous quality standards and may not be as potent as prescription formulations.

Additionally, he strongly urges patients on GLP-1 medications to maintain communication with their medical provider, friends and family so they can identify any points of concern if necessary.

What’s next?

As modern medicine continues to evolve, Tenpas predicts that Ozempic will eventually fade in popularity and usage as more evolved or potent medications come to market. At least 27 new GLP-1 drugs are currently undergoing trials at various stages, including a triple-hormone-receptor agonist combining GLP-1, GIP and glucagon receptors. Early trial data published in the New England Journal of Medicine in June 2023 suggests that this next generation of medications may offer even greater weight loss benefits than either semaglutide or tirzepatide alone.

For more information about GLP-1 medications, Tenpas suggests going to the manufacturer website, reading biomedical articles from credible outlets and talking to your medical provider.