That’s what researchers at the UHealth Comprehensive Diabetes Center, led by Dr. Rodolfo J. Galindo, have found in some astounding new discoveries. They said they’ve seen major changes in the way type 2 diabetes and weight loss medications are being prescribed. A just-published study shows the skyrocketing adoption of tirzepatide, a drug that won approval from regulators in May 2022. At the same time, prescriptions for well-established medications like metformin are plummeting. This transition goes well beyond combat and is indicative of the precious clinical experiences. Its implications extend beyond direct cost to care for diabetes and affect US health policy more broadly.
The study examined data from more than 1.8 million adults who were initiated on glucose-lowering medications from 2021 to early 2023. Our results show that as of December 2023, tirzepatide accounted for 12.3% of total GLMs prescribed. Of the 90,260 patients initiating treatment with tirzepatide, 21.1% had no other glucose-lowering medication claims. This means that tirzepatide is likely to be used as a first-line treatment.
Notable Shifts in Diabetes Treatment
Our research shows a strong directional push to fewer older diabetes medicines. The utilization of these older medications has significantly diminished, especially that of metformin, which had long been considered the first-line therapy of choice. This decrease is encouraging as a sign that we may be re-evaluating the initial treatment that patients with type 2 diabetes receive.
These technologies hold great promise and are already improving lives,” said Dr. Galindo. I think a number of reasons are at fault here. One important factor is that incretin therapies had become much better known by the time tirzepatide reached approval.
The study recorded shifts in the utilization of weight-loss drugs. Patients beginning treatment with semaglutide at the 2.0 mg dose level — marketed as Ozempic — shot up through the roof. By December 2023, that share dropped to 26.6%. Semaglutide 2.4 mg—branded as Wegovy—rocketed to fame following its US approval in June 2021. In terms of penetration rate, it shot up from 0% adoption to 32.2% adoption by December of 2023!
Implications for Cost and Health Policy
These findings have important implications for the economics of diabetes care and U.S. health policy. Joshua J. Neumiller, PharmD, CDCES, underscored the enormous effect on diabetes care expenditures in the US. He as well as others noted the long-term implications for health policy writ large. Through these rapid changes in healthcare systems, it is ever more imperative that patients have access to the therapies they need to be productive members of society.
Dr. Neumiller summarized how these newer therapies could be beneficial. He said inequities remain in who gets them. Our past reports have shown a deeply disturbing pattern. Populations that have the most to gain by using these relatively novel therapies to reduce both cardiovascular and kidney risk are disproportionately less likely to receive them.
As a result, the research found that consumers are increasingly educated on the risks associated with obesity and type 2 diabetes. That’s why they are so thrilled about new treatments that promote substantial weight loss and lower other health risks, including hypertension and cardiac disease.
Rapid Uptake of Novel Therapies
Among these trends, the rapid uptake of tirzepatide is especially remarkable. The late Dr. John W. Ostrominski, a former executive director of T4America, wrote about this unexpected trend. He observed that the uptake of novel therapeutics is typically a glacial process, so to see such a rapid uptake in 18 months for both diabetes and chronic weight management was really amazing.
This rapid adoption is likely due to both greater provider comfort with incretin-based therapies, as well as increased awareness of their effectiveness. According to Dr. Ostrominski, there is a much greater awareness now about the health effects of obesity and type 2 diabetes. Today, they’re a little more cognizant of what the risks are.
Fresh data is coming out on new therapies such as retatrutide and forglipron, both produced by Lilly. Healthcare professionals, like us, are excitedly anticipating further advancements in diabetes management practices.
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