Weight issues, obesity, hunger, and medical co-morbidities with reference to the use of Glucagon-like peptide 1 Receptor Agonists (GLP1) have taken the world by storm.
The efficiency of these once weekly injections for weight loss is not in question. Losing 10-20% of body mass is very achievable, but there are some very serious concerns that have recently come to light.
The international Danish drug company that produces the GLP1 Agonist, Semaglutide, Novo Nordisk, never forecast the overwhelming demand for its product. In September of this year the market value of Novo Nordisk on the Danish Stock Exchange was valued as being higher than that of the entire Danish GDP. Worldwide production is being ramped up with multiple new sites being built and planned. It will take 2 – 3 years to catch up with demand for this product. Fortunately, other companies such as Eli Lilly with Dulaglutide and Tirzepatide have received approval for weight loss as well as for Diabetes management. Pfizer is also looking to get into this space as a major player in the weight loss sector.
GLP1 Agonists and Type 2 Diabetes
The research of these products was initiated to improve the management of Type 2 Diabetes. Traditional medicines for the management of diabetics led to very adequate diabetic control but resulted in patients gaining weight on recognized medicines. The weight loss effect of the GLP1agonists was an inadvertent finding. These products control diabetics well AND result in significant weight loss. A completely novel chemical. When tested in non-diabetics it was found that these products had no bearing on sugar and still caused significant weight loss. Hence their registration for the management of obesity.
The Current Status Quo
In South Africa GLP1 agonists are only registered for the management of Diabetes. It is only a matter of time before they receive registration for the management of obesity. As the registration for obesity exists overseas for these products they are being used ‘off label’ here in South Africa. There is nothing wrong with that, as the issue is that the drug companies cannot produce stocks fast enough. The net effect of this erratic supply is that patients are unable to have continuity with these products, which is frustrating and not helpful. The result of this is that patients default and are unable to reach goal weight.
Enter the Black-Market Trade
The void that has been left by poor supply has led to numerous charlatans offering products and selling them as original GLP1 agonists.
Patients have been offered various products from pharmacists, doctors, and gyms and sold as GLP1 agonists. These products are all expensive, are not approved by SAHPRA, the pharmaceutical regulatory authority and are illegal.
Patients are alerted not to purchase any of these products. The two products that are available and legitimate must be scripted by your doctor and will either have the Novo Nordisk logo on the box or the Eli Lilly logo. Both products are supplied in an insulin type injectable pen. Any product offered that is in an ampoule form and needs to be drawn up and injected is illegal, has no evidence that it works, and we are not sure of its safety.
What is Available
Until the supply of GLP1 agonists matches the demand, the failure to reach targets in both diabetic management as well as weight loss management will continue. There are many other products available for diabetics that offer adequate control.
As far as weight loss management goes, patients should make appointments with their healthcare providers to discuss safe weight loss options. Once such option is tablets blocking the ‘hunger centre’ of the brain. The results of the use of this product in conjunction with a simple eating program is almost equal to the outcomes of the GLP1 antagonists.