The pharmaceutical industry has made massive strides in the realm of diabetes management and weight loss pharmaceuticals. In recent years, a multitude of new, safe, and effective agents have hit the market, bringing new hope to patients with these conditions. These drugs are providing unprecedented effects, with some providing potent blood sugar control, significant weight loss, or both. However, with great efficacy comes increased demand.

The demand for these medications has only exponentially increased as they have gained popularity. Unfortunately, the manufacturers of these medications have not always been able to keep up with the extreme demand, causing shortages across the United States (US). These shortages can have an immense impact on patients, particularly diabetic individuals, who rely on these medications to regulate their blood sugars and prevent downstream complications. Thus, this article will explore what is happening with these shortages and their immense impact.

Why are these drug shortages happening?

The first injectable diabetes medication was approved roughly a decade ago, and ever since, injectable diabetes medications have supported patients in regulating their blood sugar levels. One would think that pharmaceutical companies would be able to predict the demand for these types of drugs and adjust their course accordingly, but this has not been the case. The reality is that most of these drugs, in addition to managing diabetes, are also able to reduce weight. Some of them are incredibly effective in causing weight loss, opening up the floodgates to an entirely new demographic of patients.

So, what types of drugs are affected by these shortages? For the most part, it is the glucagon-like peptide-1 (GLP-1) agonists that are the culprit. These medications include drugs like semaglutide (Ozempic, Wegovy), dulaglutide (Trulicity), and more. These medications are effective in both diabetes and weight loss, making them incredibly popular and difficult to obtain these days.

How do these medications work for weight loss?

These drugs belong to a class of medications known as GLP-1 agonists. As an agonist, these injectables mimic native GLP-1 found in the body. GLP-1 is an incretin hormone that is naturally produced by the body to activate insulin production from the pancreas. In diabetes, where insulin is low or the body is insensitive to insulin, this helps to promote insulin release and manage blood sugar. Thus, GLP-1 agonists like Ozempic are effective as a treatment for type 2 diabetes.

GLP-1 receptor agonists also have an additional mechanism contributing to their weight loss properties. They delay a process known as “gastric emptying”, which refers to food contents moving through the digestive tract. By slowing this process down, you end up feeling full and satiated for a prolonged period. Thus, you don’t feel as hungry, don’t eat as much, and lose weight in the process.

While most of these medications were initially approved by the Food and Drug Administration (FDA) for the treatment of diabetes, some of them have also gained approval in subsequent years for chronic weight management. Take semaglutide, for example, which was originally approved in 2017 by the FDA for the management of type 2 diabetes as an adjunct to diet and exercise. This approval was based on a series of trials evaluating the active ingredient semaglutide in diabetic patients. Although the medication provided significant decreases in blood sugar parameters like hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG), it also demonstrated weight loss effects as well.

Because of these weight loss effects, the manufacturer of semaglutide continued studying it in obese and overweight patients. Four trials characterized its safety and efficacy in obese and overweight patients, indicating that it was incredibly effective in inducing weight reductions in both diabetic and non-diabetic patients. Likewise, the FDA ended up approving the same medication for an additional indication, chronic weight management, under the brand name Wegovy in 2021. This represented the first drug approval for weight loss since 2014, only further increasing interest in the medication.

This phenomenon extends to more medications than just semaglutide. Several other GLP-1s, though initially approved for just diabetes, have expanded their approved indications into the weight loss realm.

Why is there a shortage of diabetes medications, then?

You may be wondering, if semaglutide is approved for weight loss under the brand name Wegovy, then why might there be shortages of Ozempic, which is meant for diabetes? A lot of prescribers will prescribe Ozempic “off-label” for weight loss, even though it is meant for diabetes. Because the two brands share the same active ingredient and are dosed similarly, physicians will often prescribe and use the two interchangeably. This goes for other GLP-1 drugs as well, like tirzepatide for example, which is approved for type 2 diabetes (Mounjaro) and weight loss (Zepbound).

When there is an uptake in the use of these drugs for weight loss purposes, this ultimately takes supply away from those that are needing the medications for diabetes control. The hope is that pharmaceutical companies and manufacturers would be able to mitigate this phenomenon by simply increasing supply, but this has not always been the case. Shortages of these medications have swept the country, causing many to be without their diabetes medication and thus undertreated.

What is the impact of these shortages?

The impact of these shortages is widespread, affecting several different injectable antidiabetic medications in all different regions across the country. Medications like Ozempic, Mounjaro, and Trulicity have all been impacted in the last six to eight months.

The biggest consequence of these shortages is the inability to access these medications by patients. Pharmacies are not able to maintain an adequate supply of these medications for their diabetes patients, and patients are suffering as a result. Patients may miss a dose or several doses for weeks at a time because they cannot get their hands on the medication. This can have detrimental effects on blood sugar levels. The consequences of these shortages are outlined below:

  • Uncontrolled blood sugars. When someone goes too long in between doses, the blood sugar levels will elevate and increase A1c. We know that the impact of untreated diabetes and uncontrolled blood sugar levels are significant, with the potential to cause downstream heart, nerve, eye, hearing, foot, and mental health effects.
  • The need to re-titrate doses. You cannot just restart where you left off with your dose after stopping therapy for a prolonged period. Many of these medications require careful dose titration over several weeks. For example, if someone was stable on the maximum dose but then had to stop therapy because of a shortage, they would likely need to restart again at the lowest dose. The lowest dose likely would not be therapeutic, causing them to be undertreated for even more time.
  • Underdosing. While someone’s injectable medication may be available, it may not be available in the dose they are looking for. For example, someone stable on a 4.5 mg dose may need to go to a 3 mg dose because that is all that is available. Thus, the patient would be underdosed.

How long will these shortages last?

It is unclear exactly how long these shortages will last, and it is also very dependent on the drug’s specific manufacturer. Eli Lilly, the manufacturer of Trulicity, expects the shortage to continue throughout 2024.

How can I navigate these shortages as a patient?

While shortages are largely outside of our control, there are a few factors you can do as a patient to avoid missing a dose and continue to manage your blood sugars appropriately. Here are some tips:

  • Contact your pharmacy early. Do not wait until the last minute to fill your antidiabetic prescription. It is recommended to reach out to your pharmacy at least two weeks before you will need your next prescription. Doing this will increase your chances of being able to find the medication in time before your next dose.
  • Try out different pharmacies. Although your usual pharmacy may not have the medication in stock, there is a chance that other nearby local pharmacies do. Your pharmacy may be able to help you locate it at other chains. It may be a bit inconvenient and require a drive, but it would ensure you continue your therapy.
  • Discuss with your doctor. There may be instances where despite preparation and flexibility in getting your prescription, the medication is still out of stock. In these cases, patients should maintain close communication with their providers so that their providers can respond appropriately. This may mean switching to another medication (Rybelsus instead of Ozempic) or prescribing an available dose (i.e. Ozempic 4mg rather than Ozempic 2mg).

Accessible & Affordable Medication from Canada

Amid these challenges, Buy Canadian Insulin emerges as a beacon of hope for U.S. patients facing the brunt of diabetes medication shortages. This prescription-referral service connects patients with licensed and trusted Canadian pharmacies, offering a secure and straightforward platform to access essential medications. To utilize Buy Canadian Insulin, patients must have a prescription from their doctor, which can be conveniently submitted via fax, uploaded through the patient dashboard, or emailed, ensuring a seamless process from prescription to delivery.

With Buy Canadian Insulin, patients can save up to 90% on their medication costs, a significant relief given the financial strain many face due to high drug prices in the U.S. Understanding the urgency that comes with diabetes management, Buy Canadian Insulin ensures that patients receive their medications promptly, with express shipping that delivers orders within 3-5 business days. To maintain the integrity of medications, especially those requiring refrigeration, the service uses thermal packaging equipped with cool-packs, ensuring that drugs arrive in optimal condition.

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As the pharmaceutical industry grapples with the challenge of meeting the soaring demand for diabetes and weight loss medications, services like Buy Canadian Insulin provide a critical lifeline for patients. By offering a reliable, cost-effective alternative and facilitating the prescription submission process, Buy Canadian Insulin not only addresses the immediate need for affordable medication but also contributes to a broader solution for the ongoing issue of drug shortages and high pharmaceutical costs in the United States. This initiative represents a vital step towards ensuring that all patients have access to the treatments they need to live healthy, fulfilling lives, despite the current challenges in the pharmaceutical landscape.

Conclusion

The world of GLP-1s has expanded from diabetes management into the weight loss realm, creating shortages across the nation. While it is a positive that diabetes, obese, and overweight patients alike are getting treatment for their conditions, it is not without a cost. Diabetes patients in particular are suffering as a result of shortages, with inaccessibility to their medications leaving their blood sugars uncontrolled. Pharmaceutical manufacturers will need to pick up the pace, while patients will need to be adaptable in the meantime.

Key Takeaways

  • In the US, high demand has outpaced supply, causing nationwide shortages, particularly affecting diabetic patients who rely on these medications for blood sugar control and to prevent complications.
  • The shortages are primarily due to the unexpectedly high demand for GLP-1 agonists, like semaglutide (Ozempic, Wegovy) and dulaglutide (Trulicity), which are effective for both diabetes management and weight loss.
  • GLP-1 agonists work by mimicking the incretin hormone GLP-1, promoting insulin release for diabetes management and delaying gastric emptying for weight loss.
  • Some medications initially approved for diabetes have also been approved for weight management, leading to off-label use and contributing to shortages.
  • Patients face challenges in accessing their medications, leading to uncontrolled blood sugars, the need for dose re-titration, and underdosing.
  • Patients are advised to contact pharmacies early, explore different pharmacies, and communicate with their doctors for alternative medications or dosages.
  • Buy Canadian Insulin offers a service connecting US patients with Canadian pharmacies, providing a cost-effective way to access medications amidst US shortages.
  • The expansion of GLP-1s into weight loss has exacerbated shortages, impacting diabetes care. Patients and pharmaceutical companies must adapt to address these challenges.