GLP-1s have rapidly captured public attention due to their high degree of effectiveness with aiding blood sugar control, improving cardiovascular and metabolic health, and assisting with weight loss. However, people with diabetes and obesity who are eager to take advantage of what these medications have to offer are struggling with getting access to these medications due to ongoing distribution shortages that have created a classic bottleneck in supply and demand. And even when eligible patients do manage to secure a safe, affordable, and reliable supply, the challenges don’t stop there. The public discourse around these drugs, fueled by social media and celebrities, has left many people confused about how to use these medications as part of a holistic, balanced approach to managing their overall health.
For example, in a recent consumer survey, 68% of respondents said they believe GLP-1s are simply a “silver bullet” for their health issues and are able to solve a variety of health concerns without much additional effort. This type of incorrect belief can make it much more difficult for healthcare providers to work with people to adopt a successful care plan that incorporates GLP-1s into a person-centered, holistic diabetes management program.
To assist with realigning perceptions with the real benefits — and limitations — of GLP-1s, primary care and specialty clinicians will need to develop a supportive scaffolding of education and coaching to fully support individuals throughout their health journey.
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Clinicians and specialists can start by adapting lessons learned from other successful areas of metabolic health management, such as onboarding for continuous glucose monitors (CGMs) and preparation for bariatric surgery, to ensure that GLP-1 users have the tools and assistance required to be successful on these medications.
Leveraging technology to identify high-priority candidates
Shortages of some of the most popular GLP-1 options are expected to persist throughout 2024 at the very least as manufacturers sort through supply chain issues. To maximize the impact of available supplies, providers should consider using population health management techniques to identify patients who could benefit most from starting GLP-1 therapy.
Moving forward, predictive analytics tools that incorporate data from disparate sources — such as clinical, claims, purchasing, and socioeconomic status— must be more widely utilized to generate risk scores to drive preventive clinical decision-making.
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Using prioritization lists generated from predictive analytics, providers or their partners in diabetes management can conduct proactive outreach to connect individuals with the right resources, including GLP-1 therapy where appropriate, to shift the trajectory of their self-management of diabetes.
Managing expectations with evidence-based education
Instead of reinforcing misperceptions of GLP-1s as a “silver bullet,” providers and coaches will need to position these medications as another tool to power comprehensive diabetes care. People with diabetes will need education about how these drugs work alongside CGMs, insulin pumps, and nutrition and lifestyle choices to keep blood sugar under control and promote a healthy metabolism for the long and the short term.
People will also need some insight into how to manage common side effects — such as gastrointestinal symptoms, dizziness, and fatigue — and guidance as to when these issues are serious enough and worthy of reporting back to their providers. Offering a clear pathway for reporting undesirable side effects will make it easier for patients to get answers and make better decisions about using their medications now and in the future as adoption of GLP-1s continues to rise.
People with diabetes will also need to be aware that GLP-1 therapy is a long-term commitment that requires drastic, lasting change when it comes to how people interact with food. For example, sugary foods and drinks should be avoided when taking a GLP-1 as they can lower the medication’s effectiveness. People utilizing GLP-1s also often regain significant amounts of weight after discontinuing the medication and are also likely to see their cardiovascular health metrics revert to baseline after stopping their medications, which means they have to stay on therapy if they want to maintain their improvements.
Finally, prospective GLP-1 users may benefit from an evaluation and coaching structure similar to what is often provided before bariatric surgery, including a psychological consultation, nutritional counseling, and support around physical activity and lifestyle changes, to ensure they are prepared to succeed.
Building a community of care around GLP-1 users with diabetes
GLP-1s can help manage diabetes, but they don’t replace the need for proactive, individualized self-management of what is typically a lifelong condition. Even people who lose weight on GLP-1s will still need to engage appropriately with their CGMs, insulin pumps, and other medications to maintain blood sugar control, which means they will continue to need all the attention, care, and coaching that should surround everyone living with diabetes.
Working closely with people to ensure they understand the importance of adherence to all their medications, how to use personal medical devices, and how to stay on top of ordering and using diabetes care supplies will be essential for keeping patients healthy while making the most of their GLP-1 therapy.
Healthcare providers that do not have the capacity to provide this detailed level of education and ongoing coaching should consider leveraging partners in the space, such as health plans, accredited diabetes educators, and diabetes supply companies, to assist with delivering these services. By working together to build an ecosystem of support around people with diabetes, the healthcare system as a whole can ensure that no one slips through the cracks as innovation and adoption of weight loss drugs gains speed.
Creating more structure around introducing people with diabetes to GLP-1s will be essential as the number of users rapidly increases over the next few years. Developing a clear and effective onboarding strategy that relies on evidence-based education, holistic coaching, and collaborative action will help avoid misinformation while preparing people with diabetes for long-term success in managing their holistic health.
Photo: gustavofrazao, Getty Images
Dr. Arti Masturzo is the Chief Medical Officer at CCS - a company focused on simplifying holistic chronic care management for patient.
Dr. Angela Fitch is the Chief Medical Officer at knownwell - a company that provides weight inclusive healthcare for all.
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