GLP-1 Agonists: Balancing Weight Loss and Diabetes Management

We have all seen the commercials. The jingles have ear wormed their way into our everyday lives—the singing, dancing, happy people all lowering their A1C and losing weight, using drugs like Trulicity®, Rybelsus® and Ozempic® to manage their Type 2 diabetes. According to the Centers for Disease Control and Prevention (CDC), of the 37 million Americans (about one in 10) who have diabetes, approximately 90% to 95% have Type 2 diabetes, a chronic condition that requires careful management, often including lifestyle changes, diet, exercise and medication. 

Among the various treatment options available, medications known as GLP-1 agonists have gained significant attention, due to their potential to help with both blood sugar control and weight loss. But increased use of these medications for weight loss alone is causing a shortage, putting people with Type 2 diabetes at risk. 

What Are GLP-1 Agonists, and How Do They Work?

People with Type 2 diabetes usually experience a decrease in the production of important hormones. One is insulin, which helps regulate blood sugar levels. Others are called incretins, which are naturally found in the body and include gastric inhibitory peptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonists. When working properly, incretins tell the pancreas to put out insulin, which is then released into the bloodstream, telling surrounding cells to convert sugar in the blood to energy. 

Incretin-based therapies mimic the action of the naturally occurring GLP-1 hormones in the body and have been used to treat Type 2 diabetes for 17 years.

GLP-1 agonist medications primarily work in four ways:

• Slow down stomach emptying. GLP-1 medications help keep food in the stomach longer, making you feel full sooner and allowing for better food absorption.   
• Reduce the amount of sugar produced by the liver. This helps keep blood sugar levels stable between meals.
• Increase the release of insulin from the pancreas. Another way blood sugar levels remain stable between meals is through the release of insulin when food is eaten, which enables sugar from the meal to be used for energy. 
• Promote the feeling of being full. Receptors in the brain receive a signal telling the body to stop eating.

The Benefits of GLP-1 Agonists for Type 2 Diabetes

When GLP-1 medications are used in addition to healthy eating and physical activity, they can offer many benefits: 

• Improved Blood Sugar Control. By promoting insulin release and reducing glucagon secretion, GLP-1 agonists help the body maintain more stable blood sugar levels.
• Weight Loss. GLP-1 agonists have appetite-reducing effects that can lead to substantial weight loss, which is beneficial for individuals with Type 2 diabetes, since obesity is a significant risk factor for the condition.
• Cardiovascular Benefits. Some GLP-1 agonists have shown cardiovascular benefits, including a 22% reduction in the risk of heart attacks and strokes, which are common complications of uncontrolled diabetes.

Weighing the Weight-Loss Benefits of GLP-1 Agonists 

GLP-1 medications are undoubtedly a game changer for managing Type 2 diabetes. But as more people use these drugs strictly for weight loss, the side effects cannot be ignored:

• Shortage and Accessibility. The surge in demand for GLP-1 agonists for weight loss has led to shortages and increased costs. People who genuinely need these drugs for glycemic control may face difficulties accessing them, which puts them at risk and can negate the positive gains made in controlling their disease.
• Inadequate Monitoring. Using GLP-1 agonists for weight loss without proper medical supervision can lead to unmonitored blood sugar levels. This can put individuals with Type 2 diabetes at risk of hypoglycemia, a potentially dangerous condition characterized by low blood sugar levels.
• Potential Side Effects. Like any medication, GLP-1 agonists have side effects, including nausea, vomiting and diarrhea. More serious side effects, such as pancreatitis and potential for thyroid cancer, are rare. Using GLP-1 agonists without proper medical guidance can lead to an increased risk of these adverse effects.

Balancing the Benefits and Risks

While GLP-1 agonists are valuable tools in the management of Type 2 diabetes, they are not the magic bullet for weight loss we’d like them to be. They are designed to be used in tandem with the tried-and-true tenets of living a healthy lifestyle and preventing diabetes: eating healthy foods and exercising regularly.

It is crucial for individuals to use these medications under the guidance of a healthcare professional, and for their intended purpose: managing diabetes. Always consult with a healthcare provider to determine the most appropriate treatment plan for your specific health needs—and help ensure that those with Type 2 diabetes can benefit from these valuable medications without unnecessary risks.