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Living with diabetes can be managed by proper medication. However, you may have questions regarding the medications available to you. Here, we will take a closer look at two medications, Ozempic and Saxenda, so that you can see how these medications can impact your health. A CLOSER LOOK AT DIABETES Diabetes can be divided into two categories, type 1 diabetes (T1D) and type 2 diabetes (T2D). Type 1 diabetes is an autoimmune disorder and is commonly diagnosed in children. Individuals with T1D require lifelong insulin treatment to manage their diabetes. Type 2 diabetes is diagnosed later in life due to genetics, lifestyle, and other risk factors. Unlike T1D, there are numerous treatment options other than insulin therapy to manage type 2 diabetes. GLP-1 RECEPTOR AGONISTS A common drug class used to treat type 2 diabetes is glucagon-like peptide 1 (GLP-1) receptor agonists. GLP-1 receptor agonists work by lowering blood glucose and slowing gastric emptying. Benefits of using a GLP-1 receptor agonist include: weight loss, atherosclerotic cardiovascular disease (ASCVD) benefits, lowering A1C values, and chronic kidney disease (CKD) benefits with little risk of hypoglycemia. Common GLP-1 receptor agonist side effects include nausea, vomiting, diarrhea, weight loss, and injection site reactions. GLP-1 receptor agonists should not be used in patients with a personal or a family history of medullary thyroid cancer.

The General Pharmaceutical Council (GPhC) has urged health and care professionals to meet relevant regulatory standards amidst the shortage of GLP-1 receptor agonists (GLP-1 RAs). The council said: "We are concerned to hear that people with Type 2 diabetes are experiencing problems accessing GLP-1 receptor agonists (GLP-1 RAs). We know that these are being widely prescribed for weight loss purposes and in some cases prescribed off-label." "We recognise the adverse impact that shortages and supply chain issues can have on patients, the public and wider health and care teams. The Council understands that health and care professionals are using their professional judgement and making decisions in challenging situations, balancing a range of factors such as individual patient needs, wider public health and pressures and limitations on available resources such as medicines shortages or other supply chain issues.

The Department of Health and Social Care (DHSC) has issued an alert to update healthcare professionals on the shortage of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which are used to treat type 2 diabetes. It has informed that the supply of the drugs continues to be limited, and is not expected to return to normal until at least the end of 2024. An increase in demand for these products for licensed and off-label indications is cited as the cause of the supply issues. "Rybelsus® (semaglutide) tablets are now available in sufficient quantities to support initiation of GLP1 RA treatment in people with type 2 diabetes (T2DM) in whom new initiation of GLP-1 RA therapy would be clinically appropriate," the DHSC's National Patient Safety Alert reads.

Department of Health and Social Care (DHSC) has issued a medicine supply notification for GLP-1 receptor agonists used in the management of type 2 diabetes on Tuesday (27 June). "There are very limited, intermittent supplies of all glucagon-like peptide-1 receptor agonists (GLP-1 RAs) licensed in the management of Type 2 Diabetes Mellitus (T2DM)," said DHSC. The supply issues have been caused by an increase in demand for these products for licensed and off-label indications and it is not expected to return to normal until at least mid-2024. Pharmacists are urged to refer to the SPS Tool for Medicines Shortages for an up-to-date supply stock situation and clinical guidance on alternative treatment options.

Following a comprehensive review, the Medicines and Healthcare products Regulatory Agency (MHRA) has concluded that current evidence does not support a causal link between Glucagon-Like Peptide-1 (GLP-1) receptor agonists and suicidal behaviour, suicidal ideation, self-injury, or depression. GLP-1 receptor agonists , which contain active ingredients such as exenatide, lixisenatide, liraglutide, dulaglutide, and semaglutide, are commonly used to treat type 2 diabetes and obesity. In July 2023, concerns were raised about the safety of these receptor agonists after post-marketing reports suggested a potential risk of suicidal thoughts and self-harm associated with these medications. As a result, safety reviews were initiated by the Market Authorisation Holders (MAHs), evaluating the UK post-marketing data to assess the potential risks of these drugs. These reviews also examined the risk of depression in the interest of patient safety following reports of these side effects.

Kent and Medway prescribe the highest number of semaglutide, liraglutide and tirzepeptide - drugs that are commonly used for treating type 2 diabetes, weight loss, or both - in the UK, according to recent research by Click Pharmacy. Called GLP-1 agonists, these drugs mimic the effects of the GLP-1 hormone, which is released by the body after eating. This hormone slows digestion, stimulates insulin release, and inhibits glucagon, a hormone that raises blood sugar, making GLP-1 agonists effective treatments for diabetes and weight management. The online pharmacy's research reveals that Kent and Medway prescribed the most of these drugs in the month of June 2024, with 6,326 prescriptions. Other NHS Integrated Care Boards (ICBs) with high prescription rates included: Black Country and West Birmingham (5,019) Hampshire, Southampton, and Isle of Wight (4,960) Birmingham and Solihull (4,775) North Central London (4,528) North East London (3,557) North West London (3,498) Cambridgeshire and Peterborough (2,973) Coventry and Warwickshire (2,912) Norfolk and Waveny (2,575) Brighton and Hove topped the list for prescribing Wegovy, a weight-loss drug containing semaglutide, with 35 prescriptions made out in June alone.

One of the long-standing medical mysteries is the diagnosis of diabetes in majority of patients suffering from high blood pressure. The reason for this had been unknown. But now, an international team of universities have made a breakthrough. The research, published online in 'Circulation Research', involved contributions from collaborating scientists in Brazil, Germany, Lithuania, and Serbia, as well as the UK and New Zealand. The important new discovery has shown that a small protein cell glucagon-like peptide-1 (GLP-1) couples the body's control of blood sugar and blood pressure. Professor Julian Paton, a senior author, and director of Manaaki Manawa, The Centre for Heart Research at the University of Auckland, said: "We've known for a long time that hypertension and diabetes are inextricably linked and have finally discovered the reason, which will now inform new treatment strategies." GLP-1 is released from the wall of the gut after eating and acts to stimulate insulin from the pancreas to control blood sugar levels. This was known but what has now been unearthed is that GLP-1 also stimulates a small sensory organ called the carotid body located in the neck.

Victoza (liraglutide) 6mg/mL pre-filled injection pens, previously used in the treatment of type 2 diabetes mellitus (T2DM), have been out of stock in the UK since August 2023. Novo Nordisk has confirmed to The Pharmaceutical Journal that the product has now been discontinued as part of their broader strategy to consolidate their portfolio. The Danish pharmaceutical company said that they are in close dialogue with the Department of Health and Social Care (DHSC), which is expected to release guidance outlining timelines, alternative treatments, and recommended next steps for healthcare professionals. However, the company clarified that they have no plans to discontinue Saxenda (liraglutide) pre-filled injection pens, though this product has also faced supply restrictions in the UK since shortages began. The DHSC initially announced a national shortage of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), including Victoza, in June 2023. At that time, prescribers were advised to limit use of these drugs for their licensed indications and to avoid initiating new GLP-1 RA therapies for T2DM patients during the shortage.

A comprehensive cohort study has shed light on the benefits and risks associated with weight-loss drugs, offering valuable insights for clinical care and future research. Published in Nature Medicine on 20 January 2024, the study found the use of glucagon-like peptide 1 receptor agonists (GLP-1RAs)-used to treat diabetes and obesity-associated with a reduced risk of substance use disorders (including alcohol, cannabis, opioid and stimulant use disorders). Weight-loss drug use was also linked to decreased risks of psychotic disorders, seizures, neurocognitive disorders (including Alzheimer's disease and dementia), coagulation disorders, cardiometabolic disorders, infectious illnesses and several respiratory conditions. However, the use of GLP-1RAs was not without risks, as researchers identified an increased risk of gastrointestinal disorders, hypotension, syncope, arthritic conditions, nephrolithiasis, interstitial nephritis, and drug-induced pancreatitis associated with their use. The analysis, utilising the U.S. Department of Veterans Affairs databases, compared 215,970 GLP-1 RA users with patients using sulphonylureas (n=159,465), DPP4 inhibitors (n=117,989), SGLT2 inhibitors (n=258,614), or a composite of the three (n=536,068).

Medical professionals often prescribe semaglutide to patients who have type 2 diabetes. Along with a balanced diet and regular exercise, it has also shown to be an incredibly efficient weight loss aid for patients. As the active ingredient in well-known brand-name drugs such as Wegovy, Ozempic, and Rybelsus, semaglutide is currently on everybody's lips. But what exactly is semaglutide? Does it really work for weight loss? We'll find an answer for you in this article, and explain the main benefits of using semaglutide for weight loss. What Is Semaglutide? A number of diabetic and weight loss medications, including Wegovy, Ozempic, and Rybelsus, have semaglutide as their active ingredient. This substance is a synthetic form of the hormone glucagon-like peptide-1 (GLP-1), that occurs naturally. Developed by the company Novo Nordisk, semaglutide was first approved by the FDA in 2017 as an injection for the treatment of adult type 2 diabetes (as part of the approval procedure for Ozempic). In 2019, the Food and Drug Administration approved a novel semaglutide form known as Rybelsus. Rybelsus was the first oral GLP-1 receptor agonist for the treatment of type 2 diabetes in the United States.

Germany's Boehringer Ingelheim said on Thursday (Aug 17) it would conduct three late-stage studies for its obesity drug candidate after it showed up to 19 per cent weight loss after 46 weeks in a mid-stage trial. The private company plans to start enrollments for the trial of the drug, survodutide, which it co-invented with Danish biotech company Zealand Pharma, before the end of the year. The trials will evaluate the drug's safety and efficacy, Boehringer said, and added that it would provide further details on the studies before initiation. Boehringer and Zealand are among global drugmakers racing to grab a share of the potential $100 billion market for obesity treatments within a decade. Survodutide works by mimicking a gut hormone called glucagon-like peptide-1 (GLP-1), which suppresses appetite, as well as imitating another gut hormone called glucagon that helps break down fat.

The Pharmacist's Defence Association (PDA) has raised concerns over the adoption of Digital Clinical Excellence (DiCE) guidelines for online prescribing of GLP-1 receptor agonists for weight management in adults. This follows a clash with expert recommendations commissioned by the General Pharmaceutical Council (GPhC) as the PDA "believes the final guidance conflicts with the expert opinion underpins the GPhC's prosecution strategy towards pharmacist prescribers under investigation." In a recent statement, the PDA highlighted the discrepancy between DiCE's guidance and the expert report employed by the GPhC to prosecute pharmacist prescribers using a questionnaire-based consultation model. This conflict has prompted the PDA to withhold its endorsement of the DiCE guidance as it differs from an expert report commissioned by the GPhC. The PDA's reservations stem from the inherent risks associated with questionnaire-based prescribing.

In recent years, Mounjaro, a medication used for managing Type 2 diabetes, has gained significant attention due to its effectiveness in controlling blood sugar levels. However, as with any medication, Mounjaro is not without its side effects. Understanding the potential side effects of Mounjaro is crucial for patients and healthcare providers alike to make informed decisions about its use. Overview of Mounjaro (tirzepatide) Mounjaro, known by its generic name as tirzepatide, is a once-weekly injectable medication developed to help manage blood glucose levels in individuals with Type 2 diabetes. It functions by mimicking the action of the hormone GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide), which play key roles in regulating insulin secretion and blood sugar levels. Since its introduction, Mounjaro has been praised for its dual-action mechanism that not only helps lower blood sugar levels but also supports weight loss, which is often beneficial for individuals with Type 2 diabetes.

With Novo Nordisk's patent protection for liraglutide now expired, the UK is set to welcome the first wave of generic weight loss medicines. The British Generic Manufacturers Association (BGMA), the trade body for off-patent medicines, believes these generic versions could "provide could provide much-needed capacity to meet growing demand and alleviate shortages." Liraglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, is primarily used to treat type 2 diabetes and obesity. Novo Nordisk markets liraglutide under the brand names Victoza (for type 2 diabetes and Saxenda (for weight loss). In a statement released on 20 November 2024, the BGMA confirmed that "liraglutide's patent protection was no longer in force, marking the first time generic versions of diabetes and weight loss treatments can be available in the UK." The BGMA anticipates that at least four companies will obtain UK marketing authorisations for generics targeting type 2 diabetes and obesity. However, it remains uncertain how many will launch immediately.

Amid the rapid rise in semaglutide usage, a study has suggested a potential risk of a rare eye condition associated with the weight loss drug. Semaglutide, a glucagon-like peptide 1 receptor agonist (GLP-1 RA), is available under the brand name Ozempic (by Novo Nordisk) in a lower-dose form for managing type 2 diabetes mellitus (T2DM), and as Wegovy (also by Novo Nordisk) in a higher-dose form for weight management in patients with high body mass indexes. Anecdotal evidence has indicated that semaglutide might be linked to nonarteritic anterior ischemic optic neuropathy (NAION). To investigate this potential connection, researchers in the United States analysed data over a six-year period from nearly 17,000 neuro-ophthalmology patients at Massachusetts Eye and Ear Hospital in Boston, Massachusetts, all of whom had no prior history of NAION.

The European Medicines Agency's (EMA) Pharmacovigilance Risk Assessment Committee (PRAC) has initiated a review of semaglutide-containing medicines after concerns were raised regarding a potential increased risk of non-arteritic anterior ischemic optic neuropathy (NAION), a rare eye condition. Semaglutide, a glucagon-like peptide 1 receptor agonist (GLP-1 RA), is used in the treatment of diabetes and obesity, with medicines like Ozempic, Rybelsus, and Wegovy containing the active substance. A report from the PRAC highlighted two recent observational studies that suggest patients treated with semaglutide may face a higher risk of developing NAION. This condition, caused by reduced blood flow to the optic nerve, can result in vision loss in the affected eye. However, two other recent observational studies did not show an increased risk, according to the report.

National Institute of Health and Care Excellence (NICE) has not recommended 'Tirzepatide', also known as Mounjaro, developed by Eli Lilly, in its draft guidance issued on Tuesday (27 June) for treating type 2 diabetes in adults alongside diet and exercise. The independent NICE committee recognised the importance of new treatment options given that fewer than two-thirds of the adults with type 2 diabetes have adequate glucose control when using current treatment options. Evidence submitted to the committee from clinical trials showed the use of tirzepatide at any dose resulted in better glucose control and lower weight compared with semaglutide or insulin therapy. The weight reduction was more pronounced with higher doses of tirzepatide, while the effect on glucose levels seemed less dose-dependent. Similar effects were observed against all GLP-1 receptor agonists in company's network meta-analysis, but this was uncertain. The committee have asked the company to provide more data to address the uncertainties in the clinical evidence, when compared to all relevant alternative treatments.

New data on weight loss drugs that could compete with Novo Nordisk's Wegovy are raising expectations there will soon be more options, and possibly lower prices, in an estimated $100 billion marketplace, doctors and pharmaceutical executives say. Drugmakers are ratcheting up their research and aiming for new formulations that can be taken as pills, options to deliver higher weight loss or drugs that reduce fat while maintaining muscle. "It has really been an explosion of innovation," said Dr. Robert Gabbay, chief science officer at the American Diabetes Association (ADA), which receives funding from both Novo and Eli Lilly and Co and just concluded its annual meeting in San Diego, California. "If there are multiple (treatments) in the market, that will lead to some level of competition and greater access."

"Our main concerns are that the use of what they call an asynchronous supply, where the prescriber neither sees nor talks to the patient at the time they issue the prescription, does lay itself open to perhaps people getting hold of medication that they shouldn't," the Head of Policy, PDA said. The Pharmacists' Defence Association (PDA) engages in a critical conversation on BBC Radio 4's Woman's Hour, shedding light on the online prescribing of weight loss drugs and advocating for safer practices. The PDA's spokesperson, Head of Policy Alima Batchelor, emphasised the importance of adhering to professional guidelines to ensure patient safety and mitigate regulatory concerns. During the feature, the PDA highlighted the complexities and risks associated with online supply chains, stressing the necessity for direct clinical consultations and pharmacist involvement in medication management. ""There are guidelines and advice about verification within the DiCE guidance, but it doesn't go quite far enough for us. We are concerned when patients decline to allow the online prescriber to advise their GP of what they're taking," Batchelor highlighted.

The Medicines and Healthcare products Regulatory Agency (MHRA) has approved a new indication of semaglutide (Wegovy), authorising its use to reduce the risk of serious heart problems and strokes in adults who are obese or overweight. Semaglutide, a GLP-1 receptor agonist, was previously approved for use in the treatment of obesity and weight management, to be used alongside diet, physical activity and behavioural support. The latest approval establishes it as the first weight loss drug to be prescribed to prevent cardiovascular events, such as cardiovascular death, non-fatal heart attack and non-fatal stroke, in people with established cardiovascular disease and a Body Mass Index (BMI) higher or equal to 27 kg/m2. Novo Nordisk, the manufacturer of Wegovy, received this authorisation on 23 July following compelling evidence from a recent post-approval clinical study involving over 17,600 participants. The study demonstrated that Wegovy, administered at a dose of 2.4 mg once weekly via subcutaneous injection for up to five years, significantly lowers the incidence of major adverse cardiovascular events (MACE) by 20 per cent compared to a placebo.