Weight-loss clamour leading to shortage of diabetes drug

Ozempic and similar drugs have been growing as the go-to treatment for type 2 diabetes in Cayman, but their recent popularity as weight-loss tools locally and worldwide is leading to a shortage of the medication for diabetics.

Local doctors describe these types of injectable daily or weekly drugs as game-changers in the treatment of type 2 diabetes, which is one of the most prevalent diseases in the Cayman Islands.

As well as lowering glucose levels, the drugs have proven to be extremely effective in suppressing the appetite, leading to weight loss, and making it the latest diet fad.

Physician Dr. Fiona Robertson, who works in both the public and private sector, and treats many diabetics, explained why these drugs, known as semaglutides, work so well.

“They basically keep the food in the stomach for longer, so you feel full,” she says. “It’s like having a Christmas turkey dinner – you feel like you don’t need to eat for another two days.

“Effect number two is that they alter how you want food, they alter appetite, and they tend to alter it so you don’t want starchy foods, so you’re going to pick your foods better. And the other thing they do is they alter the way you store your sugars in the liver as glycogen.”

These drugs were originally designed to treat type 2 diabetes, with the US Food and Drug Administration first approving 1mg injectable doses of Ozempic in 2017. Then, in June 2021, it approved Wegovy, a stronger injectable semaglutide in 2.4mg doses, for chronic weight management in adults with high blood pressure, type 2 diabetes or high cholesterol.

Diabetologist Dr. Diane Hislop-Chestnut says she has been treating her diabetes patients with semaglutides for three or four years, but since the FDA approved the drug for weight loss, it has become harder to find on island.

“I’ve used it for our diabetic patients for years, and I’ve never had an issue getting hold of it until the last few months, since it’s been in the news for weight loss,” she says.

She warns, though, that the drug does not work for everyone and it is not a quick fix, either for weight loss or for the treatment of diabetes.

“It’s another tool to use, but by no means does it work for everybody,” she said, adding that she explains to her diabetes patients that it can take up to three months to start to see results, and they can expect to be on the drug for two years or more.

She noted that anyone who has been on Ozempic for up to three months and is not losing weight should discontinue it as it’s not working for them.

Hollywood weight-loss craze

The FDA recommended that the drugs, manufactured by Novo Nordisk, be used for ‘chronic weight management’ in patients with a body mass index of 27 or greater who have at least one weight-related ailment, or in patients with a BMI of 30 or greater.

However, they are being used by some to lose weight when they are not obese or very overweight.

Its appetite suppressant qualities have made it what US National Public Radio called ‘the worst kept secret in Hollywood’.

Reports and rumours of the widespread use of the drug in Hollywood led this year’s Academy Awards host Jimmy Kimmel to joke, “Everybody looks so great. When I look around this room, I can’t help but wonder ‘Is Ozempic right for me?'”

Among the famous people who had admitted to using it is Twitter and Tesla CEO Elon Musk, who, in response to a tweet asking him how he kept a good physique, replied, “Fasting. And Wegovy.”

Side effects

Apart from a supply-shortage issue, there are also concerns that some of those taking the drug for weight loss are not informing themselves about the side effects, of which the FDA lists many, but the most common are nausea, vomiting, stomach pain and bloating.

Robertson stresses the importance of anyone being prescribed the drug to have proper medical counselling and advice.

She says she has seen patients, who have been prescribed the drug by other clinics on island, come to her complaining of abdominal discomfort and nausea that they had not known to expect.

“Some people just don’t want to think about it,” she says. “They just want to take their Sunday injection and not think about it for the rest of the week. But I’m worried about those people because it means they’re not thinking about their food generally. So these people all need counselling and coaching.”

She adds, “It’s not a matter of just taking a medicine, you’ve got to choose your foods… This is not a free ride to weight loss. The side-effect profile is quite severe. These medicines make you feel bloated, and if you go on eating when you shouldn’t or eat the wrong stuff, you’re going to feel nauseous.”

Some patients have told her they stopped taking the medication because it made them feel bloated or sick, but “that’s what it’s meant to do”, she says, and that’s why it is vital that those patients “listen to their bodies” and adjust their diets accordingly.

Hislop-Chestnut says she has also had patients who had taken it one time and then said they won’t ever use it again because it made them so unwell or uncomfortable.

Nutritionist Andrea Hill says while Ozempic does show improvements in blood sugar levels and weight loss, there are no major studies yet that evaluate the long-term outcomes of that weight loss.

“In other words, what happens when the person stops the medication? If they haven’t learned how to navigate their meals and adjust poor lifestyle habits, this drug will only do so much,” she said, in an emailed response to queries from the Compass.

She added, “How you eat (adequate protein + fiber + healthy fats, consistent meal timings) and how you live (good sleep hygiene, moderate exercise, limited/no alcohol) are bigger players in long-term success with both weight management and blood sugar.”

Pricy option

Ozempic is expensive, costing around $400 for a month’s supply. Mounjaro, another anti-diabetes drug that is proving very popular for weight loss, costs twice that.

Currently, insurance companies in Cayman are only covering the cost of the drug for diabetics, and won’t pay for its use just for weight loss, Hislop-Chestnut said.

For some morbidly obese patients, bariatric surgery has been the option they’ve turned to.

Robertson runs the Health Services Authority’s bariatric unit, where very obese individuals undergo surgery to help combat weight-related health issues. She says she’s seeing similar weight-loss results with the use of Ozempic as through the bariatric surgeries.

She says at least 200 bariatric surgeries have been carried out at the HSA through the government’s CINICO insurance system, as most private insurance companies do not cover such treatments.

Semaglutides like Ozempic and Wegovny are not the only prescription injectable weight-loss products on the market. There are also Eli Lilly’s anti-diabetic medications Victoza, a daily injection, and Mounjaro, a weekly one, which are tirzepatides that act in a similar fashion to semaglutides, but are thought to be even more effective.

“These drugs are going to change the way type 2 diabetes is managed,” Robertson says. “Over time, as we get more, as they get cheaper, as we coach people, we may be able to give these drugs to prevent type 2 diabetes.”

‘Amazing’ treatment

Another local physician, Dr. Virginia Hobday, described the impact of the drugs as a diabetes treatment as “amazing”.

“There are very few diabetics it does not help. I know some who have lost 15% of their body weight, as much as if you had undergone bariatric surgery,” Hobday says of some of the patients she has seen.

But she pointed out, “The problem with prescribing it for someone who is not diabetic, at some point there’s going to be a supply issue. It’s a concern if, at one time, if everyone takes it, would diabetics be able to get it?”

Robertson said in the 30 years she has been treating patients on island, there has been a major increase in the number of cases of type 2 diabetes she is seeing, as people’s lives become more sedentary, and more fast food and processed meals are available.

She said the shortage of the drug, not just in Cayman, but worldwide, is because it’s proving so popular for weight loss that the manufacturer, Novo Nordisk, cannot keep up with demand. “It’s not that it’s selling out, it’s just we can’t get it in,” she said.

She understands why it’s so popular as a weight-loss option.

“This is the first weight-loss medicine that we’ve had that doesn’t really stimulate your heart rate, doesn’t push your blood pressure up, doesn’t make you stuffed with caffeine or use some hormone you shouldn’t be on. And they’re not fillers or laxatives,” she says.