Ozempic

Posted on Diabetes

Researchers move closer to a cure for diabetes

Karakose abstract

Graphical abstract of the work.  Credit Mount Sinai Health System

Diabetes researchers and bioinformaticians from the Icahn School of Medicine at Mount Sinai have developed a new understanding of how human beta cell regenerative drugs work. These drugs, developed at Mount Sinai, may hold promise for more than 500 million people with diabetes worldwide.

Diabetes develops when cells in the pancreas, known as beta cells, cannot produce insulin, a hormone essential to regulating blood sugar levels. While significant progress has been made toward discovering a durable therapy, none are scalable therapeutic options for millions of diabetics worldwide.

For more than 15 years, researchers at the Icahn School of Medicine at Mount Sinai have worked tirelessly to find a solution to cure diabetes by identifying a drug that could make human beta cells regenerate.

In 2015, Mount Sinai researchers discovered the first such drug, called harmine. Harmine is a member of a class of medications called DYRK1A inhibitors. In 2019 and 2020, the researchers reported that DYRK1A inhibitors could synergize with TGF-beta signalling as well as GLP-1 receptor agonist (GLP-1RA) drugs such as semaglutide (e.g., Ozempic) and exenatide (Byetta) to induce more robust levels of human beta cell regeneration. Finally, in July 2024, they showed that harmine alone increases human beta cell mass by 300 per cent, and if a GLP-1RA is added, by 700 per cent. 

A key question has been how harmine causes beta cells to regenerate. In the newest study, the research team reports that the new, regenerated beta cells may be coming from an unexpected source: a second pancreatic cell type called alpha cells. Since alpha cells are abundant in people with type 1 and type 2 diabetes, they may be able to serve as a source for new beta cells in both common types of diabetes.

“This is an exciting finding that shows harmine-family drugs may be able to induce lineage conversion in human pancreatic islets,” says Esra Karakose, PhD, Assistant Professor of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine at Mount Sinai and corresponding author of the study. “It may mean that people with all forms of diabetes have a large potential ‘reservoir’ for future beta cells, just waiting to be activated by drugs like harmine.”

“A simple pill, perhaps together with a GLP1RA like semaglutide, is affordable and scalable to the millions of people with diabetes,” said Dr. Stewart.

Posted on Diabetes, Obesity

Impact of weight loss and blood sugar control in T2 Diabetes

Study finds that type 2 diabetes patients treated with GLP-1RAs who lowered their BMI also reduced their cardiovascular risk
Study finds that patients with type 2 diabetes treated with GLP-1RAs who reduced their BMI also lowered their cardiovascular risk.

A research team from the Cleveland Clinic has recently conducted the first study evaluating the separate real-world effects of weight loss and blood sugar control on clinical outcomes in individuals with type 2 diabetes who are being treated with antidiabetic medications, specifically GLP-1RAs, which includes drugs like Ozempic and Wegovy.

The study discovered that for every 1% decrease in BMI, there was a 4% decrease in cardiovascular risk, irrespective of changes in blood sugar levels. Additionally, effective control of blood sugar, regardless of weight change, was associated with a reduced risk of chronic kidney disease. These findings are significant from a clinical standpoint and underscore the importance of addressing both glycemic control and obesity in individuals with type 2 diabetes.

The retrospective findings, which were published in Diabetes, Obesity, and Metabolism, used de-identified electronic health record-derived data from over 1,300 patients with type 2 diabetes who were evaluated at Cleveland Clinic.

Posted on Patient Talk

The rising popularity of Ozempic and Wegovy among privately insured patients could exacerbate disparities.

A USC study of prescription data shows that people with Medicaid or Medicare Part D may be missing out on powerful new obesity and diabetes drugs
A study conducted by USC on prescription data indicates that individuals with Medicaid or Medicare Part D plans may not be benefiting from new, effective medications for obesity and diabetes.

A new study from USC suggests that individuals with public insurance who could benefit from new drugs for diabetes and obesity are less likely to receive them compared to those with private insurance.

Prescription fills for the drug known as Ozempic or Wegovy, also called semaglutide, surged by over 400% from January 2021 to December 2023, according to new research in JAMA Health Forum. 

Semaglutide was initially approved for type 2 diabetes and later for weight loss. Studies have shown that it also improves blood pressure and reduces the risk of cardiovascular disease, which are common issues for millions of Americans. However, the majority of prescriptions for semaglutide were given to individuals with private insurance.

“Considering the established cardiovascular advantages of Ozempic and Wegovy for treating diabetes or obesity, and the higher prevalence of diabetes and obesity in Black/Latinx Medicaid and Part D populations, these results indicate that their limited use in Medicaid and Part D could exacerbate disparities in diabetes and obesity outcomes,” explained Dima Qato, who is an associate professor at the USC Mann School of Pharmacy & Pharmaceutical Sciences and a senior scholar at the USC Leonard D. Schaeffer Center for Health Policy & Economics.

“While the media focuses on semaglutide’s anti-obesity effect, we should not overlook its significant role in treating diabetes. This medication has allowed me to help some of my patients reduce their reliance on insulin,” explained Christopher Scannell, a physician and postdoctoral researcher at the Schaeffer Center. He also highlighted the importance of ensuring broader access to these medications beyond just those with private insurance or more comprehensive health plans, as this is an issue of equity affecting a large portion of the U.S. population.

Please take note of the following information:Ozempic and Wegovy are both administered via once-weekly injections. Another form of semaglutide, Rybelsus, is available in the form of a daily pill. Ozempic was approved in 2017, followed by Rybelsus in 2019, both intended for the treatment of type 2 diabetes. Wegovy, approved in 2021, is a higher-dose version specifically designed for weight loss. As for pricing, Ozempic’s sticker price is approximately $1,000 per month, while Wegovy is listed at around $1,350.

For the study, researchers utilized data from IQVIA’s National Prescription Audit PayerTrak, which captures 92% of prescriptions filled and dispensed to individuals at retail pharmacies in the United States.

They calculated monthly medication fills for semaglutide under different drug brands (Ozempic, Wegovy, and Rybelsus) and payment methods (commercial insurance, Medicaid, Medicare Part D, and cash) from January 2021 to December 2023.

  • Please make a note of the following text: In 2023, Medicaid accounted for less than 10% of semaglutide prescriptions across all three drug brands. According to Scannell, access to these drugs through Medicaid is determined at the state level. Whether or not the drugs are covered depends on the budget and politics of your specific location. It’s important to note that Medicaid provides assistance to low-income individuals, the elderly, and some people with disabilities.
     
  • In 2023, Medicare Part D represented 28.5% and 32.9% of Ozempic and Rybelsus fills, respectively. However, it only made up 1.2% of Wegovy fills. It’s important to note that Medicare Part D does not cover drugs for obesity unless a patient also has a co-morbidity such as cardiovascular disease, which both Wegovy and Ozempic can help prevent. 
  • Approximately 1% or less of all semaglutide fills went to people paying cash in 2023.

In the context of treating obesity, Scannell stated, “If Medicare only covers these drugs for patients who have obesity and a co-morbidity, it may force patients who only have obesity to develop additional chronic conditions before they can access the medications. It’s like saying, ‘You have to be sick enough, then we’ll cover that medication for you.’”

The researchers suggested that future studies should investigate how changes in Medicare Part D and Medicaid coverage restrictions impact disparities in access to these important medications. Additionally, further research could explore individual-level variables like age, race, and ethnicity, as well as whether the drugs were prescribed for obesity or diabetes.