When Diabetes and Obesity Collide: The Ozempic Shortage

Recently, I noticed that some patients with diabetes have expressed difficulty obtaining one of their glucose management medications, semaglutide (Ozempic, Novo Nordisk). Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist administered as a once-weekly subcutaneous injection.¹ While, in my experience, this medication is almost never used alone, some patients expressed great concern about the implications of the impact on overall glycemic control, and consequently the effect of missing doses on healing surgical sites and diabetic ulcerations. I assured them that between their entire care team, a short duration of change would not likely have a dramatic impact on long-term health outcomes.

Most patients were comfortable with the advice to monitor their status closely with their respective health care providers. One patient in particular, however, stood out. He shared an additional frustration which made me ponder more on this topic. He emphatically felt that individuals who elected to use semaglutide as a weight loss medication were one reason for a potential shortage, and that this was unfair to patients using it for type-2 diabetes. For this column, I am addressing only those patients  who are overweight or obese using this medication, and not those with less clinically related weight loss intentions.

I must admit, I shared his frustration at first, and this inspired more questions. Indeed, there was a shortage of semaglutide. The pharmaceutical company acknowledged “intermittent supply disruptions” late last year.² As recently as February 2023, the company continued to experience “periodic supply constraints” in some areas, but noted availability in the United States.³ While part of the shortage is due to increased demand, some felt it is also in part due to a parallel branding of the same medication to treat obesity, Wegovy (Novo Nordisk).

Semaglutide, as with most GLP-1 agonists, results in improved insulin secretion while decreasing hepatic gluconeogenesis. This clearly exhibits a benefit for those with type-2 diabetes, but interestingly, semaglutide also has an effect on many other tissues including the central nervous and gastrointestinal systems, which collectively results in decreased insulin resistance and facilitation of weight loss.² Semaglutide for the purpose has resulted in clinically significant weight loss for patients with a body mass index (BMI) greater than or equal to 30, or those with BMI greater than or equal to 27 and 1 or more weight-related comorbid conditions.⁴

This single medication has gained popularity with both endocrinologists and primary care prescribers, in my observation. Perhaps what makes this medication in such high demand is that recent research reflects health benefits related to decreased myocardial infarction, stroke and cardiovascular death with a favorable risk/benefit profile with use of GLP-1 agonists.⁵ It should be noted that both type 2 diabetes and obesity can confer unfavorable health outcomes, and each has increasing prevalence rates in the United States and abroad.^6,7 It is estimated that 1 in 10 people of all age groups in the US have diabetes.⁸ An additional 1 in 5 people have undiagnosed diabetes.⁸ Nearly 1 in 2 people in the US are obese.⁷ There are over 10 different classes of diabetes medications; approximately 40 unique medications and counting.⁹ There are only 5 FDA approved medications to treat obesity.¹⁰

I strongly believe that all treatment plans should be tailored to each patient, and that carefully measured risks and benefits can result in short- and long-term amicable health outcomes. For patients with diabetes, there is a never-ending list of medications, and combinations thereof that aim to mitigate systemic complications of this disease. For patients with obesity, semaglutide offers the same therapeutic value—to mitigate complications and improve health outcomes.

I’ve observed some propagate the notion that one pathology or cohort of patients is more deserving of treatment than another. Rather, I suspect that because obesity is highly prevalent and vastly undertreated, when a safe and effective option emerges, demand increases exponentially. In this case, GLP-1 agonists treat both type-2 diabetes and obesity, and as such, shortages related to supply and demand will be part of the medical economics. During times of shortages, we must be diligent in the care and monitoring of each patient. Prescribing patients medications within the guidelines of pathology and treatment protocols should not change.

If patients are offered a viable and safe treatment for obesity, a known health crisis, as part of a comprehensive plan of care, should we really be upset? I have adjusted my personal thoughts on this matter. While it might sound simple to ask patients with obesity to address this pathology with diet and exercise, the prevailing data that I am familiar with is almost irrefutable—the answer is medicine or bariatric surgery to appreciate sustained long-term health outcomes. I encourage the active treatment of any pathology that will improve our patients’ health and quality of life. I think most would agree that for those patients with comorbidities, including obesity, a treatment algorithm inclusive of lifestyle, diet, and behavioral modifications are a foundation on which to build care. However, this foundation does not acknowledge all we currently know and do not know about this disease. When the prospect of medical breakthrough results in unforeseen challenges, as those seen with semaglutide, we should face them with a common integrity. Time will work out its fate.

Dr. Elmarsafi is a fellowship-trained foot and ankle surgeon with Vascular Surgery Associates, LLC, in Maryland.

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References

1.    Collins L, Costello RA. Glucagon-like Peptide-1 Receptor Agonists. [Updated 2022 Nov 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022
2.    Iskowitz M. Novo Nordisk comments on role of off-label use in Ozempic shortfall. Medical Marketing and Media. Available at: https://www.mmm-online.com/home/channel/novo-nordisk-addresses-role-of-off-label-use-in-ozempic-shortfall/ . Published December 22, 2022. Accessed March 2, 2023.
3.    Skydsgaard N. Novo Nordisk launches ‘strong’ guidance, warns of supply constraints. Reuters. Available at: https://www.reuters.com/business/healthcare-pharmaceuticals/novo-nordisk-expects-13-19-sales-growth-2023-2023-02-01/ . Published February 1, 2023. Accessed March 2, 2023.
4.    Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021 Mar 18;384(11):989-1002. doi: 10.1056/NEJMoa2032183.
5.    Iorga RA, Bacalbasa N, Carsote M, et al. Metabolic and cardiovascular benefits of GLP-1 agonists, besides the hypoglycemic effect (review). Exp Ther Med. 2020;20(3):2396-2400.
6.    World Health Organization. Diabetes. Available at: https://www.who.int/news-room/fact-sheets/detail/diabetes . Published September 16, 2022. Accessed March 2, 2023.
7.    Centers for Disease Control and Prevention. Adult Obesity Facts. Available at: https://www.cdc.gov/obesity/data/adult.html . Published May 17, 2022. Accessed March 2, 2023.
8.    Centers for Disease Control and Prevention. The Facts, Stats, and Impacts of Diabetes. Available at: https://www.cdc.gov/diabetes/library/spotlights/diabetes-facts-stats.html#:~:text=37.3%20million%20Americans%E2%80%94about%201,t%20know%20they%20have%20it . Published June 20, 2022. Accessed March 2, 2023.
9.    American Diabetes Association. What are my options? Available at: https://diabetes.org/healthy-living/medication-treatments/oral-medication/what-are-my-options . Accessed March 2, 2023.
10.    Idrees A, Cancarevic I, Huang L. FDA-approved pharmacotherapy for weight loss over the last decade. Cureus. 2022;14(9):e29262.