Exploring Diabetes Management with GLP-1s and More
Posted on May 14, 2024
GLP-1s Are Effective Solutions For Managing Diabetes, But Are Only One Piece of the Puzzle
With all the talk about GLP-1s for weight loss, it is easy to forget the reason they entered the market. According to the CDC’s National Diabetes Statistics Report, an alarming 8.9% of the adult population had been diagnosed with diabetes in 2021, with estimates suggesting that an additional 3.4% may have undiagnosed diabetes. Heart disease, the leading cause of death in the US since 1921, is intrinsically linked to diabetes, as individuals with diabetes face a significantly higher risk of major cardiovascular events. In fact, major cardiovascular disease was the leading reason for hospitalization among those with diabetes, with a rate of 82 per 1,000 individuals in 2019. As a category, diabetes is one of the leading trend drivers in pharmacy and necessitates the need to understand the trend and how to manage it.
How Did We Get Here?
The recent guideline updates from the American Diabetes Association (ADA) and the American Association of Clinical Endocrinology (AACE) reflect a significant shift in focus toward preventing complications, such as myocardial infarction (heart attack), stroke, and kidney disease, for individuals with known cardiovascular disease or at high risk of atherosclerotic cardiovascular disease (ASCVD). This shift has been further influenced by the growing popularity of certain diabetes medications, particularly GLP-1s, which have gained widespread attention due to their weight loss efficacy. This has been fueled by social media platforms like TikTok and celebrity promotion leading to individuals requesting GLP1s from their providers. When combined with their other benefits, it is easy to see why their utilization catapulted. Mounjaro, for example, has improved glucose control, fewer GI side effects, and better weight reduction results, which all combat the typical reasons for treatment discontinuation (see table below). Generally, treatment guideline shifts can take time, sometimes years, for adoption by providers; however, GLP-1 utilization has seen a drastic uptick due to these reasons.
While once-weekly injectable GLP-1s have demonstrated high efficacy in reducing blood glucose levels, lowering A1Cs from 1% to 2.3%, their adherence rates are lower compared to other diabetes medications. Factors influencing adherence include the inconvenience of injection, side effects, and the high cost. GLP-1s cost over $800 per month compared to around $500 per month for other type 2 diabetes drugs like sodium-glucose cotransporter-2 inhibitors (SGLT-2s). SGLT-2s, such as Jardiance, offer notable blood sugar decreases and provide added heart and kidney benefits. Metformin still has a role as a first-line therapy for newly diagnosed patients without comorbidities, and is low cost. As payers think through their diabetes strategy, they must factor in the efficacy and cost of other medications in addition to the ever-popular GLP-1s.
Table 5 Factors affecting the adherence and persistence to GLP-1RA
From: Adherence and persistence rates of major antidiabetic medications: a review
| Reasons for treatment discontinuation | Factors for higher adherence and persistence |
|---|---|
| – Inadequate blood glucose control | – Initiating treatment with low dose |
| – Gastrointestinal side effects (including nausea/vomiting) | – Ease of use of injection device |
| – Preference for oral medication over injection | – Weekly dosing rather than daily or twice daily dosing |
| – High cost | – Early (within 6 months) weight loss |
| – Injection site reaction | – Early (within 6 months) HbA1c level reduction |
| – Inadequate body weight reduction | |
| – Inconvenience of injection schedule | |
| – Injection-related concerns (including pain and fear) |
Medications Are Just One Part of Overall Diabetes Management
While medications like GLP-1s offer promising therapeutic avenues for managing diabetes, plan sponsors must recognize the multifaceted nature of this chronic condition and promote a comprehensive approach that extends beyond pharmaceutical interventions. The Association of Diabetes Care & Education Specialists (ADCES) has identified seven crucial self-care behaviors that are instrumental in empowering individuals with diabetes to take an active role in their health management.
- Healthy coping: Cultivating mental wellness and a positive mindset is crucial for effectively managing the emotional challenges of living with diabetes. Prioritizing self-care can empower individuals to better navigate this chronic condition.
- Healthy eating: The potential for weight reduction associated with certain diabetes medications, like GLP-1s, can serve as a powerful motivator for adopting good eating habits.
- Being active: The prospect of weight reduction can also motivate individuals to incorporate regular physical activity into their lifestyle, which also offers numerous additional health benefits.
- Taking medication: Adhering to prescribed medication regimens is essential for managing diabetes, as evidenced by the efficacy of various diabetes medications.
- Monitoring: Regular self-monitoring of blood glucose levels, blood pressure, and cholesterol is vital for tracking progress and informing treatment adjustments. Certain medications, like GLP-1s, can contribute to improvements in these key health indicators.
- Reducing risks: Adopting a comprehensive risk reduction strategy is paramount for individuals with established cardiovascular disease or at high risk of ASCVD to prevent death and events like strokes and heart attacks from occurring.
- Problem-solving: Developing problem-solving skills is essential for effectively managing fluctuations in blood glucose levels, planning ahead for disruptions to routine (such as illness, travel, or schedule changes), and making informed decisions to maintain control in various situations.
Plan sponsors have a unique opportunity to empower their members by providing comprehensive education and support programs that promote these self-care behaviors. By integrating medication management with lifestyle interventions, psychological support, and risk-reduction strategies, plan sponsors can facilitate a holistic approach that maximizes the potential for improved health outcomes and quality of life for individuals living with diabetes.
Who benefits from GLP-1s? And why are treatments more successful for some patients?
Another factor that plays into diabetes management is social determinants of health and how health literacy impacts who has access to GLP-1s. Those most likely to use GLP-1s for diabetes are those for whom the cost is not a barrier and the copays are affordable. Individuals who have a better understanding of the importance of managing diabetes and are committed to doing so are more likely to be successful, especially when they have a support system to help reduce barriers for their diabetes self-care. Despite knowing the risks, they maintain a positive viewpoint due to the benefits these medications can bring, even in the face of outside influences.
Individuals most likely to benefit from GLP-1s exhibit specific clinical characteristics, including high ASCVD risk or presence, elevated blood pressure, high cholesterol, persistently high blood glucose, and a need for total body weight loss of 10-15% or greater.
Considerations for plan sponsors in managing diabetes
As plan sponsors evaluate strategies to optimize the utilization of GLP-1s and promote comprehensive diabetes management, several key strategies emerge.
30-Day Supply
Implementing a 30-day supply dispensing protocol can help ensure consistent access to GLP-1s while minimizing waste, promoting adherence, and allowing for timely adjustments as needed.
Understanding Adherence Rate
Closely monitoring and comparing adherence rates for GLP-1s to other diabetes medications can provide valuable insights into potential barriers or facilitators to treatment persistence. Using a self-service tool like Artemetrx to easily report this data can inform targeted interventions to improve medication adherence, optimize outcomes, and manage budget. This data can also create an improved understanding of the plan’s diabetes population, which is critically important for plan management.
Diabetes Management Support
Effective diabetes management extends beyond medication alone. Plan sponsors should prioritize the implementation of comprehensive support programs that encompass educational resources, lifestyle interventions, and the ongoing guidance and clinical support of diabetes educators, for example.
PSG has a depth of expertise in supporting these initiatives, allowing plan sponsors to gain valuable insights, tailor their approaches, and optimize their benefit to deliver comprehensive, personalized, and cost-effective diabetes management solutions for their members. Connect with an expert to learn more.
