New diabetes drugs like Ozempic are changing the way patients are treated

The shift could help the many people with diabetes who also deal with conditions such as hypertension, kidney disease and obesity, while still addressing the high blood sugar that is a hallmark of their diabetes.

“It’s a fundamental departure from the classic approach of trying to fix blood sugars, which we used to focus on, because that’s all we could really do,” says Dr. Marie McDonnell, director of the diabetes program at Brigham and Women’s Hospital in Boston, who has received research funding from some diabetes drugs.

These newer diabetes drugs belong to two classes known by the abbreviations SGLT-2 and GLP-1 for their actions.

The goal of the changes was to make treatment more specific to the patient rather than drug-focused, said Dr. Nuha Ali El Sayed, an endocrinologist at the Joslin Diabetes Center in Boston who is vice president for patient improvement. healthcare at the American Diabetes Association. .

The however, newer drugs cost more than metformin, and some patients may not be able to afford the out-of-pocket cost and have to go with metformin, doctors said. For example, Ozempic lists for nearly $900 per month, and Jardiance comes in at around $590 per month.

In contrast, patients can get the typical monthly supply of metformin, which is generic, for $25.72 with no insurance or rebates, according to data from GoodRx Holdings. Inc.,

which offers coupons for discounts on medicines.

“I think these drugs work really well; it just pisses me off that they’re so expensive and out of reach for many people who would benefit most from them,” said Dr. Rozalina McCoy, who treats diabetes patients at the Mayo Clinic in Rochester, Minn.

Novo Nordisk A/S, which sells Ozempic, and the maker of Jardiance, Eli Lilly & Co., say insured patients are not paying the list price of their medications, and the companies have programs to help people pay their costs, including sometimes covering an entire cost of the patient.

Some doctors also said that most studies evaluating the newer drugs didn’t test them without metformin, clouding whether the heart, kidney, and weight benefits were due to the new drugs alone. In addition, the studies tested the drugs SGLT-2 and GLP-1 in patients at high risk for heart or kidney problems, not in everyone who could receive them under the new guidelines.

Supply can be a problem. Some diabetic patients have had trouble filling prescriptions for Novo Nordisk’s Ozempic, as well as Lilly’s Mounjaro and Trulicity, as they have emerged as popular weight loss aids, even though drug regulators have not approved them for such use. The companies have said they are taking steps to help people with diabetes get the drugs.

August Bellardine, a retired Navy electronics officer from Winder, Georgia, said he took metformin from about 2000, after he was first diagnosed with type 2 diabetes. Last year, a doctor prescribed Ozempic in part to help him lose weight. He lost 5 pounds in the first three weeks on the drug. However, after two months on the Ozempic, he switched to a GLP-1 pill called Rybelsus due to supply issues.

“I am on the right track. What I do is good – it makes me feel good,” said Mr Bellardine, aged 65.

Diabetes is a chronic disease that affects the ability to control blood sugar, causing it to build up and eventually lead to heart, kidney and other health problems. According to the Centers for Disease Control and Prevention, about 37 million people in the US have diabetes, most of them with type 2 form.

Longstanding ADA guidelines had recommended that people with diabetes who had been unable to control their disease through diet and exercise should begin drug treatment by taking metformin.

Studies have shown that metformin, which was first approved in the US in 1995, reduced high blood sugar levels. However, many people with type 2 diabetes also have heart, weight and kidney problems, which often require treatment with other medications.

The ADA last December changed its guidelines and added the newer diabetes drugs to its recommendations for first-line treatment.

The SGLT-2 inhibitors, which stands for sodium-glucose cotransporter-2, lower blood sugar by preventing the kidneys from reabsorbing it. Instead, the blood sugar is released through the urine.

The pills include Farxiga from AstraZeneca PLC, Jardiance from Boehringer Ingelheim GmbH and Lilly, Johnson & Johnson‘s

Invokana and Steglatro from Merck & Co.

The GLP-1 agents copy the body’s natural response to food and produce a hormone called glucagon-like peptide 1 that stimulates insulin production. It is the insulin that helps lower blood sugar. The drugs also suppress people’s appetites, doctors say.

The class includes Byetta and Bydureon from AstraZeneca PLC, Lilly’s Trulicity and Adlyxin from Sanofi SA,

as well as Ozempic, Victoza and Rybelsus from Novo Nordisk. All are injected except for the Rybelsus pill. Lilly’s Mounjaro targets GLP-1, as well as another gut hormone.

The Food and Drug Administration started approving the drug classes years ago. In 2008, the agency advised drugmakers to test their diabetes drugs to make sure they didn’t pose dangerous risks to the heart, after researchers linked the diabetes drug Avandia to heart attacks.

In 2021, the FDA approved a GLP-1 drug called Novo Nordisk Wegovy for chronic weight management; the drug was previously approved for the treatment of type 2 diabetes under the brand name Ozempic. The FDA is reviewing whether Lilly’s Mounjaro, currently approved for diabetes, should be approved to treat obese adults.

Under the new guidelines from the ADA, doctors should consider whether a diabetic is at higher risk for heart and kidney disease and their weight, as well as their blood sugar levels, when deciding which drug to prescribe.

“That leads us into an era of what I might call precision pharmacology for diabetes, which is currently in its infancy, but didn’t exist at all 10 years ago,” said Dr. Suneil Koliwad, chief of the endocrinology and metabolism division at the University of California, San Francisco, and has consulted for several pharmaceutical companies.

Dr. Koliwad said he prescribes metformin to most of his patients first, in part because it’s cheaper than the newer drugs. He prescribes the newer drugs when it’s best for the patient, he said, though he sometimes faces health insurance paperwork and high out-of-pocket costs.

Write to Ariana Perez-Castells at ariana.perez-castells@wsj.com