Certain medications used to manage type 2 diabetes have gone out of stock globally, say experts. The semaglutide class of drugs, which also aids in weight loss, is being taken by several non-diabetic people as well to shed those extra kilos — leading to its non-availability for people with diabetes. Many people have complained of gastric side-effects after taking semaglutide medications without a doctor’s advice.
Semaglutide became popular after multiple celebrities — including Elon Musk, owner of Twitter and CEO of Tesla and SpaceX — endorsed it as a weight-loss drug in the recent past.
Professor Atul Kalhan, consultant, diabetes & endocrinology, Royal Glamorgan Hospital, Wales, UK, says, semaglutide is a GLP-1 (glucagon-like peptide) receptor agonist. It is a class of medication that improves insulin secretion and slows down digestion. “It [also] suppresses the hypothalamus that has some kind of impact on appetite also,” he adds. “So, this group of medications was launched for people with type 2 diabetes, specifically for improvement in glycemic control, and the additional benefit which was seen was related to weight loss.”
Semaglutide for weight loss
As semaglutide aids in weight loss, many people, especially digital creators and actors, have started using it for cosmetic reasons. “In the UK, we have run out of the main brands of GLP-1 receptor agonist which we were using for the last few years,” Prof Kalhan adds. “So, we’ve been advised by the department of health not to prescribe these medications to a new patient so that anyone who’s already on it can get their repeat prescription.”
In the US too, there continues to be intermittent shortages of the entire class of GLP1 medications including semaglutide. TJ Grimm, director of pharmacy, University Hospitals Cleveland Medical Center, USA, says, “It is being said that it is not a manufacturing issue, but a distribution issue as it is being used for weight loss.”
Dr Vinayak Hiremath, executive director, chief medical officer & consultant, department of internal medicine, endocrinology & diabetes, KMK Hospital, Kochi, Kerala, says the shortage in his city is so acute that people are unable to get the medicine and are having to source it from Bengaluru.
“The semaglutide drug which is available in India is also an anti-obesity medicine,” he adds. “It helps reduce calorie intake and increases energy expenditure or the basal metabolic rate. So, many people who do not even have diabetes are getting it to reduce weight for cosmetic reasons, as they are particular about the way they look.”
Katherine O’Boyle, certified nurse practitioner in Bariatric Surgery (Weight Loss Surgery); Medical Weight Loss, and Non-surgical Weight Loss at University Hospitals Cleveland Medical Center, USA, adds, “In addition to normalising the glucose and insulin levels in the blood, the medication itself has a direct effect on gastric emptying. It slows down the digestive system which helps people to stay full longer and require less food to fill up.”
Semaglutide’s side-effects
However, these weekly injectable medicines also have side-effects — some of them quite severe — if taken without medical advice. According to a report by CNN, many people have reported severe symptoms like gastroparesis (paralysis of stomach) after taking the medication for weight loss.
Experts say the major side-effects are gastrointestinal. These medicines can cause gastritis, nausea, vomiting, abdominal pain, fullness, bloating and hypoglycemia. They can also affect the kidney function and cause diabetic retinopathy for a short period of time.
“Another major side-effect of it is pancreatitis, if a person has a history of the condition,” says Dr Hiremath. “There is also data that states that it can cause thyroid cancer.”
Prof Kalhan adds that even though further data is required to prove the link, semaglutide drugs are not recommended to people with multiple endocrine neoplasia link type 2 (a hereditary condition associated with medullary thyroid cancer).
Rachel McCane, a 43-year-old US based executive assistant and digital creator started using Ozempic ( a semaglutide drug) in February 2023 for weight loss. She got to know about the drug from her friends who were already using it for weight loss. She asked her family physician about it, who wrote her the medicine off label.
She is currently at 1mg and has slowly moved her dose up using online click charts. “I had very minimal side effects. Around my fifth week I started having issues with constipation and I started taking some over-the-counter medicine daily to address that. In my 21st week, I got pretty bad nausea for the first time after moving up to 1mg but this was my first real episode dealing with that. It passed after a few days. I did move my dose down this past week slightly after that to help my body adjust,” she says adding that the reason for her ‘minimal side effects’ is that she listens to her body.
Dr Hiremath says the semaglutide drug used in India is an oral one and does not cause any major complications if taken under medical supervision. “We advise people to take it on an empty stomach with exactly 100ml of water,” he says. “It helps increase absorption in the stomach. They should not take any other drug for another 30 minutes.”
Plus, binge-eating should be avoided while on this medication since it could lead to further gastric issues.
Prof Kalhan adds that usually lower doses of these medicines are prescribed at first so one gets used to them. “There is no substitute for lifestyle modification,” he says. “If somebody’s keen on weight loss, then lifestyle changes — by cutting down on carbs, increasing physical activity and eating judiciously — will be more cost-effective than relying on a pill.”
Takeaways
- The semaglutide class of drugs, which is used in type 2 diabetes management, has gone out of stock in many countries.
- Experts say since these are also anti-obesity medicines, many people are using them to reduce weight for cosmetic reasons. Hence the shortage.
- However, these medicines have side-effects and can lead to severe conditions like gastroparesis if taken without medical advice.
- Experts instead recommend lifestyle modifications for weight loss as both better and more cost-effective.
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