The last day of the year has come and gone. A big question comes to mind: What is the most significant medical story of 2024, at least from my perspective? I would have to say that the use of GLP-1 medications for diabetes and weight loss is #1. This has been a game changer in the way I approach diabetes and metabolic syndrome in general. Now, with the reassuring safety data, and excellent tolerance well established, I feel comfortable going straight to these medications if it makes sense financially for the patient. Money continues to be the last barrier which is real and difficult to deal with, but many insurance carriers have lowered costs over time.

What are the benefits? For the patient struggling with diabetes, type II, the benefits are an average drop of A1C between 0.6%-1.7% (https://pmc.ncbi.nlm.nih.gov/articles/PMC11581925/#R22) and the average patient loses 2% of their weight after 72 months. Many patient in these large cohorts lost 5% or more of their weight and had A1C drops at the upper end of the range. The main side effects are gastrointestinal, with nausea and vomiting at the top, and there is a risk of possible pancreatitis that must be taken into account (https://my.clevelandclinic.org/health/treatments/13901-glp-1-agonists).

Available drugs:

• Liraglutide (Victoza)
• Dulaglutide (Trulicity)
• Semaglutide (Rybelsus, Ozempic)
• Exanatide (Byetta, Bydureon BCise)
• Tirzepatide (Mounjaro) – combo drug with GIP

In my practice, the thing that most impresses me is that I’ve been able to reduce the amount of insulin or move people off of it completely as I’ve introduced a GLP-1 over time. This increases safety significantly, especially among older adults who are especially sensitive to hypoglycemia.

In terms of all the hype, I think these drugs may be the solution for long term control of problematic blood sugars and resistant obesity which plagues so many people. I do not agree with using these drugs for weight loss if metabolic syndrome is not at play: in other words, if you are healthy and just want to loose some weight, then don’t do it. We need more time to evaluate these drugs in healthy folks before prescribing for mild weight loss, and there is a justice issue here. There is a legitimate shortage of medication, so these prescriptions literally rob the person who really needs it for a disease altering course. In the big picture, for these drugs to make a real dent in the obesity and diabetes epidemic, costs need to come down significantly. Hopefully this will be the case in the next few years.

That’s my vote for the number one health story of 2024!