GLP-1-based agonists (GLP-1s) are transforming the obesity treatment landscape and the positive results keep rolling in. In the last 12 months, there’s been a series of high-profile papers and clinical trials which have demonstrated GLP-1s to prevent or reverse prevalent chronic conditions such as sleep apnea, fatty liver, and CVD. Creating the potential possibility of prescribing these medications beyond the purpose of weight loss and expanding the FDA-approved indications.
First, a (very) brief history on GLP-1s: These medications, which mimic the hormone (GLP-1) that controls blood sugar and digestion, came on the market about two decades ago as an effective treatment option for type 2 diabetes. Researchers observed that individuals taking GLP-1s also experienced weight loss, and the first GLP-1 (liraglutide) for weight loss was approved ten years ago. While Liraglutide produced 5-10% weight loss, in recent years more effective options (15-25% weight loss) have become FDA-approved. But more exciting is the impact of these medications on common chronic conditions
So, what do we know so far? There’s been data that GLP-1s can improve multiple of the most common health issues, including cardiovascular, liver, sleep apnea, cognitive function, and mental health.
Cardiovascular: Heart disease is the leading cause of death in the United States – for men and women across most ethnicities. But this year, new research has shed light on GLP-1s as a new treatment option for heart disease. The findings from the SELECT trial, is that semaglutide, a GLP-1 medication, decreases the risk of major cardiovascular events by 20%. Let’s pause on that for a moment – that’s 20% fewer heart attacks and/or strokes. As a result, Medicare and some healthcare plans now cover Wegovy for individuals with a history of heart disease and are in the overweight or obese category. This was a ground-breaking trial which set the roadmap for the addition of other common conditions to be considered as an FDA-approved indication for the use of GLP-1s.
Liver: It’s estimated that 1 in 4 people in the world have non-alcoholic fatty liver disease (NAFLD. Because liver disorders are strongly linked with diabetes and obesity, researchers were interested in the effect GLP-1s could have on liver health. Accumulating data shows that GLP-1s can reverse fatty liver, which would have downstream impact on cholesterol, blood sugar control, and blood pressure.
Sleep apnea: Here’s something that’s not talked about enough – the potential impact of GLP-1s on sleep and the ripple effect that can have on the workforce. The CDC estimates that three out of four of U.S. adults have sleeping disorder symptoms, which can impact the productivity, absenteeism, and general well-being of employees. Obstructive sleep apnea (OSA), which may affect up to 20% of the U.S. population and it is associated with an increased risk of type 2 diabetes, high blood pressure, heart failure, kidney disease, stroke, and non-alcoholic fatty liver disease (NAFLD). In a large, clinical trial, Tirzepatide, a GLP-1 / GIP, can reduce sleep apnea events by up to 63%. For anyone on a CPAP machine or experiencing sleep deprivation, this could be life changing. And with OSA’s ties to so many co-morbidities, this can have a significant impact on health-care costs and employee productivity.
Kidney: Kidney disease affects 1 in 7 adults and is one of the leading causes of death in the United States. Kidney disease also has a strong correlation to coronary disease, type 2 diabetes, and obesity. Researchers examining the impact of GLP-1s on kidney health found that 22% fewer people experienced kidney-related events while taking semaglutide. Additionally, they found that kidney function and filtration improved moderately for those with normal kidney health and significantly for those with kidney disease. With the average yearly cost of dialysis per individual about $98,410, increasing treatment options will have significant financial implications for health plans and employers.
Inflammation: Every day we’re learning more about the anti-inflammation properties of GLP-1s. While this inflammation plays a role in all the benefits described above, one of the places that is particularly intriguing is the impact of GLP-1s on the brain. Research is looking into the potential to improve brain health, including Alzheimer’s, Parkinson’s, dementia, and multiple sclerosis (MS). Preliminary research has found that GLP-1s can slow the progression of Parkinson’s, decrease the risk of dementia by up to 30%, and improve memory and learning abilities for those with Alzheimer’s.
Medication alone isn’t answer
Yet here’s the thing – and something that can get lost in all the fanfare around these medications. Medication alone is not the answer. Lifestyle is equally important for long-term success. A good behavior-change program can benefit many people with chronic conditions – whether by impacting clinical outcomes, improving quality of life, or helping to lower long-term health-care costs. Whether an individual is taking medication or not, it’s important to look at the root causes and not just treat the symptoms to help improve sleep, coping mechanisms, physical activity, stress levels, and weight loss, of course, if needed. Look for support with peer-reviewed clinical outcomes, personalization that drives high engagement – treats the whole human – and ROI validated by a third-party.
We’re understanding better every day how impactful these medications can be across a wide spectrum of disorders and diseases. And while supply chain issues and cost remain barriers for many employers and health plans, I am optimistic that ongoing research on GLP-1s will make them more accessible in the future as part of managing weight and many other health issues.
Photo: Burak Sür, Getty Images
Dr. Tim Church MD, MPH, PhD, and Chief Medical Officer of Wondr Health is one of the country’s leading clinical thought leaders in exercise and obesity research. As the author of over 300 published clinical articles, Dr. Church has received many awards for his research in preventive health. At Wondr Health, Dr. Church leads the development of program curriculum, which is inspired by his medical expertise. Specializing in business-to-business strategies, Dr. Church is an advocate for the employer and has a proven track record of empowering organizations through disease prevention to decrease healthcare costs and inspire employees to be their best selves. Wondr Health works with 1,100+ employers, and 80+ partners and health plans, and has improved the health of 10 million people over the past 15 years.
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