Scott Webb (Host): Between friends and family, social media and commercials, it seems that everybody is talking about the benefits of GLP-1 medications for the treatment of diabetes and weight loss. And my guest today is here to explain the benefits and risks of GLP-1s, who's a good candidate, and so much more. I'm joined today by Dr. Jaqui Jones. She's a Family Medicine Doctor with Prisma Health.

 ​​This is Flourish, the podcast brought to you by Prisma Health. I'm Scott Webb. Dr. Jones, nice to have you here today. We're going beyond blood sugar. We're going to talk GLP-1s and the future of diabetes care, and so much more. But before we get to all that, and I don't want to jump too far ahead for listeners, like what is diabetes and why is blood sugar control so important?

Dr. Jaqui Jones: So, diabetes, there are two types. We're talking about type 2 diabetes, which is really more of a disease of lifestyle. So, there's an endocrine dysfunctional problem. We become hyperinsulinemic, meaning that insulin, that thing we use to bring sugar into our body does not function as well as we want to because of lots of different reasons, how much we've eaten, how little we've exercised, a combination of both. That results in elevated blood sugars. And when they become high enough, we can test you and diagnose you with diabetes. That's it in a scientific nutshell.

But the problem is that we really become a society that's eating too much processed foods, refined sugars, and that results in us being overflowing with fats and sugars, and that's resulting in disease.

Host: Yeah. As you say, it's behavior, lifestyle, diet, lack of exercise, maybe a little genetics, family history mixed in. Doctor, we hear all the time seemingly now about GLP-1 medications. Every time I turn on the TV, I see commercials and they're on social media. What are they and how do they work?

Dr. Jaqui Jones: So, GLP-1s have become all the rage. Now, they're not as new as people think, but I think that's always the case in medicine. They're very popular right now, and they're the new kid on the block, but the sciences has been studying GLP-1s for a long time. So, glucagon-like peptide-1 agonist medications were created for the treatment of type 2 diabetes and now labeled for the treatment of obesity. These medicines are injectables, although they're recently become oral medications, but they have been great in dropping A1c's, larger than any medicine that we have with the exception of insulin. And so, it has really been unheard of to see a drop of, you know, plus one point. So to go from like maybe a 7.2 down to a 6.2 has been hard to do on a single medication, but these medications do it. And so, they've been very beneficial in helping us with the glucagon-like peptide receptors, which help us decrease blood sugars and help with hunger.

Host: Right. Yeah. Like I said, they're seemingly everywhere. Everybody seems, you know, just talking about them. How do they differ, Doctor, than the more traditional or older diabetes treatments?

Dr. Jaqui Jones: They have a completely different approach. So, insulin, we all know it's just simply hormone replacement, right? So, I am putting insulin in your system to make it do what it's always done. There have been medicines that used to either increase how much insulin that you were producing, or they were trying to prevent absorption of sugars in the gut, like metformin.

There have never been ones that actually attack this particular receptor that really got at hunger. And so, it slows down gut motility. It has a sensation of feeling more full, and it has done a great job by doing that, making sure that people eat less or eat more appropriately.

Host: Right. So then, let's talk about who's a good candidate, right? As I said, it's seemingly everywhere and everyone's talking about it, and I'm sure lots of patients are asking you about it, the GLP-1s that is. But who's the right person, the right candidate for this therapy?

Dr. Jaqui Jones: Anybody with diabetes, I think, can be a candidate for the GLP-1s from a diabetes standpoint, just to stay the course there. I think anyone that has an elevated A1c of 6.5 and higher is an absolute good candidate, which will also be covered by insurance. So, I think, from a medicine standpoint, anyone with an elevated A1c would be a great candidate. Understanding that cost matters in our society. People want to know that it's going to be covered by most of their insurance carriers. A diagnosis of diabetes where you've not had success in controlling that through some of the traditional or older medications, I think, makes you a great candidate for having a conversation with your doctor about a GLP-1.

Host: Right. At the very least, at least have a conversation. And it makes me wonder, are there some benefits beyond just blood sugar control for GLP-1s?

Dr. Jaqui Jones: Absolutely. There are anecdotal things that you've heard, I'm sure, through the grapevine. But we do know that, you know, Ozempic and Wegovy have been studied to know improvement in people with chronic kidney disease. People with existing heart failure have seen some improvement in morbidity and mortality. And then, also, the one that everybody's in love with, weight loss.

Host: Yeah. No doubt that that's music to our ears, of course. Yes, we need to eat better and we need to, you know, get some more exercise and all of that. But the weight loss is key. Are there any side effects or risks that patients need to be aware of?

Dr. Jaqui Jones: There are some people that we are concerned about. So if you ever had a history of pancreatitis, then unfortunately GLP-1s may or may not be for you. It can cause, in some rare instances, a repeat of your pancreatitis. I do not think there's a reason for you to absolutely not have it, but you have to be cautious.

There is an absolute contraindication, and that's anyone with what we call MEN, multiple endocrine neoplasia. If you have been diagnosed with one of those or you have a family history with that, you likely may not be able to take advantage of a GLP-1. And I strongly recommend that you let your doctor know about any history or any family history before starting this medication.

Host: Sure. I want to talk to you about integrating GLP-1s, if you will, with the lifestyle changes you would recommend: diet, exercise, and so forth. How do you kind of merge those things together? How do you integrate them?

Dr. Jaqui Jones: Well, first, with education. So, I think right now the GLP-1 sound magical, that you take them and you wake up one morning and you are skinny. But that's not exactly how that works. I think the average weight loss is somewhere between 5% and 15% of the starting body weight over the first six to 12 months.

We are really trying hard to help people understand patterns and behaviors. It has been great that it has decreased our appetite and our hunger drive. And I see that as an opportunity to really buy you time to be thoughtful about the food. So, I think in addition to educating people on their diabetes, the advantages of the GLP-1. We also are trying to spend a good chunk of time saying, "Now that we have your attention, and now that you're not driven so much by your cravings and your hunger, let's talk about what you should be eating right versus all the things you should not eat." So, without that key component. I think we cannot see the sustained longevity of the weight loss and the success that people are seeing upfront.

Host: I like to do a little myth-busting when I can, Doctor. So let's bust any myths that are out there, misconceptions about GLP-1s. Anything out there that you've heard anecdotally or otherwise that you want to clear up?

Dr. Jaqui Jones: The big one is that they're magic. They're not magic. I've had many conversations with patients, some from the surprise, "I didn't think I could lose this much weight," and the other one's from, "I can't believe I'm paying this money for this medication, and I have not lost enough weight." I do think that the 5-15% is a pretty reasonable expectation for your weight loss.

I think anything past that is a combination of both the tools that you use, like GLP-1 and your lifestyle. So, I think that that is probably the biggest one. Everybody's super excited to try it. And I don't want to set a high expectation that's going to leave people disappointed because if you are a stress eater or an over eater or just love eating, nothing better than drive that craving than a big chunk of disappointment when you did not hit a goal that you were expecting. So, setting the expectations of this not being magical, but being a tool is probably the biggest myth I would like to bust.

Host: So, you mentioned earlier about cost and insurance. I just wanted to touch on that a little bit more. Like, what should patients know and/or consider when you're thinking about the cost of GLP-1s and insurance and what they cover or don't cover?

Dr. Jaqui Jones: This is still, I think, an expensive medication for most people if you're paying out of pocket. I think that the makers of the GLP-1s have put things in place where you can buy them directly from, you know, the manufacturer to try to cut down on the cost, but they are an expensive adventure.

So, I've seen cost as low as $2.99 a month to as high as $1500 a month when not covered by insurance, depending on where you're purchasing it. And so, I want people to know that there can be a cost associated with obtaining this medication if you're paying out of pocket. What I would like for people to do is check with their insurance companies, because we did a big swing of insurance companies not covering weight loss medications. But I think that that may reverse over time. And so, it will not hurt to call your insurance company to ask, "Do you cover GLP-1s?" And more importantly, "For what conditions do you cover them?" Right? So, they may say, "Yes, we cover them if you have diabetes." And you can always ask directly, will you cover them for weight loss? And if they say, yes, that's great. That's great information for us to know. If they say no, then it allows me to have a conversation about the expectation on pricing.

Host: Right. It's amazing to me, Doctor, that we're talking about these GLP-1s and we're still learning so much about them, the sort of unintended benefits that folks are experiencing. But what's next in GLP-1s?

Dr. Jaqui Jones: We just recently started to get oral options. So, you know, I don't know how many people know, but the GLP-1s today have been primarily injectable medications. But they are now offering some oral options out there that are starting to come out.

So, I think as we provide different mediums, because some people really want to take advantage of this tool, but they cannot get over self-injecting. So as the oral medications come out, I think that's going to be lots to talk about and lots to experience. But I think for now the GLP-1s are going to be the hot commodity of the moment.

Host: Yeah, going to be here for a while. As I said, we're still learning so much about them and they may not be magic, and if your insurance doesn't pay for them in some circumstances, they're pretty expensive, but they are amazing nonetheless. And I appreciate your time today. It's just great to learn more.

Dr. Jaqui Jones: Thank you so much for having me, Scott.

Host: For more information and other podcasts just like this one, head on over to prismahealth.org/flourish. This has been Flourish, a podcast brought to you by Prisma Health. I'm Scott Webb. Stay well.