GLP-1 drugs could reduce the risk of type 2 diabetes

Last week, Eli Lilly announced that its GLP-1 drug, tirzepatide, significantly reduced the risk of developing type 2 diabetes in adults with prediabetes who were overweight or obese. Tirzepatide has been approved to treat diabetes under the brand name Mounjaro and obesity under the brand name Zepbound.

In a study, participants received weekly injections of tirzepatide for over three years. In the end, people who received tirzepatide reduced the risk of progression to type 2 diabetes by 94%, compared to those who received a placebo.

Those who received tirzepatide also lost a significant amount of weight, losing an average of between 15% and almost 23% of their body weight, depending on the dosage they received. In comparison, people on the placebo only lost an average of 2.1% of their body weight.

Notably, the weight loss only seemed to last as long as patients continued taking the drug. During a 17-week off-treatment follow-up period, patients who stopped taking tirzepatide started regaining weight and saw some increase in their progression toward type 2 diabetes. However, these patients still had an 88% reduction in risk of type 2 diabetes.

"Obesity is a chronic disease that puts nearly 900 million adults worldwide at an increased risk of other complications such as type 2 diabetes," said Jeff Emmick, Eli Lilly's SVP of product development.  "Tirzepatide reduced the risk of developing type 2 diabetes by 94% and resulted in sustained weight loss over the three-year treatment period."

According to Advisory Board's Rachael Peroutky, "diabetes prevention is a notable indication, especially for commercial payers and employers."

"Some purchasers got on board with GLP-1s for weight loss after the cardiovascular protective effects were found, but others held out. These drugs are expensive, and have a broad indication, so many purchasers don't see value in covering the drugs to prevent a cardiovascular event that could happen a decade or more in the future (when the member will likely be on a different plan). Diabetes prevention could shift that equation. Compared to cardiovascular disease, type 2 diabetes impacts a younger, working population. Employees with the condition have twice the medical costs than those without diabetes, creating a much stronger case for employers and plans to expand coverage," Peroutky said.

"I wouldn't be surprised if more purchasers expanded coverage after this news," she added.

Aside from reducing the risk of diabetes, other studies have also found that tirzepatide could help reduce high blood pressure and reduce the risk of death or hospitalization from heart complications. Research also suggests that the drug could slow the progression of kidney disease in patients with type 2 diabetes and an increased cardiovascular risk, as well as significantly reduce sleep apnea symptoms.

Studies show GLP-1 drugs could reduce the risk of cancer

Currently, several studies suggest that GLP-1 drugs may reduce the risk of certain cancers.

For example, a research letter published in JAMA Oncology last year suggested that GLP-1 drugs could reduce the risk of colon cancer, even among individuals who are not overweight. Separately, an analysis published in JAMA Network Open suggested that patients with type 2 diabetes who took GLP-1 drugs were less likely to develop 10 out of 13 obesity-related cancers than those who took insulin.

Another recent study, which was presented at the American Society of Clinical Oncology (ASCO) in June, found that both bariatric surgery and GLP-1 drugs significantly reduced the risk of 13 obesity-related cancers, but the reduction was larger with GLP-1 drugs. Among patients who had bariatric surgery, their risk declined by 22% over 10 years compared to 39% among those who took GLP-1 drugs.

"We think the protective effects of GLP-1s are probably multifactorial," said Cindy Lin, resident physician at Case Western Reserve and co-author of the ASCO study. "Part of it is weight [loss], but other factors may be contributing as well — better glycemic controls, anti-inflammatory effects."

But while findings have been promising, oncologists say they will need to see more research before changing their practices.

"It's not clear if the reduction in cancer risk is due to the drugs themselves or the weight loss they cause," said Sara Jo Grethlein, executive director of the Swedish Cancer Institute. "Even though surgery leads to more weight loss than GLP-1 drugs, the drugs had a bigger reduction in cancer risk and all-cause mortality. This raises intriguing questions about how much of the benefit is due to weight loss versus something inherent to the drugs themselves."

Advisory Board's weight-related resources

To help you address the growing use of weight management drugs, Advisory Board offers several resources:

This expert insight outlines the five biggest questions about weight management drugs and their answers. Similarly, this expert insight addresses what headlines get wrong about weight management drugs and what healthcare leaders should know instead.

Radio Advisory's Rachel Woods has also covered GLP-1 drugs on the podcast, discussing the potential future of these drugs and how they could help — or hurt — health systems' finances. Other useful resources include this expert insight on the five catalysts that will impact the future of obesity care and this research on four key elements of comprehensive obesity care.

Our weight management and obesity care resource library can also help leaders understand the current care landscape, manage innovations, and prepare for transformations in care. (Loftus/Susin, Wall Street Journal, 8/20; Johnson, Forbes, 8/20; Vinluan, MedCity News, 8/20; Twenter, Becker's Hospital Review, 8/12; Noguchi, "Shots," NPR, 8/12)