Global Health
What nurses have to learn about current trends in weight reduction medications
You’ve probably seen and heard many catchy advertisements extolling the advantages of medicines to treat diabetes. You may receive questions from patients and even family and friends about using these medications for weight reduction. As a nurse, it will be important that you simply stay well informed and up up to now to share the most recent evidence and suggestions.
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The World Obesity Federation (2023) predicts that by 2035, over 50% of the world’s population (over 4 billion people) will probably be obese or obese if current trends proceed. Typical obesity treatments focus totally on weight loss plan and exercise, but for a lot of, these lifestyle modifications are usually not enough. Obesity is a posh metabolic disease that involves internal mechanisms that make weight reduction difficult. Clinical guidelines currently recommend medications for people who find themselves obese or obese and have weight-related complications (Jastreboff et al., 2022). These drugs include “long-acting glucagon-like peptide-1 (GLP-1) receptor agonists that focus on endogenous nutrient-stimulated hormones, in addition to glucose-dependent insulinotropic polypeptide (GIP), a nutrient-stimulated hormone that regulates energy balance by cell surface receptor signaling in brain and adipose tissue” (Jastreboff et al., 2022). Let’s take a look at a few of these drugs.
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Semaglutide
Semaglutide is a GLP-1 receptor agonist approved by the U.S. Food and Drug Administration (FDA) for the treatment of type 2 diabetes mellitus (T2DM) in adults (brand name Ozempic) or for supporting weight reduction control in individuals with obesity (brand name Wegovy).
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Semaglutide works in response to (Facts and comparison, 2023):
- Increased insulin secretion
- Reducing the abnormal secretion of glucagon (a hormone that increases blood glucose levels)
- Slowing down stomach emptying, promoting a sense of fullness
- It works on areas of the brain that regulate appetite and caloric intake
Semaglutide just isn’t without its drawbacks. It is related to several serious unintended effects corresponding to complications of diabetic retinopathy, acute kidney injury, gallbladder and biliary disease, gastrointestinal symptoms (abdominal pain, constipation, diarrhea, nausea and vomiting), allergic reactions, medullary thyroid cancer and inflammation pancreas. Lexicomp, n.d.).
Two semaglutide drugs in high demand today are Ozempic and Wegovy.
Ozempic
Ozempic, first approved by the FDA in 2017, is an injectable prescription drug used together with weight loss plan and exercise to enhance blood sugar levels in adults with T2DM. It can also be used to scale back the chance of great cardiovascular events corresponding to heart attack, stroke, or death in adults with T2DM and established heart disease. It is given by subcutaneous injection within the abdomen, thigh, or arm and shouldn’t be given intramuscularly (IM) or intravenously (IV). It accommodates various doses of semaglutide (0.5 mg, 1 mg or 2 mg), with an initial dose of 0.25 mg subcutaneously weekly for the primary 4 weeks, increasing to 2 mg as needed to attain glycemic control. Take Ozempic once every week, on the identical day each week, at any time of the day. It shouldn’t be mixed with insulin or given in the identical injection. It is vital to emphasise that Ozempic is simply approved by the FDA for the treatment of T2DM, not type 1 diabetes, and just isn’t approved for the treatment of obesity.
Vega
Wegovy is a prescription drug approved in 2021 as an adjunct to weight loss plan and exercise to assist fight obesity in individuals with a body mass index (BMI) greater than or equal to 30 kg/m2 (or in individuals with a BMI greater than or equal to 27 kg/m2 with a number of comorbidities corresponding to hypertension or dyslipidemia). It accommodates the next dose of semaglutide (2.4 mg) in comparison with Ozempic. Wegovy can also be administered subcutaneously, at an initial dose of 0.25 mg once every week, progressively increasing to 2.4 mg/week. People who’ve a private or family history of medullary thyroid cancer or multiple tumor syndrome type 2 shouldn’t use Wegovy.
Note on semaglutide supply shortages
Although Wegovy is approved by the FDA for the treatment of obesity, it will likely be not covered by insurance and could be very expensive. Despite its high costs, Wegovy is in high demand, leading to supply shortages. Many people without T2DM try to make use of Ozempic off-label for weight reduction, making it difficult for many who need the drug to treat T2DM to acquire the drug. It is vital to notice that although these medications help people drop some pounds, in the event that they stop taking them, they may likely regain the load inside a couple of months. These medications must be taken long-term, not as a short-term solution to weight reduction.
Tyrzepatid
Tirzepatid (trade name Mounjaro) is a once-weekly subcutaneous peptide approved by the FDA in 2022 for the treatment of T2DM, with agonist activity at each GIP and GLP-1 receptors. In clinical trials, people taking tirzepatide lost 19.5% and 20.9% of body weight at doses of 10 mg and 15 mg, respectively, in comparison with placebo. The initial dose of tirzepatide is 2.5 mg subcutaneously once weekly for 4 weeks, then increased to five mg once weekly. The dose could also be increased by 2.5 mg/week every 4 weeks to attain glycemic goal, with a maximum weekly dose of 15 mg/week subcutaneously.
Monitoring patients taking semaglutide or tirzepatide
For people taking semaglutide or tirzepatide, the next parameters must be fastidiously monitored (Facts and Comparisons, 2023):
- Plasma glucose
- Gastrointestinal unintended effects (i.e. nausea, vomiting, diarrhea)
- Renal function (in the beginning of treatment and after dose increases)
- Pancreatitis (i.e. abdominal pain with or without vomiting)
- Gallbladder disease
- Intensification of diabetic retinopathy
- Hemoglobin A1C (HbA1C) in individuals with T2DM:
- Patients with stable glycemia must be monitored not less than twice a yr.
- Monitor quarterly for patients who haven’t achieved treatment goals.
- Monitor along with blood glucose in patients liable to glycemic variability or in patients whose A1C doesn’t correspond to serum glucose.
As these medications proceed to extend in popularity, be sure you’re knowledgeable in regards to the administration, unintended effects, and monitoring parameters related to them. Full details could be present in the leaflet that comes with each medicine or within the Nursing2023 Medicines Manual + medicines updates.
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Facts and comparisons. (2023, March 20). Semaglutide injection. Facts and comparisons.
https://fco.factsandcomparisons.com/lco/action/doc/retrieve/docid/fc_dfc/6577239?cesid=0svWYVOgvdJ
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Jastreboff, A. M., Aronne, L. J., Ahmad, N. N., Wharton, S., Connery, L., Alves, B., Kiyosue, A., Zhang, S., Liu, B., Bunck, M. C., Stefański, A. and SURMOUNT-1 researchers (2022). Tirzepatid once every week for the treatment of obesity. (3), 205–216. https://doi.org/10.1056/NEJMoa2206038
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Lexicom. (n.d.). Semaglutide: Drug Information. Retrieved April 24, 2023 from
https://www.uptodate.com/contents/semaglutide-drug-information
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World Obesity Federation. (2023, March 3). World Obesity Atlas 2023. www.worldobesity.org. https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2023
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