Trends in Diabetes, Obesity, and Equitable Access to GLP-1s

Transparent in PerspectiveWhen the subject of equitable access to GLP-1s arises, contrasting perspectives of what is equitable become apparent. Last week in the Annals of Internal Medicine, an analysis of prescription data for GLP-1 agonists made two facts about their use very clear. First, their use for obesity is growing much faster than the use for type 2 diabetes. And second, the access to them is going disproportionately to non-Hispanic White females.

The authors conclude:

“These findings call for strategies to address the growing demand and ensure equitable access to GLP-1RAs.”

But What Is Equitable?

The obvious problem with health equity is the disparity in healthcare and thus health outcomes for Hispanic and Black persons in the U.S. So is this where the focus of concerns about equitable access to GLP-1s dwells?

Not really.

Instead, the headlines for this study point more to a concern that GLP-1 use for obesity might be “worsening diabetes drug shortages.”

Resentments about obesity treatment are evident almost everywhere we turn. A story about availability of a generic GLP-1 prompted this response:

“Let’s hope the generics go to the diabetic population and not hoarded by the weight loss population. It’s a shame those who need it most can’t get it.”

The Lost Perspective

Patience with such warped perspectives can be hard to summon. For one thing, the overlap between obesity and diabetes is great. Many people with obesity have diabetes or are on their way to having it. Likewise, people with diabetes often (but not always) have obesity. Each of these conditions can contribute to the other and make it harder to manage. Neither one exists in a vacuum.

Another thing is that diabetes still accounts for the majority of GLP-1 use and this use is still growing.

But the genuinely lost perspective is that advances in GLP-1 medicines are not going to the communities with the greatest need for better diabetes and obesity care: Black and Hispanic persons. This is where we would all do well to direct our passions for equity.

Everyone deserves a fair shot at good health.

Click here for the paper in Annals and here for a complimentary pre-print on MedRxiv. For additional reporting, click here and here.

Transparent in Perspective, painting by Paul Klee / WikiArt

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July 29, 2024