Disclaimer: This article is for general health information only and is not an advertisement for, or recommendation of, any medicine. GLP-1 medicines are prescription medicines and may not be suitable for everyone. Speak to your doctor or pharmacist for advice.
Glucagon-like peptide-1 (GLP-1) receptor agonists have been around for some 20 years, says Dr Angela Murphy, a specialist physician in Gauteng with a particular interest in endocrinology, diabetes and obesity.
They were developed for managing type 2 diabetes but began attracting widespread attention when studies revealed their weight-loss effects. Since then, demand for these medicines has grown significantly around the world.
Today, several GLP-1 receptor agonists are available in South Africa for the treatment of type 2 diabetes and obesity. Newer medicines that act on both the GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptors have also expanded treatment options.
Who qualifies for GLP-1 medicines?
GLP-1 and GLP-1/GIP medicines are indicated for the treatment of both diabetes and obesity, says Dr Murphy.
For diabetes: "The indications are for type 2 diabetes with poor control despite lifestyle and other medications, high risk of or established cardiovascular disease, and concurrent obesity."
"In South Africa, these medications are usually given as third- or fourth-line agents. However, American and European guidelines recommend them as second-line agents in patients with type 2 diabetes and cardiovascular risk," she says.
For obesity: "The indications are at present usually BMI-based, but other parameters such as waist circumference, waist-to-hip ratio and waist-to-height ratio are used."
Dr Murphy says these indications include overweight or obesity together with risk factors for cardiovascular disease, particularly type 2 diabetes, hypertension and dyslipidaemia.
Safe use of GLP-1 medicines for weight loss
"It's essential to consult with a qualified medical practitioner to determine if a GLP-1 medicine is appropriate for you," says Johannesburg-based dietitian Lila Bruk.
Like all medications, they can have side effects, and these should be discussed with your doctor. They may include nausea, indigestion, bloating and, less commonly, vomiting and diarrhoea, although this can often be reduced by eating small portions, avoiding fatty meals and chewing food well.
These are not "miracle" drugs, and diabetes and obesity require lifestyle changes and medical monitoring, Bruk emphasises.
"A healthy, calorie-controlled diet and regular exercise are essential as part of holistic treatment, as well as addressing any psychosocial concerns," says Dr Murphy.
"Treatment is chronic – that is, long term – for both diabetes and obesity. The medications cannot work if they are not being taken. There is substantial long-term evidence of the benefit and safety of GLP-1 receptor agonists in people with type 2 diabetes. The long-term safety data in obesity is still being gathered but to date is reassuring."
GLP-1 medicines require a prescription from a licensed medical practitioner and should be bought from a licensed pharmacy.
The South African Health Products Regulatory Authority (SAHPRA) has warned of falsified, compounded and substandard GLP-1-containing products being made available to the public via websites, social media and other informal channels, which can pose a health risk.
Are GLP-1 medicines covered by medical aids for weight loss?
"Funding for GLP-1/GIP medication for diabetes is becoming more difficult every year, with some medical aids requiring established cardiovascular disease to qualify for reimbursement on chronic medication," says Dr Murphy.
"No funder will cover it from chronic medication for obesity, as obesity is not recognised as a prescribed minimum benefit."
"For both indications, cost needs to be discussed with the patient, as the medications are expensive."
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