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Key Points: - GLP-1 is the first-line injectable for poorly controlled type II diabetes, preferred over insulin due to its favorable metabolic profile. - When adding a GLP-1 to a patient already on insulin: - If blood sugar is well controlled (Hgb A1c less than 8% or time in range greater than 50%), reduce insulin by 20%. - If blood sugar is not well controlled (Hgb A1c greater than 8% or time in range less than 50%), start GLP-1 without adjusting insulin. - As GLP-1 dosage increases, insulin needs typically decrease. - SGLT2 inhibitors have a less potent effect on glucose but may warrant insulin dose reduction. Core IM interviews Dr. Tom Martens who explains how he goes about adjusting insulin regimens as he adds GLP-1 or SGLT2is to diabetes regimens. Although he explains that GLP-1 therapy is now first line therapy for type 2 diabetes, he provides insight on how to add on these treatments in patients previously prescribed insulin while mitigating risk of hypoglycemia. Credits: Discussant: Dr. Tom Martens Interview: Dr. Rebecca Easly-Merski Video: Jason Krastein & Dr. Alice Kennedy #continuousglucosemonitor, #cgm, #insulin, #glp1, #endocrinology, #diabetes, #prevention, #primarycare, #internalmedicine, #medicaleducation, #residency, #CoreIM, #IMcore

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Obesity expert Dr Holly Lofton reviews three alternatives to GLP-1s to help patients drop excess weight. https://www.medscape.com/viewarticle/1000474?src=soc_yt -- TRANSCRIPT -- Hi. I'm Dr Holly Lofton. I'm a board-certified obesity medicine specialist, and I direct the medical weight management program at NYU Langone Health. There is so much information about glucagon-like peptide 1 (GLP-1) agonists as anti-obesity medications. I bet you can't think of a single person who hasn't heard of them, and many of your friends or family members may have even tried them. However, we also have what we call the first generation of medications for weight management, and I'll talk about some of those today. Phentermine. If your patient is not able to tolerate a GLP-1 agonist or is unable to access these medicines for various reasons, one option is phentermine, which has been around for decades. It is an oral medication that's usually taken once a day in the morning. It is a classic appetite suppressant. Phentermine makes people feel less hungry. It also gives people a little more energy, so they're able to increase their activity while creating a caloric deficit, and this leads to weight loss over time. Phentermine differs from the GLP-1 agonists, which are intended for chronic weight management. The FDA has approved phentermine for short-term weight loss; its use is recommended for no more than 12 weeks at a time. The medication comes in doses ranging from 8 mg to 37.5 mg and is usually slowly titrated up depending on tolerance and effect. Side effects that are most often reported include a racing heart, insomnia, agitation, and dry mouth. This drug is not for everyone. Phentermine is contraindicated in those with uncontrolled hypertension, with cardiac disease (such as a history of heart attack), or who are at high risk for heart attack or stroke. Some drug interactions can occur, which should be considered on a case-by-case basis. Phentermine may be an option for your patients if an elevated appetite is keeping them from losing weight. It should be used as an adjunct to lifestyle recommendations, which means eating fewer calories and increasing activity. Phentermine-Topiramate. Another non–GLP-1 agonist medication indicated for obesity is phentermine-topiramate [Qsymia]. This is another oral medication. The idea behind combining these two medications is that they can generate more appetite suppression without the high potential for side effects of phentermine alone, such as agitation, increased heart rate, or increased blood pressure. Topiramate is used for migraine or seizure prevention. One side effect of topiramate is unintentional weight loss, so they decided to combine phentermine with topiramate in one pill. Phentermine-topiramate comes in four different doses and is usually titrated up from the lowest to the highest dose. People who can't tolerate the higher doses of phentermine are able to tolerate Qsymia because the dose of phentermine is lower. This medication came to the market in 2012, after the SEQUEL trial, which demonstrated its safety and efficacy, achieved about 12% weight loss, which for many years was the highest weight loss seen with any other anti-obesity medications on the market. Because this is a combination medication, it has some potential side effects and contraindications. For example, we don't give phentermine-topiramate to people with uncontrolled hypertension or anxiety, and it is contraindicated in those with glaucoma. We don't give this medication to anyone who has had adverse reactions or hypersensitivity to either of the ingredients. Because the combination contains topiramate, it should not be prescribed to anyone with childbearing potential unless they are using an effective form of hormonal contraception or even two effective forms. Topiramate can increase the risk of having a baby with a cleft palate by five times if they become pregnant while taking this medication. Phentermine-topiramate is dosed once daily. One commonly reported side effect is paresthesia: numbness and tingling of the fingers and toes that can manifest as feeling very cold when it's cold outside. Although some patients report paresthesia, most say that it's not so intolerable that they want to discontinue the medication. There have been reports of vision changes in people taking phentermine-topiramate; if severe vision changes occur, it is recommended to discontinue the medication. Transcript in its entirety can be found by clicking here: https://www.medscape.com/viewarticle/1000474?src=soc_yt

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00:00 - GLP-1 Drugs: Shifting Consumer Pack Sizes in the CPG Industry 04:51 - How GLP-1 Weight Loss Drugs Are Reshaping the Food Industry 09:15 - Ozempic Menus: How Weight-Loss Medications Are Changing Restaurant Dining 1. GLP-1 Drugs: Shifting Consumer Pack Sizes in the CPG Industry The increasing popularity of GLP-1 drugs like Ozempic, WeGovy, and Mounjaro is reshaping consumer behavior and prompting a potential shift in consumer packaged goods (CPG) packaging. A recent Big Chalk Analytics survey of 4,511 U.S. shoppers indicates that 11.2% of adults are currently using GLP-1 drugs, and 8.3% are considering it within the next 12 months. This trend is leading to a significant reduction in caloric intake, estimated between 16% to 39%, which could translate to a 1.2% to 2.9% reduction in overall food sales, with snacks and sweets taking the biggest hit. As consumers reduce their caloric intake, there is a growing demand for smaller package sizes, potentially reversing the 'bigger-is-better' trend that has dominated the industry for decades. Food manufacturers and retailers may need to adapt their product offerings to cater to this new demographic, with an increased focus on high-protein, smaller-sized foods. This shift is already evident as companies like Nestlé and Conagra launch GLP-1-friendly products, including Nestlé's Vital Pursuit line of frozen dinners and Conagra's 'On Track' badge for 26 products in its Healthy Choice line. The report suggests that GLP-1 users are trading down on package sizes, with coffee and soft drinks showing the highest percentage of downsizing. As consumer demand for smaller pack sizes grows, food manufacturers may be motivated to reduce package sizes to meet the needs of the growing GLP-1 demographic, diversifying product offerings to include smaller sizes while maintaining larger options. This trend is expected to have significant implications for the CPG industry, with potential impacts on sales, product development, and marketing strategies. 2. How GLP-1 Weight Loss Drugs Are Reshaping the Food Industry Discover how GLP-1 weight loss drugs like Ozempic and Wegovy are transforming the food industry by altering consumer eating habits. Learn about the decline in grocery spending, shifts in dietary preferences, and new product innovations from companies adapting to these changes. Understand why food remains essential for nutrition, social experiences, and cultural connections despite reduced appetites. Stay informed on what this means for the future of food marketing and consumption. 3. Ozempic Menus: How Weight-Loss Medications Are Changing Restaurant Dining Discover how Ozempic and other GLP-1 weight-loss drugs are transforming restaurant menus and dining habits. Learn why eateries are introducing smaller, 'Ozempic-friendly' meals to cater to diners with reduced appetites, and how these drugs are impacting food choices, portion sizes, and even food waste. Hear from restaurant owners about their new strategies, see examples of mini-meals and snack-style plates, and find out what these changes mean for diners and the future of eating out. Key topics: - How GLP-1 medications like Ozempic, Wegovy, and Zepbound work to suppress appetite - Real examples of 'Ozempic menus' and mini-meal offerings in restaurants - The impact on restaurant profits, food waste, and dining culture - What to expect if you’re dining out while taking weight-loss drugs Perfect for foodies, health-conscious viewers, and anyone interested in the latest trends in dining, nutrition, and weight-loss. Keywords: Ozempic menu, GLP-1 restaurant trends, weight-loss drugs, smaller portions, healthy meals, food waste, dining out tips

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