NEW DELHI: High demand for semaglutide, a medicine primarily used to treat type 2 diabetes and which became a blockbuster drug to reduce weight, led to severe shortages for patients who relied on it for managing and maintaining blood sugar levels, a latest Lancet article said.
Published in The Lancet Diabetes and Endocrinology, the editorial said that initially developed to regulate blood sugar in people with type 2 diabetes, GLP-1 receptor agonists, a class of medications used to treat adult type 2 diabetes and obesity, are now widely used for weight loss, both through approved prescriptions and off-label use.
“Notably, the high demand for semaglutide has already contributed to shortages for patients with type 2 diabetes who rely on it for glycaemic control.”
The article noted that the benefits of these new drugs are not in question, as they have shown unprecedented effectiveness in many clinical outcomes.
“Their success is also changing the public perception of metabolic disease, helping to reframe it as a complex treatable condition rather than a personal failure,” it said.
However, the growing reliance on expensive therapies raises concerns about sustainability and equity, especially in Low and middle income countries (LMICs), where for many people access to these therapies will remain entirely out of reach, it added.
Agreeing with the Lancet editorial, Dr V Mohan, Chairman of Chennai-based Madras Diabetes Research Foundation (MDRF), one of India’s premier institutions dedicated to diabetes and metabolic research, said they heard from the manufacturers that the great demand for the GLP drugs, particularly semaglutide, resulted in shortages as it became a blockbuster drug.
“They were not able to supply enough to meet the world's requirements,” he told TNIE. “This led to the purchase of these drugs in the black and grey markets. There was also a delay in bringing these drugs to India,” he added.
These drugs are now available in India, too. US-based Eli Lilly has launched its easy-to-use injector pen of its blockbuster weight-loss drug Mounjaro after its competitor, Danish drug manufacturer Novo Nordisk, launched Wegovy, a once-weekly injectable, in a similar pen device.
Dr Mohan said the public response to the weight loss-cum-diabetes treatment drug was unexpected and unprecedented. “I don't think even the manufacturers thought this would be such a big runaway success.”
He, however, said the cost of these drugs is still a barrier for many, as it costs over Rs 15,000 a month and has to be taken continuously.
“This means that unless the drug is provided free of cost by the government or paid for by insurance, a large number of people in India will not be able to afford these drugs.”
Dr Mohan said, as argued in the Lancet editorial, for many people, there is no alternative but to use pharmacotherapy.
“These drugs are life-changing for some people. It will be a game changer (if it became affordable) for people in India and in other low-and-middle income countries,” said the Padma Shri awardee whose centre collaborated with the Indian Council of Medical Research (ICMR) in conducting a first-of-its kind national study, which found that an estimated 101 million people in India were suffering with diabetes, 136 million were prediabetes and 315 million people detected with hypertension in 2021.
He hoped that part of the problem of high cost would be solved next year when semaglutide goes off patent.
“Already several Indian companies are getting ready to launch generic versions of semaglutide, which I understand will be considerably cheaper than the original molecule produced by the multinational company. This would mean a larger section of people will be able to have access to the drug, and it will become more affordable.”
There is, however, another catch: The drug works only as long as it is taken. Studies have shown that when the drug is stopped, the weight comes back.
“At least 50 per cent of the weight lost comes back within a few months to one year, which means that on a long-term basis, one must be prepared to take these expensive drugs,” he added.
However, Dr Mohan said the long-term effects of these drugs are still not known, as they have been around only for a few years now.
“No serious side effects have been reported, although some instances of stomach paralysis and loss of vision due to a form of optic neuritis affecting the eye have been reported in a few cases. So we do need more long-term and real-world experience with the use of these drugs, not only in India but in other parts of the world,” he said.
The Lancet article highlighted that globally, countries are facing an alarming rise in metabolic diseases, particularly type 2 diabetes and obesity, and related complications. “In response to this rise and the resulting burden on health-care systems, management of these conditions has shifted.”
“Once centred on lifestyle modifications—such as dietary change, physical activity, and behavioural support—treatments for metabolic diseases have increasingly relied on pharmacological interventions. This change is particularly evident in high-income countries, where drugs such as semaglutide and tirzepatide often dominate media coverage,” the article said.
It added that the answer is not to push back on pharmacological innovation, but to find a balance where prevention through lifestyle modifications remains central to care for people with obesity and type 2 diabetes. “We must ensure that the promise of expensive drugs does not come at the cost of public health itself,” the article added.