Understanding GLP 1

Introduction

 My name is Dr. William Conway.  I am  a general internist in Nashville. I was honored to become  a fellow of American College of Physicians for my work on intensive insulin therapy in diabetes. 

 My practice, Nashville Concierge Medicines, is private  concierge medicine practice . I study and translate medical science for patients in Nashville and beyond.

I write these blogs to provide you with key concepts which will benefit you in your decision-making. What you do on  a daily basis is an important as what you understand. My goal is to provide you with simple actionable steps that can make long term health and vitality more likely. 

Executive Summary

  1. Semaglutide( Novo Nordisk) and Tirzepatide (Eli lilly) are effective drugs for weight loss 
  2. In clinical trials, average weight loss was 18-22%. Individual results vary
  3. There is a wide variability in how much weight an individual patient will lose
  4. Nausea, vomiting, and diarrhea are common side effects.
  5. How your physician  in Nashville adjusts your dose matters for your long-term success
  6. Only buy these medications with a prescription from your licensed physician, filled at  a licensed pharmacy
  7. In my concierge medicine practice, I see every patient’s results vary, which is why careful physician oversight is essential

 Your Choices

Semaglutide is a medication that took nearly twenty years of development from Novo Nordisk before being approved for diabetes and obesity. A new category of medicine, it mimicked gut hormones that do the following:

  • regulating insulin 
  • managing the emptying of stomach
  • reduce appetite

 Since 2017, it has been proven to:

  • protect the heart
  • protect the kidney
  • protect the liver

 It is a once-a-week injection

Tirzepatide is an Eli Lilly medication, in the same family as semaglutide, but works slightly differently. In recent trials, it is slightly more effective than semaglutide

Liraglutide is the oldest of this family of medications, being available since 2010, with similar benefits, though, generally with less weight loss than the newer agents.

I, Dr. William Conway, use semaglutide, tirzepatide, and liraglutide, in my concierge medicine practice, carefully tailoring therapy to each patient in Nashville

The Effectiveness

All of these medications are effective. All produce weight loss.  The main difference lies in how much weight an individual patient may lose. As Dr. Conway emphasizes in his concierge medicine approach, long term results depend not just on the drug, but the physician’s ability to guide patients.

 The Variability

Both semaglutide as well as tirzepatide show a similar pattern of individual effectiveness. In a given patient, weight loss can be none, a little, a lot, or a remarkable amount. Clinical data suggests that tirzepatide appears to foster in some individuals’ greater weight loss. In my concierge medicine practice, I, Dr. William Conway, have seen this variability first hand, which is why close monitoring and dose flexibility are essential

 Comparison of Tirzepatide versus semaglutide

Tirzepatide, in a sample of 100 patients, has a similar pattern to semaglutide. Tirzepatide has a greater response rate at the low end of distribution, and a greater weight loss at the high end of distribution. This distribution will apply to patients in Nashville.

 

Adverse Effects

Nausea, vomiting, and diarrhea occur with both agents. These side effects occur

more frequently at beginning,

 when doses are increased. 

While these side effects usually reduce, they can persist.  In myself, Dr William Conway, I have experienced nausea on a persistent basis. In my concierge medicine practice, I emphasize staying at a dose  that balances comfort and effectiveness, because tolerability is more important than choosing every extra pound lost.

The dosing these medications requires skill and sensitivity from your physician. Remember that this is a marathon. Maintaining a dose that you can be comfortable with is far more important than pushing to lose every additional pound.

Words of Wisdom from Attorney General Skermetti from Nashville

Attorney General Skermetti has wrote a letter to the Food and Drug Administration requesting administrative action against “bad actors” selling illicit GLP1. A word to the wise is sufficient. Please obtain your medication from a licensed physician and a licensed pharmacy.

Conclusion

I have summarized the basics of these medications for your understanding. Please see my two separate blogs on Obesity and the Medical Management of Obesity for greater insight. GLP-1 medications fit in to the concierge medicine model at Nashvile Concierge Medicines. As Dr. Conway, I believe these therapies succeed best when integrated into long term physician-patient relationships.

CTA. Contact Dr. William Conway at Nashville Concierge Medicines for an appointment at   615-708-0390.

References:

Perkovic V, et al. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes. N Engl J Med. 2024;391(2):109-121.

Kosiborod MN, et al. Semaglutide in patients with obesity-related heart failure and type 2 diabetes. N Engl J Med. 2024;390(15):1394-1407.

Lincoff AM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389(24):2221-2232.

Kosiborod MN, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084.

Weghuber D, et al. Once-weekly semaglutide in adolescents with obesity. N Engl J Med. 2022;387(24):2245-2257.

Frías JP, et al. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. N Engl J Med. 2021;385(6):503-515.

This content is for informational purposes only and does not constitute medical advice. Always consult a licensed physician before starting any prescription medication, including semaglutide.