Why Regular Blood Testing is Crucial for Effective Weight Management Medications

Semaglutide, part of the glucagon-like peptide-1 (GLP-1) receptor agonist drug class, is a big topic in pharmaceuticals.¹ Though initially introduced as a treatment for type 2 diabetes, semaglutide has rocketed to popularity as the new weight loss drug due to the common side effects it has on body weight. According to Medscape, prescriptions for semaglutide medications increased by around 150% between 2022 and 2023.²

Around 42% of Americans are obese;³ as such, subcutaneous semaglutide injections are being viewed as a solution to rampant obesity and the severe health problems that can come with it.

As we explore this new use for semaglutide, the extent of possible adverse effects, particularly the impact of long-term usage, have yet to be fully understood. These unknowns make patient testing before, during and after semaglutide treatment an essential practice. 

Why baseline health screening is necessary

One reason for baseline health screening before using semaglutide is that it can highlight why the patient should be utilizing the drugs, i.e. qualify them. For example, the FDA approved the use of Wegovy, a semaglutide injection, for weight management in overweight adults with at least one related condition like high cholesterol or type 2 diabetes.⁴ Providers can use initial blood tests to analyze heart health biomarkers, like cholesterol or triglycerides, or blood glucose indicators to assess the risk of diabetes.  

In addition to qualifying patients, baseline testing provides a crucial general overview of their health. This analysis is particularly relevant for individuals without a regular healthcare provider familiar with their history or medication use and who instead rely on telehealth services.

Conditions patients and providers should be aware of before starting semaglutide medications include, but are not limited to:⁵

• Diabetes: Though semaglutide is a treatment for type 2 diabetes, there are dangers associated with mixing it with other medications, and it can affect related conditions, like diabetic retinopathy, an eye condition that causes vision loss in people with diabetes.⁶⁷ It is also important to note that individuals with type 1 diabetes should not use semaglutide.⁸
• Thyroid cancer: Studies have linked the use of certain semaglutide medications to thyroid tumors in rats.⁹ These findings mean patients are advised to inform their healthcare providers if they have any thyroid concerns or any family history of thyroid tumors, medullary thyroid carcinoma (MTC) or the tumor condition, Multiple Endocrine Neoplasia syndrome (MEN 2).¹⁰
• Pancreatitis: Providers should be aware of any history of pancreas issues, as certain studies indicate an association between specific GLP-1 therapies and an increased rate of pancreatitis.¹¹¹²
• Kidney disease: Research suggests that the kidneys may be affected by semaglutide medications, and given the relatively new nature of this drug, it is an important consideration until there are more definitive long-term clinical trials on the matter.¹³

Baseline blood tests paint a detailed picture of patient health, highlighting the need for weight loss medication and helping their healthcare provider anticipate how semaglutide treatment may impact their health.

Reasons to implement regular monitoring

Once patients are prescribed semaglutide, testing every few months enables healthcare providers, both in-person or through telehealth, to supervise usage and monitor patients for positive or adverse effects.

1. Evaluate drug effectiveness

As semaglutide's primary purpose is to treat type 2 diabetes, testing blood glucose levels with HbA1c tests is an essential check-in for this drug.

Additional testing also helps identify the extent of its effectiveness, as certain individuals may not experience the anticipated level of weight loss. For example, a double-blind trial for semaglutide found that 86.4% of participants lost over 5% of their body weight in 68 weeks, while 13.6% did not.¹⁴ Though more research is needed to understand why it works for some but not others, even when patients do not report significant weight loss, they may experience other health benefits that require testing beyond a scale.

"You could lose 3% [body weight], but that could all be in your waist, and therefore, your liver function tests improved. You get improvement of, say, visceral body fat, maybe you get improvement in blood sugar or blood pressure. To just say, 'Okay, what is the scale telling me, if I should continue this or not?' as the only read out, I think, would be a mistake." - Jody Dushay, an endocrinologist at Beth Israel Deaconess Medical Center, via MedPage Today.¹⁵

2. Track usage adherence

Patients may want to increase their dosages if they are not seeing the desired results, which can be dangerous. Regular monitoring can help providers ensure that patients use their medication as instructed.

America's Poison Centers reported nearly 3,000 calls involving semaglutide from January to November 2023, an increase of more than 15-fold since 2019.¹⁶ While many of these incidents were attributed to patients accidentally taking too much at a time, regular monitoring could deter patients from purposefully increasing their dosage to see quicker results or make up for missed doses. 

As more patients are prescribed semaglutide, constant supervision of patients remains a concern among healthcare professionals.¹⁷ In an interview with Business Insider, endocrinologist and obesity specialist Dr. Scott Isaacs shared that a common concern is the growing number of patients getting online prescriptions for semaglutide with little to no follow-up medical care. He went on to note that patients should use semaglutide medication in combination with lifestyle changes and healthcare supervision to minimize adverse effects while ensuring effectiveness.¹⁸

3. Address clinical concerns 

"My biggest concern is that there's misinformation everywhere. People are seeing on social media it's a quick fix or a way to lose a few pounds. That's not how they're studied or intended to be used." – Dr. Christopher McGowan, a board-certified physician in internal medicine, gastroenterology and obesity medicine, via Business Insider.¹⁹

Professionals want patients to understand that semaglutide on its own is not a fast and permanent fix. For example, semaglutide can improve heart health by helping patients reach a healthy weight, but that is not the only important factor in reducing the risk of cardiovascular disease. Patients wishing for long-term results must combine it with other lifestyle changes, like eating right, noted cardiologist Dr. Elizabeth Klodas in the same Business Insider article.²⁰

Healthcare providers and patients are encouraged to work together for the best health results. Regular testing can monitor critical health indicators, helping providers guide patients to other best practices alongside their semaglutide use.

4. Avoid adverse side-effects 

In a CBC interview, Dr. Mahyar Etminan explained that though some health risks of semaglutide are considered "rare," affecting only a small percentage of users, the increase in people using semaglutide means more people are falling into that percentage.²¹ Dr. Etminan, an epidemiologist and author of a study on the effects of semaglutide and liraglutide, went on to say that there are many adverse effects for which we do not currently have long-term data, especially in the case of taking semaglutide solely for weight loss purposes.  

Due to the various health concerns, it is a good idea to monitor specific areas, such as:

• HbA1c: Blood glucose should be monitored, given semaglutide's effect on the amount of sugar released into the bloodstream. This can also help on the rare occasion someone experiences hypoglycemia (low blood sugar), which is a higher risk when using semaglutide in combination with certain medications.²²
• Thyroid-Stimulating Hormone (TSH): TSH tests are an essential method of providing assurances given the potential risk of thyroid tumors.
• Lipids: A lipid panel provides general insight into the effects of semaglutide (and other lifestyle changes) on areas of the patient's body, like their cardiovascular health.

"When we look at a medication that works at a much higher level and causes much more weight loss, we're going to see more side-effects." - Dr. Sean Wharton, an internal medical physician, via CBC.²³

Evolving considerations of frequent testing

Given the rising number of users and the high cost of semaglutide medications, healthcare coverage plans are expected to roll out stricter coverage criteria and require periodic assessments for continued coverage. 

One strategy analysis, Payer strategies for GLP-1 medications for weight loss, advises payers to implement four stages in their coverage strategy:²⁴

1. Evaluate coverage
2. Ensure appropriate utilization
3. Develop patient engagement strategies for optimal value
4. Evaluate the pharmacy supply chain

Strategies like 1 and 2, in particular, would necessitate baseline testing and strict evaluations to verify effectiveness in order to continue coverage. 

Should such changes occur, proactively implementing initial testing and monitoring measures would help ensure a smoother and safer patient transition.

The value of testing post-usage

Blood tests have a role to play even once the patient stops taking semaglutide medications.

Whether they stopped due to health issues, financial restraints or something else, patients have reported experiencing a variety of symptoms after quitting their semaglutide medications. In one clinical trial, the patients who stopped semaglutide (and positive lifestyle changes) regained around two-thirds of the semaglutide weight loss.²⁵ Weight is not the only area of patient health that can be affected as the body must adjust and return to its regular function. 

Health providers should monitor areas of patient health like blood pressure, blood sugar and cholesterol levels. Fluctuations in cardiometabolic levels can help providers determine the right path for each patient to taper off their usage. Some patients may even be advised to stick to a lower maintenance dose and nutrition plan to prevent significant weight gain and other sudden changes.²⁶

Summary

The evolving landscape of this GLP-1 receptor agonist as a weight loss medication underscores the need for continuous screening before, during and post-usage, as well as collaborative efforts between healthcare providers and patients. Baseline screening and monitoring tests help evaluate the drug's effectiveness, identify potential adverse effects and ensure a healthy patient weight loss journey. 

Beyond that, there's a distinct competitive advantage to readying your business to meet stricter coverage criteria — and doing so proactively. Knowing that payer strategies around GLP-1 medications are evolving and health insurance plans may require periodic assessments for continued coverage, ramping up your testing capabilities will set you up for success and set you apart from the competition.  

For your company and your customers' futures, offering pre-, during and post-treatment health data is a worthwhile pursuit. As we navigate this new frontier in pharmaceuticals, prioritizing patient safety through meticulous testing will be vital to unlocking the full potential of semaglutide in the ongoing battle against obesity and its associated health challenges.

Let your company lead the charge.