Why do people with obesity but without diabetes start taking semaglutide?

Why do people with obesity but without diabetes start taking semaglutide?

Factors such as gender, insurance plan type, and use of shared medications influenced whether people with obesity but without diabetes initiated semaglutide treatment

A current oneJama Network OpenThe study examined the factors associated with semaglutide initiation in obese adults without diabetes and with commercial insurance.

An increased demand for semaglutide

Demand has increased for novel GLP-1 receptor agonist drugs such as tirzepatide (Zepbound, Mounjaro) and semaglutide (Wegovy, Ozempic). These medications were originally prescribed for type 2 diabetes (T2D) and are now FDA-approved for weight management and cardiovascular disease prevention.

Obesity, often overlooked as a treatable disease, is a significant risk factor for diabetes and cardiometabolic diseases. Despite the availability of effective treatments such as GLP-1 receptor agonists, many obese individuals remain stuck with lifestyle choicesAdvicebe the main recommendation.

In the United States, where 73.6% of the population is overweight or obese, a notable number of individuals use GLP-1 agonists for weight management without medical guidance.

However, access to these medications is often limited by insurance disparities, which disproportionately affects those from low socioeconomic backgrounds and Black and Hispanic communities. Addressing these inequalities is critical to reducing the burden of obesity.

About the study

The current study sought to examine the factors controlling semaglutide initiation in obese adults without diabetes and commercial insurance. A machine learning approach was used to identify factors, and a multivariable regression modeling strategy helped quantify the association of leading factors with semaglutide initiation.

All relevant data was obtained from Merative Marketscan's commercial claims and database (formerly IBM Marketscan) as of the period between June 5, 2020 and December 31, 2022. Claims and medications prescribed to insured customers between 18 and 64 years old.

A cohort was created including individuals with at least one encounter with an obesity health professional in an inpatient or outpatient capacity. The first claim identified from the database was used as baseline data for diagnosing obesity. Individuals who had bariatric surgery, those prescribed an antihyperglycemic medication, and those who were pregnant six months before obesity diagnosis were excluded.

Study results

A total of 97,456 individuals between the ages of 45 and 54 met the inclusion criteria, of which 50.7% of the cohort were covered by Preferred Provider Organization (PPO) plans. More than 50% of the cohort lived in the Southern region.

Approximately 2% of selected participants were prescribed semaglutide within 6 months of the initial obesity diagnosis. People aged 55 to 64 were more likely to be prescribed semaglutide than those aged 18 to 24.

Individuals with the highest body mass index were the largest group receiving semaglutide prescriptions. An AUROC model identified gender, economic status, age, region, employee status, and insurance plan as the top factors associated with semaglutide initiation.

Compared to men, women, and older people from the Northeast and South who were employed in the service industry and had PPO plans were more likely to receive semaglutide prescriptions. Individuals with unknown employer industries were less likely to have semaglutide initiation.

Multivariable logistic regression analysis revealed that individuals with more recent index data had a higher likelihood of initiating semaglutide within 6 months, peaking in March 2022 and declining through June 2022. Additionally, individuals from the North Central and Northeast regions were more likely to receive semaglutide compared to those residing in the West.

Individuals with employers in nondurable goods manufacturing, insurance, real estate, and finance were more likely to start using semaglutide. Participants with a prescription of amphetamine stimulants and antidepressants were more likely to receive semaglutide.

Conclusions

This study used a novel machine learning approach to identify healthcare, sociodemographic, and clinical factors associated with initiation of semaglutide within 6 months of obesity diagnosis.

The group studied showed the presence of inequalities in access to medicine. Further research could be conducted to understand whether concomitant use of shared medications influences effectiveness and impacts a sample of public payer plans.

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