Semaglutide, better known under the name Ozempic, has received significant attention since it was launched in Denmark as a new treatment for type 2 diabetes in 2018.

Interest intensified with the development of Wegovy, containing a higher dose of semaglutide, which is specifically approved for the treatment of obesity. This has sparked debate among experts, patients, and in the media.

A new comprehensive study from Aarhus University and the University of Southern Denmark now sheds light on the explosive increase in the number of Ozempic users in Denmark, including the so-called off-label use for weight loss among non-diabetics.

The study was conducted by examining data from Danish health registries for hospital contacts and diagnoses, prescription drug redemptions, and blood tests from more than 100,000 new users of Ozempic from 2018 to December 2023.

One-third of the users did not have diabetes

The survey shows, among other things, a tenfold increase in the number of Ozempic users over the past six years.

According to Professor and Senior Consultant at Aarhus University and Aarhus University Hospital, Reimar W. Thomsen, this is very significant. Even more interesting, however, is examining the user profile, including the number of non-diabetic users.

“There was a significant acceleration in the number of new users from 2021 to 2022, and the proportion of users who apparently did not have diabetes increased. Even though the medication is not approved for weight loss alone, one-third of Danes who started on Ozempic in 2022 did not have diabetes,” explains Reimar W. Thomsen.

Not the best solution in all cases

During 2023, the number of new Ozempic users decreased, and fewer new users without diabetes were registered.

This is probably because Wegovy, specifically as a treatment for obesity, came onto the market at the end of 2022, while there were also supply issues with Ozempic in 2023, according to Reimar W. Thomsen.

The survey shows that about 70 percent of Danes with type 2 diabetes who started on Ozempic during the period 2018 to 2023 had a treatment need for additional diabetes medication in relation to their blood sugar regulation.

However, Ozempic is far from being the only or most optimal solution for patients in all cases, says Reimar W. Thomsen.

"Ozempic and other new diabetes medications are particularly beneficial for patients with type 2 diabetes and known cardiovascular or kidney disease, who are considered high-risk patients. However, the study suggests that it is not necessarily this patient group that is primarily being prescribed the medication,” he says, adding:

"Only about 30 percent of the new users had cardiovascular disease or kidney disease, and that is hardly more than the average. So the question is whether the right high-risk patients with type 2 diabetes are currently getting Ozempic.”

New guidelines May 1

The regions' expenses for diabetes medication have increased dramatically in recent years, and treatment with Ozempic is significantly more expensive than other types of diabetes medication.

On Wednesday, May 1, 2024, the Danish Medicines Agency announced that patients with type 2 diabetes can only receive public subsidy for Ozempic if they have tried another, cheaper treatment first.

Only when there is no longer a sufficient treatment result from the other drugs, can the doctor prescribe Ozempic with subsidy.

Users are getting younger

According to Reimar W. Thomsen, "it is probably a rational decision," considering healthcare costs, as a large part of the patients who today get Ozempic should not necessarily be prescribed it, if doctors were to follow the national and regional treatment guidelines.

"The authorities probably have a point when they say that many patients with type 2 diabetes should not necessarily get Ozempic according to the guidelines. And certainly not as a first choice,” he says, adding:

"Our study also shows that the new Ozempic users over the years have become younger, and the proportion of women has increased. It is now given earlier in the diabetes course and at lower blood sugar levels, and general practitioners confirm that there has been a certain patient pressure to get Ozempic, where the desire for weight loss has been significant.”

Behind the research result - more information

Study type: Population-based cross-sectional study based on health registries from January 2018 to December 2023.

Collaboration partners: Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Department of Public Health, University of Southern Denmark, Research Unit for General Practice, Danish Medicines Agency.

External funding: None

Conflict of interest: Professor Anton Pottegård reports grants from Novo Nordisk, unrelated to the submitted work. Professor Jens Søndergaard reports grants from Roche Diagnostics, AstraZeneca a/s; personal fees from Novo Nordisk a/s, Abbott Rapid Diagnostics a/s, unrelated to the submitted work. The authors report no other conflicts of interest in this work.

Link to the scientific article: Published in the journal Clinical Epidemiology https://www.dovepress.com/articles.php?article_id=92206

Contact

Professor and Senior Consultant, Reimar W. Thomsen
Aarhus University, Department of Clinical Medicine and Aarhus University Hospital, Department of Clinical Epidemiology.
rwt@clin.au.dk
Phone: +45 20482890