Latest / Flourish- A Prisma Health Podcast / Beyond Blood Sugar: GLP-1s & the Future of Diabetes Care

Transcript

Beyond Blood Sugar: GLP-1s & the Future of Diabetes Care · Flourish- A Prisma Health Podcast

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  Scott Webb: Between friends and family, social media and commercials, it seems
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  that everybody is talking about the benefits of GLP one medications for the
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  treatment of diabetes and weight loss.
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  And my guest today is here to explain the benefits and risks of GLP one's,
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  who's a good candidate And so much more.
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  Scott Webb (Host): I'm joined today by Dr.
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  Jaqui Jones.
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  She's a Family Medicine Doctor with PRISMA Health.
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  This is Flourish, the podcast brought to you by PRISMA Health.
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  I'm Scott Webb.
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  Scott Webb: Dr.
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  Jones, nice to have you here today we're going beyond blood sugar.
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  We're gonna talk GLP ones And the future of diabetes care And so much more.
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  But before we get to all that, and I don't wanna jump too far ahead for
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  listeners, like what is diabetes and why is blood sugar control so important?
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  Dr. Jaqui Jones:
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  So diabetes?
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  There are two types.
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  we're talking about type two diabetes, which is, really more of a.
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  Disease of lifestyle.
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  So, there's an endocrine dysfunctional problem.
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  We become hyperinsulinemic, meaning an insulin.
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  That thing we use to bring sugar into our body does not function as well as
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  we want to because of lots of different reasons, how much we've eaten, how little
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  we've exercised, a combination of both that results in elevated blood sugars,
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  and when they become high enough, we can test you and diagnose you with diabetes.
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  That's it in a scientific nutshell.
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  But the problem is that we, we.
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  Really become a society that's eating too much processed foods, refined
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  sugars, And that result in us being overflowing with fats and sugars,
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  and that's resulting in disease.
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  Scott Webb: Yeah, as you say, it's behavior, lifestyle, diet, lack of
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  exercise, maybe a little genetics, family history mixed in, and doctor we.
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  Hear all the time, seemingly now about GLP one medications.
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  Every time I turn on the TV, I see commercials and they're on social media.
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  What are they and how do they work?
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  Dr. Jaqui Jones:
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  So GLP ones have become all the rage.
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  Now, they're not as new as people think, but I think that's
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  always the case in medicine.
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  They're very popular right now, and they're the.
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  New kid on the block, but the science has been studying GLP ones for a long time.
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  So glucagon like peptide one, agonist medications were created for the
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  treatment of type two diabetes and now labeled for the treatment of obesity.
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  These medicines are injectables, although they're recently become oral
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  medications, but they have been great in dropping a one Cs, larger than
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  any medicine that we have with the exception of insulin and So, It has
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  really been unheard of to see a drop of.
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  You know, plus one point.
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  So to go from like maybe a 7.2
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  down to a 6.2
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  has been hard to do on a single medication, but these medications do it.
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  And so they've been very beneficial in helping us, , with the glucagon-like
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  peptide, receptors, which help us decrease blood sugars and help with hunger.
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  Scott Webb: Right.
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  Yeah.
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  Like I said, they're seemingly everywhere.
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  Everybody seem, talking about them.
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  How do they differ, doctor, than the more traditional or older diabetes treatments?
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  Dr. Jaqui Jones:
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  They have a completely different approach.
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  So insulin, we all know it's just simply hormone replacement, right?
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  Yeah.
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  So I am putting insulin in your system to make it do what it's always done.
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  There have been medicines that used to either increase how much insulin.
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  That you were producing, or they were trying to prevent absorption of
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  sugars in the gut, like metformin.
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  There have never been ones that actually attack this particular,
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  receptor that really got at hunger and So, It slows down gut motility.
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  It has a sensation of feeling more full, and it has done a great job by
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  doing that, making sure that people eat less, um, or eat more appropriately.
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  Scott Webb: Right.
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  So then let's talk about who's a good candidate, right?
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  As I said, it's seemingly everywhere and everyone's talking about it,
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  and I'm sure lots of patient's are asking you about it, GLP ones That is.
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  But who's the right person, the right candidate for this therapy?
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  Dr. Jaqui Jones:
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  Anybody with diabetes I think can be a candidate for, the GLP
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  ones,, from a diabetes standpoint, just to stay the course there.
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  I think anyone that has an elevated.
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  A1C of 6.5
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  and higher is an absolute good candidate which will also be covered by insurance.
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  So I think from a medicine standpoint, I think anyone with an elevated
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  A1C would be a great candidate.
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  Understanding that cost matters in our society.
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  People wanna know that it's gonna be covered by most of their insurance
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  carriers, a diagnosis of diabetes.
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  Where you've not had success in controlling that through some of the
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  traditional or older medications, I think makes you a great candidate
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  for having a conversation with your doctor about a GLP one.
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  Scott Webb: Right.
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  At the very least, at least have a conversation.
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  And it makes me wonder, are there some benefits beyond just
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  blood sugar control for GLP ones?
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  Dr. Jaqui Jones:
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  Absolutely.
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  There are anecdotal things that you've heard, I'm sure, sure.
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  Through the grapevine, but we do know that, you know, Ozempic, and Wegovy
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  have been studied to, , know improvement in people with chronic kidney disease.
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  People with existing heart failure have seen some improvement
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  in morbidity and mortality.
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  And then also the one that everybody's in love with, weight loss.
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  Scott Webb: Yeah, that, uh, no doubt that, that's music to our EARS.
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  Of course.
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  Yes, we need to eat better And we need to, you know, get some
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  more exercise and all of that.
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  But the weight loss is key.
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  Are there any side effects or risks that patient's need to be aware of?
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  Dr. Jaqui Jones:
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  There are some people that we are concerned about.
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  So if you ever had a history of pancreatitis, then unfortunately
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  GLP ones may or may not be for you.
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  It can cause in some rare instances, a repeat of your pancreatitis.
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  I do not think there's a reason for you to absolutely not have
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  it, but you have to be cautious.
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  There is an absolute contraindication, and that's anyone with what we call
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  MEN, multiple endocrine neoplasia.
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  If you have been diagnosed with one of those or you have a family history with
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  that, you likely may not be able to take advantage of a GLP one, and I strongly
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  recommend that you let your doctor know about any history or any family
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  history before starting this medication.
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  Scott Webb: Sure.
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  I wanna talk to you about integrating GLP ones, if you
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  will, with the lifestyle changes.
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  Would recommend diet, exercise, And so forth.
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  How do you kind of merge those things together?
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  How do you integrate them?
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  Dr. Jaqui Jones:
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  Well first with education.
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  So I think right now the GLP one, sound magical, that you take them and you
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  wake up one morning and you are skinny.
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  But that's not exactly how that works.
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  I think the average weight loss is somewhere between five and
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  15% of the starting body weight.
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  , Over the first six to 12 months.
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  We are really trying hard to.
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  Help people understand patterns and behaviors.
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  It has been great that it has decreased our appetite and our hunger drive, and I
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  see that as an opportunity to really buy you time to be thoughtful about the food.
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  So I think in addition to educating people on their diabetes, the
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  advantages of the GLP one.
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  We also are trying to spend a good chunk of time saying, now that we have
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  your attention, and now that you're not driven so much by your cravings
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  and your hunger, let's talk about what you should be eating right versus
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  all the things you should not eat.
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  So, it without that key component.
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  I think we cannot see the sustained longevity of the weight loss And the
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  success that people are seeing upfront.
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  Scott Webb: I like to, do a little myth-busting when I can, doctor.
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  So let's bust any myths that are out there, misconceptions about GLP ones.
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  Anything out there that you've heard anecdotally or otherwise
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  that you want to clear up.
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  Dr. Jaqui Jones:
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  The big one is that they're magic.
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  Um, they're, they're not magic.,
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  I've had many conversations, , with patient's, some from the
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  surprise, I didn't think I could lose this much weight.
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  And the other one's from, I can't believe I'm paying this money for this medication,
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  and I have not lost enough weight.
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  do think that the five to 15% is a pretty reasonable,
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  expectation, for your weight loss.
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  I think anything past That is a combination of both the tools that you
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  use, like GLP one and your lifestyle.
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  So I think that That is probably the biggest one.
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  Everybody's super excited to try it and I don't want to set a high
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  expectation that's gonna leave people disappointed because if you are a
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  stress eater or an over eater or just.
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  Love eating.
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  Nothing better than drive that craving than a big chunk of
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  disappointment when you did not hit a goal that you were expecting.
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  So setting the expectations of this not being magical, but being
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  a tool is probably the biggest myth I would like to bust.
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  Scott Webb: so you mentioned earlier about, cost and insurance.
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  I just wanted to touch on that a little bit more.
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  Like what should patient's know and or consider when you're thinking about
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  the cost of GLP ones and insurance And what they cover or don't cover?
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  This is still, I think, an expensive medication for most people if
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  you're paying out of POCAT.
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  I think that, the makers of the GLP ones have, put things in place where
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  you can buy them directly from.
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  You know, the manufacturer to try to cut down on the cost, but
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  they are an expensive, adventure.
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  So I've seen cost as low as 2 99 a month to as high as 1500 a month when
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  not covered by insurance, depending on where you're purchasing it.
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  And so I want people to know that there can be a cost associated
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  with obtaining this medication if you're paying out of POCAT.
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  What I would like for people to do is check with their insurance
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  companies because we did a big swing of insurance companies not
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  covering weight loss medications.
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  But I think that that may reverse, , over time and So, it will not hurt
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  to call your insurance company to ask, do you cover GLP ones?
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  And more importantly, for what conditions do you cover them?
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  Right?
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  So they may say, yes, we cover them if you have diabetes.
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  And you can always ask directly, will you cover them for weight loss?
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  And if they say, yes, that's great.
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  That's great information for us to know.
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  If they say no, then it allows me to have a conversation about
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  the expectation on pricing.
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  Right.
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  It's amazing to me, doctor, that we're talking about these GLP ones
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  and we're still learning so much about them, the sort of unintended
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  benefits that folks are experiencing.
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  But what's next in GLP ones
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  Dr. Jaqui Jones:
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  We just recently started to, get oral options.
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  So, you know, I don't know how many people know, but the GLP ones today have
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  been primarily injectable medications.
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  Yeah.
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  But they are now offering some oral options out there
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  that are starting to come out.
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  So I think as we provide, different mediums, because some people.
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  Really want to take advantage of this tool, but they cannot
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  get over self-injecting.
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  So as the oral medications come out, I think that's gonna be lots to
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  talk about and lots to experience.
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  But I think for now the GLP ones are gonna be the hot commodity of the moment.
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  Scott Webb: Yeah, gonna be here for a while.
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  I said, we're still learning so much about them and they may not be magic, and if
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  your insurance doesn't pay for 'em in some circumstances, they're pretty expensive.
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  But they are amazing nonetheless.
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  And I appreciate your time today.
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  just great to learn more.
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  Dr. Jaqui Jones:
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  Thank you so much for having me, Scott.
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  Host: For more information and other podcasts just like this one, head on
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  over to prismahealth.org/flourish.
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  This has been Flourish, a podcast brought to you by Prisma Health.
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  I'm Scott Webb.
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  Stay well.