A new study adds to mounting evidence showing that drugs like Ozempic don’t just treat diabetes — they can also prevent it.
The new paper, published Wednesday in The New England Journal of Medicine, showed that the compound in the diabetes drug Mounjaro and the weight loss drug Zepbound slashed by 94 percent the risk that overweight or obese adults with pre-diabetes would develop diabetes. The trial, which was funded by the drugs’ maker Eli Lilly, found that most patients on the medication had their blood sugar in control after three years.
Previous studies have shown that the substance in Ozempic can have a similarly powerful effect. More than a third of American adults — roughly 98 million people — have pre-diabetes, or elevated blood sugar levels that can lead to diabetes.
The question now: Are these drugs necessary?
Some doctors say that these drugs should not be first line treatments for every patient with pre-diabetes, given that changes in diet and exercise are often effective for addressing the condition. There’s also a question of whether insurers, who are already straining to pay for these sought-after medications, will cover them when there are other, far cheaper, treatments available.
“Potentially a lot of those same people could have had a great outcome with lifestyle intervention or with a much less expensive, much more accessible medication,” said Dr. Kristina Henderson Lewis, an associate professor of epidemiology and prevention at Wake Forest University School of Medicine.
“Just because something works, is the most potent possible thing, doesn’t mean that everybody needs it, wants it, should have it,” she added.
The goal of treating pre-diabetes is to stop it from progressing to full-blown diabetes, preventing downstream damage to the nerves, heart and other organs. Roughly 5 to 10 percent of people with pre-diabetes will develop diabetes in a year.
Dr. Stephen Mohring, a primary care physician at Nebraska Medicine, said that after he diagnoses a patient with pre-diabetes, he always starts with discussing nutrition and physical activity.
“I know it’s not exciting, but nutritional approaches and exercise really go a long, long way,” he said.
Doctors also often prescribe metformin. Even if patients can access drugs like Ozempic — which is more effective than metformin at helping people lose weight, lowering their diabetes risk — some doctors said they would start with metformin, since it is far cheaper. But a large 2002 study found that intensive lifestyle interventions like brisk walking for at least 150 minutes per week and eating a diet low in fat were more effective at reducing diabetes risk than metformin.
One concern doctors have about prescribing the newer drugs for pre-diabetes is that when patients stop taking a medication like Ozempic, it stops working, which can lead a patient to regain weight and develop high blood sugar again. People frequently go off these medications, in some cases because of insurance lapses or shortages.
But some patients with underlying conditions that could lead to worse complications from diabetes, like cardiovascular or liver disease, may benefit from trying drugs like Ozempic sooner rather than later, Dr. Lewis said. Doctors may also prioritize these drugs for patients with higher body weights.
The question of whether insurers will cover these medications is top of mind for some patients with pre-diabetes. When Ozempic hit the market in 2018, insurance companies were more lenient about prediabetes coverage, said Dr. Michelle Hauser, obesity medicine director of the Stanford Lifestyle and Weight Management Center. But as the drug has become more popular, insurance companies now typically cover it only for patients with diabetes.
Rhea Behlke’s insurance plan had covered Ozempic since her doctor first prescribed it in 2022 to help manage her pre-diabetes. Ms. Behlke has kidney disease, which made her doctor especially eager to get her blood sugar under control. But a year later, a pharmacist gave her unwelcome news: The drug she was getting for $25 a month would now cost over $600, because her insurance had changed and would not cover it. Ms. Behlke, 59, left the pharmacy and found herself crying behind the wheel of her car in the parking lot.
“There was nothing I could do,” she said. “It was like when people find out there’s a surgery that can save their life, but their insurance won’t cover it.”
Dr. Scott Hagan, an assistant professor of medicine at the University of Washington who studies obesity, said that some patients have asked him whether they should just eat plenty of sweets for a month — intentionally raising their blood sugar levels, so they can get on Ozempic.
Ms. Behlke eventually was able to get coverage for Wegovy, which contains the same compound as Ozempic but is authorized for weight loss. Any weight she loses, she said, is a secondary effect — what she cares about more is keeping her blood sugar in control. Her numbers crept up when she was off drugs like Ozempic entirely.
“This literally could be lifesaving,” she said. “But there’s the constant worry of: Are we going to have it?”
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