Diabetes injection: miracle cure or economic injection?
Diabetes
1.1 Types of diabetes
As the drugs are primarily intended for the treatment of diabetes, the following is an overview of the different types of diabetes and the treatment of type 2 diabetes. The treatment of type 1 diabetes is neglected here, as the drugs are not intended for this disease. Compared to type 2 diabetes, which is often caused by an unhealthy lifestyle and Adipositas type 1 diabetes is not associated with this and often occurs in childhood and adolescence. Type 1 diabetes is characterized by a complete failure of the pancreas, which means that it no longer produces insulin and those affected have to inject insulin for the rest of their lives. Type 1 diabetes is still incurable and is also known as insulin-dependent diabetes mellitus.
In contrast, type 2 diabetes is caused by insulin resistance. Although the body produces insulin, the body's cells are no longer sensitive enough to process it properly. In contrast to type 1 diabetes, not all people with type 2 diabetes need to undergo insulin therapy. As type 2 diabetes is caused by an unhealthy lifestyle with too little exercise in addition to a hereditary predisposition and usually sets in gradually, it can be treated well with a change in diet and sufficient exercise. Medication only needs to be used when the condition becomes severe. Initially, tablets such as metformin are available, but insulin injections may also become necessary as the disease progresses (BMG, 2024). Type 2 diabetes is therefore an acquired disease that is directly linked to lifestyle, even if genetic factors also play a role. Accordingly, this type of diabetes can often be treated well with a change in lifestyle. If this is no longer sufficient, medication such as Metformin be taken. Patients with severe type 2 diabetes can also Insulinpflichtig be treated. GLP-1 injections are another medication used to treat the disease.
1.2 What similar medications have been available so far?
In 2009, the first product Victoza was launched on the market, which is approved for the treatment of type 2 diabetes. The drug Saxenda is a weight loss medication, was also launched in 2009. Both preparations are manufactured and distributed by the company Novo Nordisk manufactured and marketed by the company and use Liraglutid as an active ingredient that binds to the GLP-1 receptors and has similar properties to the newer preparations. Liraglutide stimulates insulin secretion in a glucose-dependent manner and inhibits glucagon secretion under hyperglycemic conditions, thereby inhibiting appetite and inducing a prolonged feeling of satiety. It is important to emphasize that this medication is not an insulin replacement. Patients who are treated with liraglutide must continue to inject insulin. In addition, the medication must be administered daily (Pharmaindex, current status 09.05.2024). Classic medications in diabetes therapy are also insulin or metformin. However, not all type 2 diabetics need to be put on these medications.
1.3 What distinguishes the new GLP-1 syringes from other diabetes medications?
The different diabetes injections use different ways to develop their effect. GLP-1 drugs are also called incretin mimetics and have a direct effect on insulin secretion, which is reduced in type 2 diabetics (Pharmaindex 2024).
Wegovy of $NOVO B (-0.15%) used as the active ingredient Semaglutidwhich is similar to the body's own hormone GLP-1. By binding to the GLP-1 receptors, it promotes the release of insulin, which lowers blood sugar levels. It also makes you feel fuller for longer and slows down gastric emptying (Sartori 2024).
Another drug, which is also marketed by Novo Nordisk, is available under the brand name Ozempic on the market in Germany and the USA. It also uses the active ingredient semaglutide and is approved in Germany for the treatment of type 2 diabetes. It can be used as monotherapy if, for example, metformin is not tolerated. Ozempic can also be used in combination with other antidiabetic drugs (Pharmainfo Gelbe Liste, current status 09.05.2024). In contrast to Wegovywhich is also approved for obesity reduction, Ozempic is Ozempic is only approved in Germany for the treatment of type 2 diabetes (Sartori 2024, Steiner 2024). Another difference lies in the treatment dose, as both drugs are based on the same active ingredient. The maximum dose for Ozempic is 1 milligram, for Wegovy it is 2.4 milligrams. However, doctors are allowed to issue the drug on private prescription, which repeatedly leads to bottlenecks in the care of diabetics. In addition, there are no long-term studies on the effects and long-term consequences for obesity patients without type 2 diabetes.
Other active ingredients include tirzepatideas used by the company $LLY (+0.02%) in its product with the brand name Mounjaro (Sartori 2024). This also binds to the GIP receptors and thus has a dual effect. It improves the glucose sensitivity of the pancreatic beta cells and insulin sensitivity, which leads to prolonged satiety (Pharmaindex, current status 09.05.2024).
1.3.1 What are its advantages and disadvantages compared to other diabetes treatments?
A major advantage of these drugs compared to traditional diabetes treatment with insulin or the use of Victoza is that the injections do not have to be administered daily. For example Ozempic only needs to be injected into the subcutaneous fatty tissue once a week (Steiner 2024). With conventional insulin therapy, the patient is dependent on having insulin syringes within constant reach, an insulin pump must be worn on the body and is therefore relatively cumbersome to use, and metformin must be taken orally. After a training and familiarization phase, patients can use the diabetes syringes themselves and are therefore more flexible than with other treatment methods. Of course, this only applies if the injections are used as monotherapy. Nevertheless, there is a long list of side effects that should not be underestimated.
Among the significant disadvantages of these forms of therapy are the extensive lists of side effects, which are described in detail in subchapter 3.2.3.
2.1 Facts and figures about the market
The IDF predicts that by 2045, one in eight adults, i.e. around 783 million people, will have diabetes. The situation is no better for obesity and pre-obesity. Institutes such as the WHO or the IOF assume that around 45 to 55 percent of the world's population will be pre-obese or obese. This is particularly important for the diabetes market.
The market for diabetes drugs will grow to around EUR 70 billion by 2024 and to EUR 100 billion by 2030. But that is not all. The cost of treating obesity is expected to rise to 3.3 trillion dollars by 2030. This does not even take into account follow-up costs such as heart problems, knee implants and the like, so it is assumed that the fight against obesity could become one of the largest markets in the world (→?).
2.2 The economics behind Ozempic and Wegovy
The question that quickly arises is how big the business is, and the graph shows how well it is doing. Ozempic was launched in 2017-2018 and needed to catch on. It was used more and more, and sales also rose sharply during the Corona period. But the profits have yet to materialize. As you can see, the hype wasn't there yet, and off-label use was still almost non-existent. In 2022, there was hype around Ozempic when speculation arose about its effectiveness as a slimming product, although these claims had not yet been empirically proven. Despite the lack of scientific evidence, sales and profits of the drug rose sharply. This changed abruptly when studies were published in 2023 confirming the positive effect of Ozempic on weight loss. The immense hype surrounding Novo Nordisk's weight loss drug Ozempic brought the company record profits in 2023 and shows no sign of abating in 2024. To meet the sharp rise in demand, Novo Nordisk acquired pharmaceutical supplier Catalent for USD 16.5 billion in March 2024. This acquisition illustrates the company's intensive efforts to expand production capacity and ensure the availability of Ozempic.
The positive development can be seen above all in the market capitalization. In the last 10 years, the share price has increased approximately sevenfold and Novo Nordisk is now the largest company in Europe. Novo Nordisk has also managed to become one of the top 15 listed companies in the world, and this has an impact on Denmark in particular (→?).
2.3 GDP change due to the syringes
The size of Novo Nordisk becomes particularly clear when looking at Denmark's GDP. Although GDP cannot be compared to market capitalization, Novo Nordisk's market capitalization is larger than Denmark's GDP. This is astonishing and also has significant implications.
If you look at the GDP growth rate, it quickly becomes clear that Denmark is doing better than other European countries. This is not only because GDP in Denmark has fallen less sharply, but also because it has recovered more quickly. Novo Nordisk is a key factor in this. So how much do the weight loss injections contribute to the Danish economy? Experts say not insignificantly. The $DANSKE (-0.14%) Bank A/S initially estimated GDP growth for 2023 at 1 %, but then raised its forecast to 2.1 %. These figures exceeded all other forecasts. Without the contribution of the pharmaceutical industry, particularly Novo Nordisk, the growth of 1.8 % in 2023 would hardly have been noticeable. Novo Nordisk, now the most valuable company in Europe, plays a decisive role in this.
The contribution of the pharmaceutical industry is also expected to boost economic growth in other countries, including Sweden. Expectations for 2024 have been raised: Sweden is expected to grow from 1.3 % to 1.5 %. However, the increase in Denmark is particularly noteworthy. The Danish central bank revised its forecast for 2024 from 1.3 % to 2.4 % and for 2025 from 1.3 % to 1.4 %. Novo Nordisk will also have a significant share here (→?).
The users
3.1 Obesity
As the injections are not actually primarily intended to treat obesity, i.e. morbid obesity, it should be briefly mentioned here what this actually is. The Obesity Society defines the disease as follows: "a chronic disease defined as an increase in body fat that exceeds normal levels. Traditional obesity treatment includes services such as nutritional counseling and exercise therapy. In the case of persistent and severe obesity, gastric bypass surgery can also be attempted in order to get the morbid obesity under control.
3.2 How exactly are the injections used?
These drugs are primarily used to treat diabetes mellitus. However, some doctors also prescribe them on a private prescription and thus enable so-called "off-label use", i.e. the use of a medication for a purpose other than that originally intended. Some patients in Germany and many patients in the USA would like to receive injections such as Ozempic or Mounjaro exclusively for weight loss. This has repeatedly led to shortages and supply problems, including in Germany. The problem is now so serious that pharmacists are advised to ask for a diabetic ID card and only give the injections to diabetics (Leyke-Hess 2023).
The injections can therefore be used to treat type 2 diabetes, but also for pure weight reduction or as a mixed therapy for diabetics who also want to lose weight. They can be used as monotherapy or as part of a diabetes therapy.
3.2.2 To what extent is the drug used for weight reduction?
Ozempic is explicitly only approved for the treatment of type 2 diabetes and can therefore not be paid for by health insurance companies as a weight loss agent. The Mounjaro-injection is not only approved for the treatment of type 2 diabetes in Germany. According to an official statement from the manufacturer Eli Lilly, the drug can also be used to treat severe obesity without diabetes. However, there is a lack of studies on possible side effects or long-term consequences (Leyke-Hess 2023).
3.2.3 What are the known side effects?
Side effects of Ozempic according to EU Zulassung:
The side effects of Wegovy are similar, but may occur in addition to cold symptoms (Wegovy.com 2024). Mounjaro also has a similar list of side effects (European Commission 2024).
It goes without saying that all medications have potential side effects. Ultimately, each patient must decide in consultation with their doctor whether the benefits outweigh the risks.
3.3 What are the differences between Germany and the USA?
In Germany, these drugs are only approved on medical prescription (see, for example, consumer information on the Seite von Eli Lilly) . The prescription is subject to strict guidelines and can be refused by health insurance companies. Nevertheless, it is not only in the USA that there are doctors who advocate off-label use and prescribe the drugs on private prescriptions. However, this trend should be viewed critically, as the long-term effects of off-label use have not been researched (SOURCE) It can generally be said that it is much easier to obtain a prescription for these drugs in the USA, even though they are also available on prescription there. In addition, there are other weight loss injections, such as Trulicity, which are not approved in Germany (Superdrug.com). Drug approvals in the EU are subject to different guidelines than in the USA. Trulicity is only approved in the EU for the treatment of type 2 diabetes in children, despite the increased risk of thyroid cancer. A corresponding warning can be found as a fixed banner on the U.S. Website of the manufacturer. Meaningful long-term studies are still lacking for the entire range of these drugs, as they are still too new on the market (Jacobi 2023).
Competition
4.1 Overview of the competition
Novo Nordisk, the manufacturer of Wegovy and Ozempic, is the leader with a market share of 55.3 %. Eli Lilly follows with 18 %, while the other competitors together account for 26 %. According to market forecasts, this distribution will hardly change. The market assumes that market shares will continue to split, but that Novo Nordisk and Eli Lilly will retain over 60 % of the diabetes market.
Although Novo Nordisk and Eli Lilly are active in more areas than just diabetes and obesity, a pie chart illustrates the importance of these two companies. Together they account for more than 13% of the market capitalization of the healthcare sector. Given their enormous revenues, both companies are expected to continue to grow as they invest continuously. In 2023, Eli Lilly invested 9.3 billion dollars and Novo Nordisk 4.7 billion dollars in research and development. If only these sums were added together, they would be among the largest listed companies in Germany.
Looking at the turnover by region, one thing stands out: North America (NA) is clearly the market with the highest turnover, accounting for over 50%. There are several reasons for this. Firstly, NA has one of the highest obesity rates in the world, and secondly, consumers are significantly more profitable. In contrast to Europe, drugs in NA are not subject to such competition. Prices are negotiated, but not through standardized health insurance companies as in Europe.
This can be seen very clearly in the following diagram. At $1,000 a month, the price in the US is almost 12 times more expensive than in Germany, and it doesn't stop there. If you look at the dark blue bar, you can see that products are even becoming more expensive. It is clear from this that demand is outstripping supply and prices can be set more easily. But this is not the case everywhere. In Japan, prices are falling, but this is not necessarily due to demand, but to the weak yen. This is confirmed by the price negotiation in Germany, where the price is just under $69, making it the lowest here. (Please note: prices can vary greatly depending on conditions).
Where such money is earned, the question quickly arises as to why two companies are so dominant and where the competition is. The latter is just starting to develop its own products and, above all, it takes time to approve them. The conclusion is that prices should fall in the long term (→?).
4.2 Why is Novo Nordisk so interesting for the competition?
Looking at all the available data, it quickly becomes clear that Novo Nordisk is strongly positioned in the market. But why is this the case and what makes the manufacturer of Ozempic so special? Although we can't go into the whole story here, the company's main objective from the outset has been the treatment of diabetes, which is reflected in its internal structures.
Novo Nordisk's voting rights belong to a foundation, Novo Holding A/S to be precise. It holds 77.1 percent of the voting rights and 28.1 percent of the capital. Its declared aim is the treatment of diabetes. With this majority of voting rights, the foundation can significantly influence the Group's decisions and ensure that the company remains true to its original goal. Historical events and frequent mentions of this goal indicate that Novo Nordisk remains firmly focused on fighting diabetes (→?).
Cultural impact
5.1 What impact does the emergence of these drugs have
The emergence of Ozempic led to a significant increase in the use of injectable weight loss drugs, particularly in the US. In the United States, the drug gained widespread attention after numerous influencers and celebrities promoted it as an effective weight loss aid. Initially, many users tried to hide the fact that they were taking Ozempic were using it for weight loss. Over time, however, its use became increasingly public. Celebrities such as Khloé Kardashian, Kelly Osbourne and Rebel Wilson openly admitted to using injections for weight loss (Hogan et al. 2024). The increasing popularity of Ozempic and similar drugs has led to a societal debate about the ethical and medical implications of using such drugs. On the one hand, the potential of these drugs for obesity treatment is emphasized, especially for people who do not respond to conventional weight loss methods. On the other hand, there are concerns about availability and security of supply for diabetics, as increased demand is causing supply shortages worldwide (TGA 2024). Novo is also reporting ongoing supply shortages in Germany for the coming year 2024, including for starter kits. As a consequence, the manufacturer Novo Nordisk, for example, is requesting that Ozempic is only prescribed by GPs to diabetics (Burger 2024).
5.2 What are the cultural consequences of influencers and celebrities promoting it?
But not all influencers and social media creators only advertise these drugs. One Youtuber who regularly draws attention to the dangers and side effects of Ozempic is ObeseToBeast. The YouTuber has been running his channel for many years and has achieved significant weight loss himself. He uses his platform to educate people on various topics related to weight loss and hopes to use his reach to provide a realistic view of these drugs. D’Angelo WallaceA month ago, a more well-known YouTube channel, published a critical Video on the topic, which has already garnered 1.5 million views.
Unfortunately, the drugs are often promoted by influencers without reflection. Under the hashtag #Ozempic there are over 190,000 posts on Instagram, almost 87,000 videos on the topic on TikTok and there are also numerous posts on the topic on X. Ozempic is now such a big topic, especially in the USA, that it is even being addressed by series such as SouthPark. In the episode "The End of Obesity” the show focuses on how the American healthcare system deals with the drug.
The demand for these drugs is so high that the Federal Institute for Drugs and Medical Devices (BfArM) has issued an official warning against counterfeit drugs. In the Update of the BfArM, however, it is also clear that the counterfeits have been uncovered. This example illustrates the serious consequences of an extremely high demand. The use of counterfeit medicines can not only be harmful to health, but also fatal.
It gives the impression that weight loss can be achieved easily and without side effects if you have access to these drugs. Celebrities such as Kelly Osbourne also reinforce a class image which reinforces the impression that these drugs are elitist due to their price, i.e. an expression of wealth and luxury. With statements such as that critics of the drugs either take them in secret or are just jealous that they can't afford them (Schultz 2024), it reinforces a clear class image that further stigmatizes obesity. Such statements encourage an unreflective approach to these drugs and give the impression that there are no side effects.
After the body positivity movement was propagated by influencers in recent years, this ideal is now being reversed. Being slim at all costs is once again becoming the ideal of beauty. When normal-weight celebrities are prescribed weight loss injections that are actually intended to treat severe obesity or diabetes, this has a negative impact on the self-image of teenagers and young adults. The impression is created that being thin is the only value worth striving for and that achieving this goal is only a question of money. The negative consequences are predominantly kept quiet, and those who speak out critically are sometimes publicly attacked by other celebrities.
Conclusion
The discussion surrounding the diabetes injection clearly shows that there are both enthusiastic supporters and skeptical critics who view the treatment method from different angles. On the one hand, the injection is seen as a potentially revolutionary means of combating obesity and diabetes, offering not only physical but also psychological benefits; on the other hand, the risks are sometimes seriously underestimated. People struggling with obesity could be given a new chance at a healthier life through the use of these drugs, which in turn could reduce the risk of cardiovascular disease and other obesity-related health problems. In addition, reduced weight can also have a positive impact on self-esteem, which in turn further supports a healthier lifestyle. The ease of use of the medication also means that it is low-threshold in application and can therefore also be used by people with limitations such as depression (which can lead to a reduced ability to carry out activities) or fear of social contacts or doctors.
However, there are considerable concerns regarding the careless use of these medications. Critics warn against the uncritical and unreflective advertising of the syringes, particularly on social media. They often paint an unrealistic picture of the drugs that fails to adequately address the considerable side effects and potential dangers. Celebrities contribute to this distorted image by presenting the drugs as a kind of status symbol, as they are associated with considerable costs as a private prescription. This not only leads to social inequality in the availability of the drugs, but also means that the serious health risks, particularly the long-term consequences, are largely ignored.
It is particularly problematic that the long-term effects of these drugs in relation to the treatment of overweight and obesity have not yet been sufficiently researched. The potential long-term damage that could be caused by hormonal and enzymatic changes in the body is largely unknown. The side effects that patients often experience at the beginning of treatment, such as nausea and vomiting, are often not adequately communicated, resulting in incomplete patient education.
Given these concerns, it is crucial that a balanced and responsible approach is taken. Care should be taken not only to communicate the positive effects of the diabetes injection, but also to take the potential risks and side effects seriously. Informing patients comprehensively and transparently about the advantages and disadvantages of treatment is just as important as strict regulation of advertising for these drugs. There should be stricter regulations on the extent to which such things can be advertised on social media so that the impression is not created that it is a harmless thing that only brings benefits. In particular, care should be taken to ensure that the availability of medicines is fair and independent of social status.
Overall, it is clear that the diabetes injection can be a promising tool in the fight against obesity and diabetes, but only if it is used carefully and responsibly. The balance between the potential benefits and the possible risks must be carefully weighed to ensure that the health and well-being of the patient is paramount.
Summary
The new diabetes injections such as Ozempic and Wegovy represent a significant advance in the treatment of type 2 diabetes and at the same time have a remarkable effect on weight loss. These drugs, manufactured by Novo Nordisk, bind to GLP-1 receptors in the body and promote insulin secretion, thereby improving blood glucose control and reducing hunger.
The GLP-1 drugs have been shown to be effective in controlling blood sugar and regulating appetite, making them suitable for type 2 diabetes. However, the dual function has significantly increased the demand for these drugs, which has significantly increased the commercial importance of these drugs. As the market for diabetes drugs is expected to grow to 100 billion euros by 2030, it can be assumed that demand will also increase. Novo Nordisk will make considerable profits from these drugs, which raises the question of how to deal with them.
In addition to the health benefits, there are also side effects and challenges. Although the drugs are primarily approved for the treatment of diabetes, they are often prescribed off-label for weight loss, which leads to supply bottlenecks. It should also be noted that in Germany these medications are only available on prescription, whereas in the USA they are easier to obtain.
The cultural impact is also significant. Influencers and celebrities are promoting these drugs as miracle weight loss cures, which has led to increased demand and global supply shortages. Not to mention the long-term effects and side effects, as the drugs are still relatively new to the market.
In summary, GLP-1 injections play an important role in modern diabetes treatment and have both positive and negative effects on society and the economy. However, the long-term effects of these drugs remain to be seen.
Sources
Chapter 2.1
https://idf.org/about-diabetes/diabetes-facts-figures/ (08.05.2024)
https://ourworldindata.org/obesity#all-charts (08.05.2024)
https://diabetesatlas.org/data/en/world/ (08.05.2024)
Chapter 2.2
Financial results and events overview - Novo Nordisk 2017-2024 Q1
https://www.catalent.com/catalent-news/novo-holdings-to-acquire-catalent/
https://companiesmarketcap.com/novo-nordisk/marketcap/#google_vignette
Chapter 2.3
https://www.imf.org/en/Home (08.05.2024)
https://companiesmarketcap.com/novo-nordisk/marketcap/#google_vignette
https://fortune.com/europe/2024/03/05/novo-nordisks-wegovy-and-ozempic-boom-saved-denmarks-gdp-from-a-no-growth-2023/ (09.05.2024)
Chapter 4.1
https://investor.lilly.com/ 2022-2024 Q1
Financial results and events overview - Novo Nordisk 2017-2024 Q1
https://www.healthline.com/health-news/heres-how-much-more-ozempic-costs-in-the-u-s-compared-to-other-countries# (09.05.2024)
https://www.msci.com/www/fact-sheet/msci-world-health-care-index/08721816
Chapter 4.2
Financial results and events overview - Novo Nordisk 2017-2024 Q1
https://www.novonordisk.com/investors/stock-information/share-and-ownership-structure.html
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