Chapter 53
Obesity and Diabetes — 12
Beyond the issue of side effects, there is cost, which is high. In the United States, thirty days of Wegovy costs $1,350, although the company claims the copay for those with insurance only amounts to $25 per month out of pocket. The monthly tab is $147 in Canada and $93 in the United Kingdom. It has been pointed out the cost of making a month’s worth of these drugs is about $5.
The problem with the cost of these drugs, coupled with the potential need for lifelong duration, is that the people with the most to gain will likely be the least to derive the benefit—again, obesity is most common among people of color and low socioeconomic status. The likelihood of them having insurance that covers these drugs is quite low, no less access to physicians to get prescriptions. While the GLP-1 drugs have such formidable impact to promote health span, they may ultimately be viewed as the worst offender for taking health inequities in the United States to an unprecedented high.
EVEN WORSE THAN OBESITY
Diabesity is a portmanteau term coined in 1973 by Ethan Sims following experiments in overfeeding twenty-four prisoners, increasing their body weight by more than 20 percent, and noting their development of glucose intolerance and insulin resistance. Little did he know that term, over the subsequent half century, would come to refer to the twin pandemics of diabetes and obesity. While most people who have type 2 diabetes are obese, there are many holes in that relationship. Many thin people can develop this type of diabetes; most overweight or obese people do not. Why?
In the past two decades, the genetic underpinnings of type 2 diabetes have become clearer. “Type 2” is a mosaic of genes and pathways that include impaired insulin secretion, insulin resistance, abnormalities of insulin signaling or mutations in insulin receptors, pancreatic beta cell dysfunction, glucose transporter genes, and many more. It’s not simple. There’s considerable overlap from one person to the next, so we can’t break it down easily to type 3, 7, 10, and so on. So we’re stuck with this catchall of type 2. There is considerable heritability of type 2 diabetes that we can determine from a sample of a person’s saliva or blood, using a gene chip (array) or a genome sequence. Hundreds of common genome variants are collectively linked to the risk of people developing type 2 diabetes. One’s tally of these variants is known as a polygenic risk score, now validated across the main ancestries of European, African, Hispanic, and Asian.