'Long-term harm' for diabetics unable to access medication

Diabetes patients could face avoidable liver transplants due to the shortage of a life-altering drug.

Diabetes patients could need liver transplants down the line due to the shortage of an life-altering drug.

Type 2 diabetics are being left in “dire straits” due to a critical shortage of the drug Ozempic, resulting in patients potentially requiring otherwise-preventable liver and kidney transplants, a top endocrinologist has revealed.

Ozempic, a once-weekly injectable diabetes drug, has been in scarce supply since April due to “increased global demand” after it gained huge popularity on TikTok as an effective weight-loss treatment.

While doctors prescribed a replacement drug, Trulicity, to fill the gap, it has become almost impossible to locate and will be in short supply until next year, according to the Therapeutic Goods Administration (TGA).

Head of Endocrinology at Nepean Hospital Dr Kathryn Williams, who also leads a Nepean lifespan obesity service, said the lack of Ozempic means “poorer quality of life” for her patients while their ”diabetes complications get much worse”.

“We're really actually in dire straits for the patients I’m treating in ... greater Western Sydney,” she said. "Even if we got them back on track in a year or two, there could potentially be long-lasting harm due to the ... temporary cessation (of the drugs)”.

Australian doctors have long been prescribing Ozempic off-label as an effective drug for weight management due to what they say are a lack of accessible and affordable therapies for obesity. 

Last week, drug manufacturer Novo Nordisk advised the TGA Ozempic wouldn't be available in Australia until early 2023. The TGA have urged doctors to prioritise any supply of the drug for type 2 diabetics since it first ran out. 

Dr Williams said one 50-year-old patient with a young child, who has diabetes and significant liver and kidney disease had “managed to go from very poor sugar control to very good sugar control” on these medications and had lost 15kgs. But, as he was unable to source Ozempic or Trulicity for the last six weeks, he has regained 10kgs, his diabetes has become unmanageable and all the markers of severe liver and kidney disease are back.

“He could require a liver transplant or a kidney transplant down the track and we could prevent that by using these medications,” she said.

Another middle-aged patient, who is being considered for cardiac transplant, may be forced to go back on four-times-daily insulin injections, which Dr Williams said was “a scary thought for him”.

Dr Williams said there was “no equivalent medication” to Ozempic and Trulicity, adding that the "only other option” was the more-complex treatment, insulin.

Insulin involves checking sugars multiple times per day, and come with the risk of weight gain and sugar lows. The complications of sugar lows, which “can lead to serious harm”, don‘t exist with Ozempic and Trulicity.

Dr Williams said she often treated public patients with significant socioeconomic disadvantage, many medical and psychological issues and complex lives.

“For me, it's an absolute tragedy, actually, that we haven’t been able to get any of these medications for patients who have actually had their lives changed.”

“The burden on the healthcare system is greater as well because if you have to switch someone from these drugs to insulin, that's not easy,” she added.

National Pharmacy Guild of Australia President, Professor Trent Twomey, said the Ozempic shortage was “definitely a concern for our patients”.

“The original serious shortage notice that was released at the beginning of this calendar year said the shortage would be in place until Easter and that was in place until June and now they‘re saying the end of this year,” he said. ”I have very little confidence unfortunately that Ozempic will return to some form of normal supply by the end of this calendar year.”

Last week, the TGA approved a high-dose semaglutide like Ozempic called Wegovy, also made by Novo Nordisk, specifically for chronic weight management. The drug is not yet available in Australia and the drug company has not yet confirmed when it will be available.