GLP-1 Drugs: What an ER Doctor Wants You to Know

A patient came into my emergency room vomiting 10 times a day. It started two days after a semaglutide injection. They had just increased their dose, and when I asked why, they did not know. It was what the app told them to do. Ozempic, Wegovy, Mounjaro and the rest of the GLP-1 family are the biggest story in medicine right now, and the conversation around them is a mess. Half the internet treats them as a miracle. The other half treats them as poison. Neither is being straight with you. So in this episode I run these drugs through the same framework I use for every medication. What they are and how they work, what the evidence actually shows across diabetes, cardiovascular disease and weight, what the real side effects are and how common they are, and the one thing I want you to know as an emergency physician. I am Dr Adrian Cois, an Emergency Medicine physician and Assistant Professor. These drugs are a genuinely good tool for the right person. This episode is about using them properly. In this episode: ● How GLP-1 and GIP work in your body, and why the two drug classes are not interchangeable ● What the diabetes evidence shows, including the head-to-head trial data on HbA1c ● The cardiovascular result in 17,604 people without diabetes, and why it reframes the whole conversation ● How much weight loss the tirzepatide data actually show, and how that compares to surgery ● The real rate of discontinuation due to side effects, with the number from a large trial ● Why slowed gastric emptying is the mechanism rather than a side effect, and what that means before surgery ● The gastric ultrasound study that found food still in the stomach despite correct fasting ● Why muscle and fiber intake matter more on these drugs, not less ● What the weight regain data actually mean, and why the same thing happens after any diet ● The specific hazard with compounded and app-directed prescribing Resources and links ● Companion guide and full reference list: https://drcois.com/blog ● Listen on Spotify: https://open.spotify.com/show/5wKvs7C... ● Subscribe on YouTube: @dr_cois ● Watch first, the medication framework episode that is the hub for this series: How to Think About Any Medication Your Doc... ● Tell me in the comments which drug you want me to run through the framework next. Key papers ● Alfaris N, et al. GLP-1 single, dual, and triple receptor agonists for treating type 2 diabetes and obesity: a narrative review. eClinicalMedicine. 2024;75:102782. https://doi.org/10.1016/j.eclinm.2024... ● Ahmann AJ, et al. SUSTAIN 3: semaglutide versus exenatide ER in type 2 diabetes. Diabetes Care. 2018;41(2):258-266. https://doi.org/10.2337/dc17-0417 ● Lincoff AM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes (SELECT). N Engl J Med. 2023;389(24):2221-2232. https://doi.org/10.1056/NEJMoa2307563 ● Jastreboff AM, et al. Tirzepatide once weekly for the treatment of obesity (SURMOUNT-1). N Engl J Med. 2022;387(3):205-216. https://doi.org/10.1056/NEJMoa2206038 ● Nersessian RSF, et al. Residual gastric content and peri-operative semaglutide use assessed by gastric ultrasound. Anaesthesia. 2024;79(12):1317-1324. https://doi.org/10.1111/anae.16454 ● Rubino D, et al. Continued weekly semaglutide vs placebo on weight loss maintenance (STEP 4). JAMA. 2021;325(14):1414-1425. https://doi.org/10.1001/jama.2021.3224 ● Hartmann-Boyce J, et al. Behavioural weight loss programmes and weight change after programme end. BMJ. 2021;374:n1840. https://doi.org/10.1136/bmj.n1840 ● Sumithran P, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365(17):1597-1604. https://doi.org/10.1056/NEJMoa1105816 Disclosures I have no financial relationship with any product, company, laboratory, book or author mentioned in this episode. No affiliate links are used anywhere on this channel or at drcois.com. Disclaimer This video is for educational purposes only. It does not provide medical advice and does not establish a physician-patient relationship. Always consult a qualified clinician about your own health.