Often times there can be difficulty getting approval for the patient to use a GLP-1 analog and so the patient may miss a few days of the medication and possibly decide they don’t want to continue. I have gotten in the habit of ordering the medication from the pharmacy the same day that I give them their first month sample. This way the pharmacy can make sure they get the prescription ready before the patient actually needs it and if a prior authorization is needed I can make sure there is plenty of time for the process to occur….
I have found that having my patients come back after 30 days for a follow-up also improves their success. I will give them a glucose log sheet with selected before and after meal times to check glucose so they can see the benefit of taking the medication. In addition I will have them record what they eat for two meals a week so they can see themselves if they have decreased their food intake.
Many of my patients are looking for big weight loss from a GLP-1 analog and although this does occur in some patients I like to prepare them for the fact that some patients have no weight loss early in the course of the medication. I will point out their weight gain over the past couple of years and have them look at the steadiness of their weight while on the medication.
In addition I explain that since one of the features of the GLP-1 analog is the increase of first phase insulin release that they are now moving more glucose out of the blood stream and into the cells so that weight loss may not be occuring at this time due to their improving glucose levels and as they decrease their food intake the weight loss will likely begin. I also remind them that this is a medication for lowering glucose levels and the improvement in those levels is more important than possible weight loss.
I have found that my patients have done better on the once-a-day GLP-1 analog and have found that making it available to those who are on the twice a day version helps keep them on track.