CEimpact Podcast

GLP-1s - Is There Anything They Can't Do?

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GLP-1 receptor agonists are revolutionizing healthcare, offering benefits far beyond glucose management—from weight loss to potential improvements in sleep apnea and cardiovascular health. This episode explores the multifaceted roles of GLP-1s, the latest evidence behind their expanding uses, and what pharmacists need to know to maximize their impact. Don’t miss this chance to stay informed on one of the most versatile classes of medications shaping patient care today!

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
John Swegle, PharmD
Clinical Associate Professor
University of Iowa College of Pharmacy

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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe the diverse therapeutic applications of GLP-1 receptor agonists, including their roles in glucose management, weight loss, and other emerging uses.
2. Identify key considerations for pharmacists in optimizing GLP-1 therapy to improve patient outcomes across various conditions.

0.05 CEU/0.5 Hr
UAN: 0107-0000-25-074-H01-P
Initial release date: 3/17/2025
Expiration date: 3/17/2026
Additional CPE details can be found here.

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Speaker 1:

Hey, ce Impact subscribers, Welcome to the Game Changers Clinical Conversations podcast. I'm your host, josh Kinsey, and, as always, I'm super excited about our conversation today. Glp-1 receptor agonists are redefining what a single medication can do, offering benefits that extend far beyond diabetes management. In this episode, we'll explore how these versatile therapies are transforming care for conditions like obesity, cardiovascular disease and even sleep apnea, and we'll talk about what pharmacists need to know to help patients get the most from these game-changing medications. It's so great to have our guest with us today, john Swegel. Thank you so much for joining us. We really appreciate you taking time out of your busy schedule to join us today.

Speaker 2:

Absolutely, Josh. I'm happy to be here.

Speaker 1:

So, for our learners who may not be familiar with you, if you want to take just a couple minutes to introduce yourself, give us a little bit about your background, your current role and practice side, and maybe why GLP-1s interest you so much to do this talk today.

Speaker 2:

Absolutely Happy to do so. Yeah, so I'm John Swegal and I've been a pharmacist now for gee, it was over 30 years, I think Started out my career back in the early 90s after I graduated from Drake University. I was in the community setting for a couple of years and then I elected to go back to school and I got my PharmD from the University of Iowa and I also did a residency down there in family medicine, which led me to the position that I've been in for the past 27, 28 years now so.

Speaker 2:

I am actually, it's sort of a dual role. It's a very intriguing role, so I on paper and I guess, in person too.

Speaker 2:

I'm a faculty, at the University of Iowa College of Pharmacy. I'm an associate professor in the clinical track there and I practice my practice site's actually in a family medicine residency program. So I am up in Mason City, iowa, and the fun part about my job, josh, is that I get to work with physicians every single day in the inpatient setting. We also work with them in the clinic. I work with them at the nursing home. We do rounds in all those different areas. I also work a little bit with hospice, a little bit with palliative, and so it's kind of a jack of all trades, master of none, and I think that's kind of what you get with family medicine anyway which kind of?

Speaker 2:

leads us then to the GLPs. You know why the interest in the GLP-1s? And I've always been intrigued with new medications that come out from a mechanism standpoint, and certainly when these came out, you know we're like, wow, all this came from the HeLa monster. That's kind of cool and so, but they've impacted so many, so many disease states, aside from, you know, just diabetes, and that is extremely intriguing to me. And so that's kind of why I have an interest, I guess, in the GOP ones.

Speaker 1:

Awesome, yeah, that's great, that's great. I remember, you know, first hearing about them you mentioned the Gila monster and all that and just thinking how absurd it was and oh, these aren't going to be like there's going to be a downfall of some sort, you know right, because it just sounds too good to be true. But I mean, as we've seen, they continue just to be pushing the envelope and really just kind of changing practice. So so, yeah, that's why we're going to talk about today. I always like to set a foundational stage for listeners, so in case they are, you know, maybe not in certain practice settings, they don't see GLP-1 often I just want to set the stage and make sure everybody's on the same page as we move forward. So let's do a little brief overview of what exactly is a GLP-1 receptor agonist, maybe their mechanism of action and kind of, as we mentioned, their initial role, which was in diabetes management.

Speaker 2:

Absolutely. So you know I mentioned the Gila monster and people probably know this, but I'll just reiterate it. So you know it's interesting that the venom of the Gila monster has this thing called Xenon-4, which is very, very similar to GLP-1s in humans. We endogenously secrete GLP-1 when we eat food and things like that. But like a lot of venoms, you can't just give venom to people, so you have to analyze all these different aspects of it and research. Actually this is.

Speaker 2:

It's always intriguing to me how long it takes for you discover something to get to market. And so this idea of a synthetic version of Xenon 4, which was called Xanatide so fancy naming there that first developed really back in the early 1990s, but it wasn't FDA approved until 2005. So it took a while to process and I think all of us understand that, but the concept is very interesting. So when we as humans ingest food, there are some incretin hormones is what they call them that are released, and so GLP is one of those. And then you have another one, the glucose dependent insulinotropic polypeptide, or GIP, that is also released, and those are found in the gut and when those are released they stimulate then the release of insulin from the pancreas in response to that oral glucose load, and so you might. You know some of the listeners might've heard of this thing called the incretin effect, and what that means basically is that you get secretion of these hormones when you ingest things orally. You don't get the same effect when you get dextrose through an IV, for example.

Speaker 2:

So in healthy individuals, these are secreted at the same time, and then that basically accounts for a lot of the insulin secretion, and that's what's known, really, as the incretin effect. So the glp ones, um, you know, they came out, uh goodness. So the first one was approved in 2005, and, and it wasn't too long after that that we had other uh medication classes that hit the market. Uh, one is the dpp4 inhibitors, which, interestingly enough, dpp4 is what breaks down glp11. And so the concept, of course, is you delay breakdown of that to allow the endogenous GLP to have more of an effect. And so originally, they didn't think the GIP did anything, but lo and behold, they found, with the drug called tersepidide or Mongero, that actually it does have an effect. So, really, what did GLP-1s do? Okay, right, that's always the question that mechanistically, there's a number of things.

Speaker 2:

And so from from a diabetes standpoint, it's that insulinotropic effect and that's really their main effect.

Speaker 2:

So they stimulate the glucose dependent insulin biosynthesis and release essentially is what they do, and so by doing so it sort of restores insulin response to a near normal level with meals for people that don't have diabetes.

Speaker 2:

They also inhibit the post-meal glucagon release, which is also very, very important, and so that, along with that insulinotropic effect, are the main things that they do from a diabetes standpoint, and they found early on that people are like I feel kind of full, I don't know why, but I don't want to eat anymore, and that's because they have effects on promoting early satiety, and they do that predominantly through delayed gastric emptying, which can be problematic in some patients. But that's another one of their mechanisms metabolism, and they are known we'll talk about this here, josh, in a little bit but they're known to have cardiovascular effects, beneficial effects on blood pressure, beneficial effects on lipids, help with endothelial function, it can help with weight loss, which obviously is also part of the whole cardiovascular picture. But they do cause a slight increase in heart rate as well and that's one of the other effects that they may have. But those are the main things that they do, but from a diabetes standpoint, it's those top two that I had mentioned earlier as to why we use them in diabetes.

Speaker 1:

Okay, wow, that's a great review. Thank you. I felt like I just sat through a really in-depth review of those I needed. That that's perfect. So let's talk a little bit about. You kind of touched on this, but let's go ahead and jump into it. Obviously, they are expanding the use of them and, whether it be off-label or actually approved, they are treating more than just diabetes now. So let's talk a little bit about kind of what's come into play there.

Speaker 2:

Yeah, for sure. You know it's interesting. I don't want to skip over the what they're approved for. And the reason I bring this up is because and the listeners will get more about the standards of care from the ADA, and you know listeners know that they come out every year, right.

Speaker 2:

So, the ADA changed how they approach type two diabetes from a pharmacologic standpoint. You know it used to be. If you have type 2 diabetes and you're not symptomatic, you're not in the hospital, you don't require insulin. Foundational med was metformin, right. That's changed. Now they're asking people what's your goal? So if you have a goal of looking at cardiovascular and kidney disease risk reduction, then you're looking at GLPs or SGLT2s or the other big goal they ask is are you looking about, you know, weight maintenance and trying to get good glycemic control? So those are the two big categories and I'm not taking anything away from the SGLT2 inhibitors. But GLPs fit a lot of those roles and we'll talk about those. Clearly they work in diabetes, they clearly work on lowering blood glucose, and so we certainly use them when we can, especially in those who are overweight. So then what about weight loss? Right? I mean we have. You know it's funny because a lot of drugs they come out and they get used for one thing, but then you find out they have another indication that they work for.

Speaker 2:

And that's the same thing that happened. People, because of that promotion of early satiety, people started losing weight, and so that then led to approval. So we essentially have three medications that kind of fit into this category. So the first one is semaglutide, right, so semaglutide which is ozempic for diabetes but it's wagovi for weight loss. We also have loraglutide, which is saxenda for weight loss but it's victoza for diabetes. And then we have the big one, and I shouldn't use that term, but point is, we have trisepatide, which is a GLP-GIP agonist, and that one is the Mongero. Okay, so they work. Now, of those three, from a weight loss standpoint, um, the use of liraglutide is probably the least effective of those.

Speaker 1:

Okay.

Speaker 2:

Only maybe about an eight percent reduction um in in weight, which is still pretty good compared to some of the other ones. We've passed um semaglutide's better uh semaglutide's probably in the 14 15, but then you get to terzepatide. You can get up north of of 20 percent uh reduction in weight and so clearly they're useful in that category and that also, you know, is FDA approved. And I've had questions before what about the other ones? Like what about ribelsis, the oral formulation of some maglutine? They've not. You know it doesn't really work as well for weight loss and it's not that people can't lose weight with taking that, it's just it's not as good.

Speaker 2:

And so not as effective, not as effective. Then you have this big role, this whole concept of clinical ASCBD, the atherosclerotic cardiovascular disease. These GLPs are all approved for reducing the risk of what they call major adverse cardiovascular events or MACE, and that's really a composite of stroke, mi and cardiovascular death, and they're approved for those people with diabetes and established CBD. But they also are being used in people who have obesity and ASCVD or even risk factors for that, and there's tons of studies out there on this. I mean you have the SELECT trial, the Pioneer, sustain later. There's tons of studies out there and the overall reduction is about 12 to 14% in those major adverse cardiovascular events. So they do know that they help to. You know mechanistically, what do they do? Well, they obviously help with the weight loss, which helps, right. But they have effects on improving endothelial health, reducing the oxidative stress that happens, decreasing inflammatory signaling. There's numerous mechanisms that they have to help reduce some of those things that happen. Then you have newer things.

Speaker 2:

So the role in CKD. What is the role in chronic kidney disease? Now, historically? I mean Cadego came out with guidelines last year but historically the role in CKD from a medication standpoint have been the SGLT2 inhibitors. There's tons of data on SGLT2s and slowing progression of CKD. Obviously, you know about ACE and ARBs, obviously know about finarinone, but the SGLT2s had that market until last year when they thought, hey, do the GLPs also show the same benefit? And the trial that came out last year was called the FLOW trial and that was with some eglutide, surprisingly. And that one showed that, yeah, some eglutide can help reduce the risk of chronic kidney disease progression. And of one showed that, yeah, semaglutide can help reduce the risk of chronic kidney disease progression. And of course you know a bulk of that was really from its reduction in cardiovascular death, which is known that they can do that.

Speaker 2:

The caveat is is that we only have approval of semaglutide or ozempic in patients with diabetes, so we don't know if they have the same benefit in those who do not have diabetes. And then you had mentioned, at the top of the hour, so to speak, this whole thing of sleep apnea. And trisepatide recently just got FDA approval actually in December of 24, for the treatment of severe obstructive sleep apnea in adults with obesity. So those are the approved indications, right? So what about the new stuff? What about?

Speaker 1:

the stuff that people are like oh, do these drugs actually work? Dr Justin Marchegiani yeah, Dr Tim.

Speaker 2:

Jackson, when can we expand this? And so one of the interesting indications that are out there and some of these have, I would say, more data than others, and so I want the listeners to keep that in mind but one of the ones that's out there is this non-alcoholic fatty liver disease, which technically now is this metabolic dysfunction associated steatototic liver disease, or MASLD that's the new terminology for it. But the GOPs are very promising in helping to reverse the effects of that. And now it's all part of an approach, right. The primary approach for management of the MASLD, in addition to abstaining from alcohol, that sort of thing, is weight loss, right. So obviously weight does tie into that. But they also think that the GLPs may have direct effects on the liver as well, to halt and even, you know, reverse some of the effects of this. So that's a big area Okay.

Speaker 1:

Yeah.

Speaker 2:

And then it's kind of funny. I shouldn't laugh about this the idea of can it help with cognitive function, I mean that's a huge thing that's out there and there's this concept out there of brain insulin resistance. You know, and I honestly, josh, some days I think I have brain insulin resistance. I can't quite think as clearly as I want to.

Speaker 2:

Sure foggy brain, yep, exactly exactly, but the theory is is that the brain can't utilize glucose because of this insulin resistance and that then leads to inflammation and deposits of plaques and tangles and that sort of thing. We know that diabetes is a risk factor for dementia, right? We know that that's out there. So theoretically, then, this pro-inflammatory state can then contribute to more development of dementia. So there's two areas that they looked at. Okay, so one is Alzheimer's disease and the other one is Parkinson's disease.

Speaker 1:

And.

Speaker 2:

Parkinson's is a little bit different. You obviously can get a dementia secondary to Parkinson's. I don't know of any data so far in Lewy body dementias but with Parkinson's disease it is thought that the GLPs can help, at least theorize, to help decrease the degeneration of dopaminergic neurons and maybe help them with improvement in motor function, which all of us have seen people with Parkinson's disease, especially toward the end of that disease state, motor function is a big, big problem and difficult to treat.

Speaker 2:

Absolutely so. Parkinson's, I I think, is a very promising area, uh, for these gops. But the big one and and this is so alzheimer's disease, right, huge, huge disease state affects millions of people. The projections are going to get worse moving ahead. So this whole idea of insulin resistance and the concept of, you know, depositions of amyloid plaques, the tau protein tangles, that sort of thing in the brain, okay, can we reverse or at least slow down progression of that? I?

Speaker 2:

think that's what they're looking at Because we know again theoretically that the use of GOPs can help reduce that brain insulin resistance and maybe reduce these pro-inflammatory things. But if you already have those plaques and tangles developed then I don't know if these drugs are going to help with that, and so the theory is maybe get it earlier, and so the theory is maybe get it earlier.

Speaker 2:

And it's interesting because if you look at like like aducanumab lacanumab, well, aducanumab's gone but lacanumab. Lacanumab does reverse those plaques, but the cognitive changes are really not that pronounced. So where this is going to fit I don't know, but it's very, very intriguing.

Speaker 1:

Yeah, yeah, that's. I mean, that's way more than I've even ever heard. So thank you for going into the greater detail of you know kind of what's on the horizon, because clearly we hear of the things that are happening currently. But I also think it's important to note that and correct me if I'm summarizing it incorrectly. But it's important to note that it's more than just the weight loss, like it actually affects other things, like you said with the endothelial line, like just there's several other things that it can do that's actually affecting the disease states, more so than just the fact that, oh well, they're losing weight. So that's why it works in that.

Speaker 1:

So I think it makes it even more of a wonder drug that we're talking about here, because it has it has, it's more than a one hit wonder, right? So it has, it has multiple mechanisms and everything. So, yeah, that's great. Okay, well, that's a great foundation. So thank you for reminding us of exactly what what they are and how they work, and then also talking about the current I guess studies that are happening surrounding GLP-1s. It's super helpful. So let's talk a little bit about some opportunities for our pharmacists, our listeners. What are some of the things that they can do to help increase access, increase utilization, talking about educating the patients so that they're aware of what side effects are coming and how to overcome those. So let's talk a little bit about what are some of those opportunities for pharmacists to get involved in this space, more so than just, obviously, the dispensing of them. We always like to be sure that we are the medication experts, so let's dive into that just a little bit.

Speaker 2:

Yeah, absolutely so. I mean, let's be honest, everybody knows about these drugs. It seems like Patients, physicians, providers, pharmacists everybody knows about these drugs, so they're everywhere and so I think you know pharmacists can have an integral role in well, first of all, helping to educate patients.

Speaker 2:

I'll be upfront with you, josh. I mean, are they wonder drugs? I don't know. I think it's a bit premature. I know there's a lot of data coming out on that, but I think pharmacists can help you know kind of real patients in on, really, what are the realistic expectations from?

Speaker 1:

these medications.

Speaker 2:

And you know this too. Every medication that's taken, there's always risk, even though you don't hear about. You tend to hear about the glorified benefits of a medication, but you know the listeners know this too. I mean, you watch any drug ad. Everyone looks like they're happy this, that and the other and then you have the legal disclaimers at the end with all the different ever since. And these are no different. These are no different.

Speaker 2:

So yeah, so it's, there's going to be a demand and and patients are going to come into pharmacies and talk to the pharmacist and say you know, what about this drug, what about that drug? And I just I think that, from an educational standpoint, letting patients know that, well, there's there's a number of barriers, I think, to getting them, which we'll get into here in just a bit.

Speaker 2:

But, I think the biggest selling point that I would say from an educational standpoint is saying yes, they can work. They're not without risks and you know, there's still a lot of studies that need to be done before we can broaden to all these different indications or potential uses that are out there.

Speaker 1:

Mm-hmm, mm-hmm. Yeah, and it's not without the side effects that are sometimes rate limiting, and so I think again. People think, oh, wow, I'm gonna lose all this weight, but they don't realize that there are some intolerable potential side effects that may prevent someone from staying on it, or at least staying on it long term.

Speaker 2:

So yeah, absolutely, I mean, and the big one that we think about. So you know, from a side effect standpoint, if you're educating a patient about that, the number one thing they're going to notice right away is the GI adverse effects. And so you know nausea, vomiting, diarrhea, and so we try to. You know that's why we have the dosing scheme of starting low and then slowly increasing to help minimize that.

Speaker 2:

And that's also why the weekly versions hopefully have less of that. But the other side effect that you know patients may experience are the injection site reactions, which generally are mild and transient, so we don't worry too much about that. But then you get into the less frequently encountered but somewhat potentially problematic so one of which is risk of hypoglycemia. Is there a risk of hypoglycemia? When used by themselves, it's extremely low, obviously, and used in combination with things like sulfonylureas, which we don't use that much anymore.

Speaker 2:

But certainly insulins, then certainly that could be there. But the stuff you hear about so like pancreatitis, so do they actually increase the risk of developing pancreatitis? And I think the jury's still out on that. It's unclear if this is a causal relationship or not. It's clearly an association, but there are some meta-analyses out there that are not finding an association. So but I think if somebody has a history of pancreatitis or you have patients that have chronic pancreatitis, I'd probably not be, you know, using these medications out of the gate.

Speaker 2:

The other big one is this whole thing about thyroid cancer, and so there's certainly warnings in there about thyroid cancer, mainly from animal models, but nonetheless, you know people are concerned about that and so it is contraindicated if you have a personal or family history of medullary thyroid cancer, which is the least common form of thyroid cancer. So you know papillary is 80% of your thyroid cancers, so medullary is veryestasis choleothiasis, mormon Association. Stuff that's really heading the press right now is this concept about risk of an ileus and also risk of bowel obstructions, and more recently they came out with risks of aspiration pneumonia.

Speaker 2:

So people that are going in for elective procedures undergoing anesthesia, they always tell you you know fasting the night before. Well, because these things slow down GI peristalsis, you might have a risk of aspiration, because you still have contents there Wow.

Speaker 1:

I have not even made that connection.

Speaker 2:

I've heard that it's a new warning that's out there, yeah, yeah.

Speaker 1:

Yeah, okay, interesting. But one of the things I was going to mention too is you know the talk that's out there, obviously is it when you go off of them. If you're taking them for, you know, weight loss or whatnot, then is the, is there that rebound effect and is it just you know, did you go through all of that for nothing and whatever? So I think that's something else to kind of consider as well is that it has to be more than just the medication is doing, that. There have to be lifestyle changes, there have to be changes to, you know, diet and health and exercise and so forth to kind of couple with that.

Speaker 2:

So I agree, you know. It's interesting. You mentioned that, josh, because and I'm old enough to know kind of lived through this too, but and I'm old enough to know, kind of lived through this too, but years and years and years ago there was a study done by Michael Weintraub back when the FEN-FEN trial. I don't know if you ever heard of that one, so fenfluramine, dexamethylamine or fentramine, excuse me.

Speaker 2:

And so what they found with that is that because we treat obesity as if it's not a chronic disease which it is a chronic disease and so you know any of these medications that you use, they do require, as you had mentioned, you have to have lifestyle modifications to go along with it. But the study that they did back in the late eighties, early nineties they kept people on fen-phen for for five years and only 5% of the population maintained their weight loss 5%, that's it. So we don't know, because I think that some of these are too new. If you go off of these, do you get the same rebound? Theoretically, yes, I've been around obesity and seen many, many treatments, even surgeries over time If patients don't make those changes in lifestyle, then it reverts.

Speaker 2:

It's going to go back. And that's an important thing to keep in mind, Absolutely yeah for sure.

Speaker 1:

So we've touched on a little bit and before we run out of time, I want to just talk briefly about the challenges. So we talked about how access and affordability not just the fact that there are shortages how access and affordability not just the fact that there are shortages, but access, you know, insurance may or may not cover, only certain ones might be covered based on true FDA indication, you know, whatever. So our true FDA approval. So what are just kind of briefly touch on the access issue. How can pharmacists kind of help with that?

Speaker 2:

Yeah, for sure. You know access is a problem and none of us have control over supply, supply and demand, and manufacturers, of course, are not going to have a whole lot of surplus because they don't want that right, because it can be utilized. So I think one of the challenges that we run into I know my clinic would do is that you know that getting prior authorization is one barrier as you had mentioned.

Speaker 2:

On the pharmacy end, though, the one that pops up the most, and we hear about it too, is what about compounded versions of this? And I mean, I get it If you either cannot afford one of these agents or you can't find it and you you have people that are sending you things about. What about a compounded version of ozempic? Um, you know the fda came out with concerns about unapproved gop drugs used for weight loss in particular. Uh and uh. I think that you know pharmacists need to understand the compounding part of it. If you are a compounding pharmacist and doing this, I'm not going to say don't do it, but I'd be cautious for people just to go out to any compounding pharmacy and obtain a cheaper version or a version that can be shipped to them. There's no worry about supply because there are some adverse effects that have been reported of the FDA from compounded medications. Know some adverse effects that have been reported, the FDA from compounded medications? There's adverse effects from commercially made medications.

Speaker 1:

Absolutely.

Speaker 2:

But compounding is one avenue I know that people are starting to utilize. I would discourage patients. This kind of gets back to education, but certainly discourage patients from obtaining these medications without having a provider prescription for it. I mean, don't just go to some random website and get stuck over that Dr. Andy Roark Right, it needs a relationship with the provider.

Speaker 1:

Yeah, for sure, dr Andy Roark.

Speaker 2:

Absolutely.

Speaker 1:

Dr Andy Roark and I would even go further and say I would hope you have a relationship with the pharmacy that you're obtaining it from as well, more so than just you're the next number in the batch and they're shipping it to you, kind of thing.

Speaker 2:

Yeah, absolutely 100% agree.

Speaker 1:

One thing I'll approach and I feel like this could take us down a rabbit hole and or its own whole podcast episode on it, but you know I think I'd be remiss if we didn't talk briefly about it the ethical consideration of. You know I have a short supply. I have patients who have diabetes that these are quote unquote life-saving medications for, and then I have someone who's, you know, elected to do this for weight loss. Any thoughts on that? I know, you know it's an it's mostly an ethical issue, so there's no right or wrong answer per se, but any guidance that we can give to pharmacists as they're trying to manage the release of these medications, you know, like the dispensing of them.

Speaker 2:

Yeah, for sure. So I would go back to FDA-approved indications. You're right, this is an ethical thing and everyone will have differing opinions on this. My bias is, if you have known, cardiovascular disease and diabetes you should be on these. If you have known obesity and cardiovascular disease, you should be on these agents. I would give preference to those, versus somebody who, perhaps you know, has a BMI of 32. They want to get something to jumpstart it. Not that obesity is something to take lightly. I'm not saying that.

Speaker 1:

For sure, for sure.

Speaker 2:

But, that being said, you can have and there's good evidence on the benefits on reducing those major adverse cardiovascular events. And so that would be a patient population I would focus on for sure.

Speaker 1:

Yeah, that's great. That's great advice. Well, as with every episode, I'm always shocked how the time goes by so quickly. I think we're going to have to start upping these to 60 minutes so I can continue to learn about things. But yeah, so that's pretty much our time for today. But before we wrap up, I always like to kind of come back to give the speaker a chance to talk about how. You know, what's the game changing thing here? Right, it's the name of our episode. We always like to kind of bring it back to that, so summarize and share with our listeners. You know, what's the take home from this? What is the game changing?

Speaker 2:

topic. Yeah, I think you know honestly, josh, you and I talked earlier and I honestly think that the biggest game changer is where are these drugs going to stop for what they can be used?

Speaker 1:

for.

Speaker 2:

More and more data is coming out on beneficial effects and disease states that I don't think we ever thought that they would work in. Yeah, they would work in absolutely, and so I don't know where it's going to end, um, but I think that's the biggest thing is where is it going to stop you? Know what other indications will these be approved for? Or used for uh moving down the road. I think that's the biggest take-home message from a game-changing standpoint.

Speaker 1:

Standpoint yeah, and logically, if you're looking at, okay, yes, they can be used for obesity because we saw that they cause weight loss. Yes, they can be used for sleep apnea because of the weight loss and the cardiovascular benefits and whatever. But I think, like you said, the ones that came out of left field are the Parkinson's or the Alzheimer's, like that's just looking at it and saying, okay, they've been approved and used for these things, but also maybe this way over here, you know that they might treat.

Speaker 1:

So, yeah, I'm with you. It sounds like the game changing thing here is maybe we haven't even seen it yet. There might even be something bigger that they're going to do that these medications are going to do.

Speaker 2:

Who knows? I will tell.

Speaker 1:

Yeah Well, John, thanks so much. I really appreciate you taking time out of your schedule and spending it with us to talk about GLP-1s. This was super, super interesting and very helpful. Thank you.

Speaker 2:

Absolutely, josh. It's my pleasure. I'm always happy to be on the Game Changers podcast and thank you for inviting me. And so, yeah, happy to do it, happy to do it.

Speaker 1:

Awesome, thank you. If you're a CE Plan subscriber, be sure to claim your CE credit for this episode of Game Changers by logging in at CEimpactcom and, as always, have a great week and keep learning. I can't wait to dig into another game-changing topic with you all next week.