Dear Dr. Roach: I have Type 2 diabetes. My BMI is 29. My last A1C was 8.4%. I currently take metformin and glipizide. I’ve asked my doctor about the new medications, like Ozempic and Mounjaro, but he is reluctant to prescribe them. The past two times we’ve discussed it, he talked me out of it, saying that I’d have to take it the rest of my life. He also said that if I stopped taking it, the weight will come back on.
I have been overweight all my life, and it is difficult for me to get the weight off. What’s the difference between taking Mounjaro or Ozempic for the rest of my life or metformin and glipizide for the rest of my life?
Also, my friend who is a registered nurse says that it will ruin my kidneys and liver, and he is against taking these drugs. He said he knows someone who had to go on dialysis after taking Mounjaro. If these drugs could help me get the weight off and keep it off while getting my A1C down, why not take them?
R.B.
I am cautious about prescribing semaglutide for weight loss. (When prescribed for diabetes, the brand name for semaglutide is Ozempic, but for weight loss, it’s Mounjaro.) However, there are clearly people for whom it is a great benefit, although it is likely to be a lifelong medication. It is indicated for weight loss by the Food and Drug Administration in people with a BMI over 30.
For treatment of diabetes, I have much less hesitation. It sounds like you want to use it mostly for diabetes, but the weight loss would be an added benefit. The data in people with diabetes show that compared to medicines like glipizide, medicines like semaglutide have significant benefit. They reduce the risk of heart attack by 20% and the risk of overall death by about 33%. Unlike what your nurse friend said, there is no evidence of damage to the kidneys or liver by semaglutide or similar drugs.
Since there is strong evidence for improvement in critically important areas (by living longer and avoiding heart disease), a medicine like semaglutide is likely to give you a large benefit.
Dear Dr. Roach: I developed a blood clot in my left leg in 2019 after a brief hospital stay. I have never had any before and have had no new ones since. Testing every six months shows that my clot is calcified in place. All my doctors say that it is not moving. It is not going anywhere or breaking off, and I shouldn’t still be taking warfarin five years later.
My hematologist said that I would have to be on it for life, but I haven’t seen him since. I would like to get off of it, since I’m more worried about bleeding out than I am about having the clot move to my lungs.
N.G.
I don’t know why your hematologist recommended lifelong treatment. Normally, when there is a transient reason for a clot, such as a hospital admission or a surgery, anticoagulation by warfarin continues for three to six months in a person with no risk factors, such as a genetic predisposition or active cancer.
In someone with recurrent blood clots, especially if they are life-threatening, or in someone who is otherwise at a high risk, then lifelong treatment is considered. Getting imaging of the blood clot is not particularly helpful in a person without symptoms of a new clot.
I would ask your primary doctor whether you can stop anticoagulation, and if they aren’t willing to commit, a visit with the hematologist would be indicated.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
