The pathophysiology is unclear, but risk factors are thought to be the same as the type 1 diabetic patients who rapidly improved A1c in the Diabetes Control and Complications Trial: long duration of diabetes mellitus, long duration of poor glycemic control, worse baseline level of DR prior to treatment and magnitude of reduction in A1c after treatment
Thakur U, Bhansali A, Gupta R, Rastogi A
However, Morgan Stanley Research analysis of such markets as Brazil and China suggests these barriers could diminish with the introduction of oral therapies, broader insurance coverage and the eventual entry of generics
These molecules are more resistant to degradation by DPP-4, which results in a prolonged half-life in comparison with endogenous GLP-1
For further details on proglucagon processing see the reviews by Holst (51) and Muller et al (78)
Based on analysis of employer experiences, vendor data, and expert interviews, PHTI outlines five key recommendations for employers: Establish clear, clinically driven eligibility pathways for GLP-1 coverage Require participation in behavior, nutrition, or lifestyle change programs as a condition of coverage Provide structured support for employees who choose to taper or discontinue GLP-1 therapy Review existing vendor capabilities before adding additional point solutions Contract with vendors to drive outcomes while examining overall program costs The report identifies three critical phases where these solutions can support employers in managing their GLP-1 coverage: Initiation: Providing targeted GLP-1 coverage using clinical criteria, behavioral or AI-based screening, narrow prescribing networks, or step-therapy pathways that include lower-cost alternatives or lifestyle change programs
