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The American College of Physicians issued new guidelines for Type 2 diabetes treatment, which for the first time recommends the use of GLP-1s and another class of diabetes drugs called SGLT-2s alongside metformin, though this may exacerbate the ongoing drug shortages of several GLP-1s.

美国医师学会发布了新的2型糖尿病治疗指南，首次建议与二甲双胍一起使用GLP-1和另一类称为SGLT-2的糖尿病药物，尽管这可能会加剧几种GLP-1的持续药物短缺。

An Ozempic (semaglutide) injection pen is seen on a kitchen table.NurPhoto via Getty Images

厨房桌子上有一支Ozempic（semaglutide）注射笔。通过Getty Images拍摄NurPhoto

Key Facts

关键事实

GLP-1s are medications designed to manage obesity and Type 2 diabetes by interacting with the hunger part of the brain to suppress the appetite, and lowering blood sugar and A1C, while SGLT-2s lower blood sugar levels by preventing the kidneys from reabsorbing sugar that’s made by the body.

GLP-1是一种药物，旨在通过与大脑饥饿部分相互作用来抑制食欲，降低血糖和A1C，从而控制肥胖和2型糖尿病，而SGLT-2通过阻止肾脏重新吸收身体产生的糖来降低血糖水平。

The ACP recommends treating Type 2 diabetes using GLP-1 agonists to reduce the risk for all causes of death, major adverse cardiovascular events and stroke, and it recommends using SGLT-2s to reduce the risk for all causes of death, major adverse cardiovascular events, progression of chronic kidney disease and hospitalization due to congestive heart failure, according to a new study published in the Annals of Internal Medicine..

ACP建议使用GLP-1激动剂治疗2型糖尿病，以降低所有死亡原因、主要不良心血管事件和中风的风险，并建议使用SGLT-2s降低所有死亡原因、主要不良心血管事件、慢性肾病进展和充血性心力衰竭住院的风险，根据《内科年鉴》上发表的一项新研究。。

In the updated guidelines, the ACP also recommends against the use of DPP-4 inhibitors alongside metformin, because new evidence showed DPP-4s didn’t reduce disease or death.

在更新的指南中，ACP还建议不要将DPP-4抑制剂与二甲双胍一起使用，因为新的证据表明DPP-4s不能减少疾病或死亡。

However, the high costs of GLP-1s, which can go for upward of around $1,070, and SGLT-2s—the most common SGLT-2 costs around $650—may be a “significant barrier” in providing patients with access to treatment, according to an accompanying editorial by Fatima Zyed, an internal medicine doctor at Duke University’s Division of General Internal Medicine..

然而，杜克大学普通内科内科医师法蒂玛·齐耶德（Fatima Zyed）的一篇社论称，GLP-1s和SGLT-2s（最常见的SGLT-2）的高成本可能是为患者提供治疗的“重大障碍”，GLP-1s的价格可能高达1070美元左右，而SGLT-2s（最常见的SGLT-2）的价格约为650美元。。

This is an update to the ACP’s 2017 guidelines, which recommended physicians prescribe metformin to patients with Type 2 diabetes, and recommended the use of other diabetes drugs like SGLT-2s and DPP-4s as secondary medications to help improve high blood sugar.

这是ACP 2017年指南的更新，该指南建议医生为2型糖尿病患者开二甲双胍，并建议使用其他糖尿病药物，如SGLT-2s和DPP-4s作为辅助药物，以帮助改善高血糖。

Will This Affect The Supply Of Glp-1s?

这会影响Glp-1的供应吗？

Some GLP-1 medications are already in a shortage due to high demand. Though all doses of diabetes drug Ozempic are available, all doses of Nordisk’s weight loss drug Wegovy are in a shortage except for its highest dose, 2.4 milligrams. Nordisk hasn’t provided a timeframe for when the supply will improve.

由于需求旺盛，一些GLP-1药物已经短缺。虽然所有剂量的糖尿病药物Ozempic都有，但除最高剂量2.4毫克外，所有剂量的Nordisk减肥药Wegovy都短缺。Nordisk没有提供供应改善的时间表。

Nordisk told Forbes it will gradually increase supply of all doses of Wegovy throughout the rest of the year, and it said in its annual report it was thinking of ways to remove “bottlenecks” from the supply chain like by making disposable injection pens. All doses of Eli Lilly’s diabetes drug Mounjaro and its weight loss drug Zepbound—both contain the active ingredient tirzepatide—are in a shortage until at least the end of June, except for the 2.5 milligram doses, according to the Food and Drug Administration’s drug shortage database.

诺德告诉《福布斯》，它将在今年剩下的时间里逐步增加所有剂量的Wegovy的供应，并在其年度报告中表示，它正在考虑通过制造一次性注射笔等方式消除供应链中的“瓶颈”。根据美国食品和药物管理局的药物短缺数据库，所有剂量的礼来糖尿病药物Mounjaro及其减肥药物Zepbound都含有活性成分tirzepatide，但2.5毫克剂量除外。

The 2.5 milligram doses are the lowest dosage Lilly offers, and often the dose patients start on when they’re first prescribed the drugs. Patients typically stay on a dose for at least four weeks and then progress to the next-highest dose, but this may not be an option for some if the drugs are still in short supply.

2.5毫克的剂量是礼来提供的最低剂量，通常患者在第一次服用药物时就开始服用。患者通常会服用一剂药物至少四周，然后进展到下一个最高剂量，但如果药物仍然短缺，这可能不是一些患者的选择。

Lilly told NBC News it plans on opening a new manufacturing facility in North Carolina by the end of the year to help increase supply..

礼来告诉NBC新闻，它计划在年底前在北卡罗莱纳州开设一家新的制造工厂，以帮助增加供应。。

Big Number

大数字

38.4 million. That’s how many Americans had diabetes in 2021, totaling 11.6% of the population, according to data from the American Diabetes Association. Another 97.6 million over the age of 18 had prediabetes.

3840万。根据美国糖尿病协会的数据，2021年有多少美国人患有糖尿病，占总人口的11.6%。另有9760万18岁以上的人患有糖尿病前期。

Key Background

关键背景

Much research on the effects of GLP-1s on diabetes and weight loss has been conducted. During a 72-week trial, participants saw a “substantial and sustained reduction in body weight” by taking tirzepatide, regardless of the drug dosage, a 2022 study found. Participants taking semaglutide—the active ingredient in Ozempic and Wegovy—lost an average of 15% of their body fat, according to a 2021 study.

关于GLP-1对糖尿病和体重减轻的影响已经进行了大量研究。2022年的一项研究发现，在一项为期72周的试验中，参与者通过服用tirzepatide，无论药物剂量如何，都可以“显着且持续地减轻体重”。根据2021年的一项研究，服用semaglutide（Ozempic和Wegovy中的活性成分）的参与者平均减少了15%的体内脂肪。

German researchers found semaglutide offered improvements in blood sugar and weight loss for Type 2 diabetics after a six-month trial. Tirzepatide “robustly” improved blood glucose levels and aided in weight loss in patients with Type 2 diabetes, according to research published in JAMA Network Open..

德国研究人员发现，经过六个月的试验，semaglutide可以改善2型糖尿病患者的血糖和体重减轻。根据JAMA Network Open上发表的研究，替罗西肽“强有力地”改善了2型糖尿病患者的血糖水平并有助于减肥。。

Further Reading

进一步阅读

Wegovy: Here’s When Supply Of The Weight Loss Drug Could Improve This Year (Forbes)

Wegovy：今年减肥药的供应可能会有所改善（福布斯）

List Price Of Ozempic And Other Drugs Reportedly Rise: Here’s What That Means For Consumers (Forbes)

据报道，奥赞匹克和其他药物的标价上涨：这对消费者意味着什么（福布斯）

What To Know About Ozempic: The Diabetes Drug Becomes A Viral Weight Loss Hit (Elon Musk Boasts Using It) Creating A Shortage (Forbes)

关于Ozempic需要知道什么：糖尿病药物成为一种病毒性减肥药物（埃隆·马斯克自夸使用它），造成短缺（福布斯）

Diabetes Drug Mounjaro Expected To Be Approved For Weight Loss Soon: What To Know And How It Compares To Similar Drugs (Forbes)

糖尿病药物Mounjaro有望很快被批准用于减肥：知道什么以及它与类似药物的比较（福布斯）

As Zepbound shortage grows, Eli Lilly says no immediate end is in sight (NBC News)

随着Zepbound短缺的增加，礼来表示目前还没有立即结束的迹象（NBC新闻）