As the USVI assesses how to combat high levels of diabetes in the territory, policymakers are keeping a keen eye on the growing use of one prescription medication.
Semaglutide — marketed as Wegovy and Ozempic, is administered in weekly injections to manage type 2 diabetes, and spurs the production of insulin in the body, reducing blood sugar levels. Taken orally, prediabetic patients also show better control of blood sugar, slowing the progression of their disease. However, the medication is skyrocketing in popularity due to one side effect in particular: weight loss.
Lifestyle outlets in the U.S. have reported on the use of the drug by several celebrities to fast-track their journey to a slimmer body. In late 2023, media mogul Oprah revealed her use of the medication as a “maintenance tool”. As local legislators discussed the management of diabetes and its related illnesses last week, Senator Marise James initiated a line of questioning on the use of the drug.
Suggesting that “most of us don't like to take the long difficult road to change behavior,” Ms. James wanted to know how extensively Ozempic and other semaglutide medications were being used here in the territory. Nurse practitioner at the V.I. Diabetes Center of Excellent, Carlos Castillo, suggested that it was not as widely adopted as it should be.
“When it comes to our patients here in the Virgin Islands, for some reason, they do not like to lose the weight,” she said. A semaglutide regimen can result in a person shedding 4 percent - 6 percent of their weight, according to Mr. Castillo. He told lawmakers that unlike many on the mainland, patients in the territory often do not welcome this outcome. “Some of them say…’I rather not take the Ozempic because it’s going to make you lose weight."
Affordable access to the drugs, even for those who wish to take them, is another barrier, the nurse practitioner noted. Without insurance that covers the prescription, the cost for the treatment could reach $1,200 per month. “It's great for the patients. Unfortunately, not everybody is going to be able to afford it,” lamented Mr. Castillo.
Nationally, the intense demand for Ozempic and other injectable semaglutide medications have caused shortages in the supply, a scenario which is expected to continue intermittently as manufacturers work to stabilize higher production rates.
The desire of some pre-diabetics or diabetic patients to keep their weight on “goes contrary to what needs to be done,” Sen. James observed. She admitted she was “a little concerned” and wondered whether the territory’s culture played a part. “There's a little resistance in all of us, culturally,” Ms. James remarked.
According to Julia Sheen, executive director of the Virgin Islands Diabetes Center of Excellence, the answer is yes. “I do think that is very much cultural,” she said. She explained that the sentiment did not just apply to Ozempic and similar drugs. “Patients do not like to take their medication, and they don't adhere. They prefer to use natural remedies.”
Nonetheless, Ms. Sheen remains resolute that the programs and activities organized by the Virgin Islands Diabetes Center of Excellence are helping to manage and prevent diabetes in the territory. Continuous education and outreach including monthly diabetes self-management classes promote the adoption of healthy lifestyles as a part of a comprehensive disease management strategy, she told lawmakers. Ms. Sheen countered Mr. Castillo’s inference that Virgin Islanders preferred to stay on the heavier side. “That might be true for some patients, but I can tell you it is not true for the majority of the patients.” The center, she argued, has been successful in informing patients of the connection between weight gain and their A1C – a key indicator of blood sugar trends.
