Diabetes Medication Shortages Stem from "Dietary Purposes" Usage in Japan

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Diabetes Medication Shortages Stem from “Dietary Purposes” Usage in Japan

Currently, there is a shortage in the supply of diabetes treatment medications in Japan, and the Japan Medical Association has raised concerns that these crucial medications are not reaching the patients who need them.

One of the root causes of this supply shortage is the use of these drugs for weight loss purposes. What exactly is happening?

Diabetes Medication Shortages Stem from "Dietary Purposes" Usage in Japan

In Tokyo, a man in his 50s has been living with diabetes for approximately seven years and is undergoing treatment.

He is taking a medication called GLP-1 receptor agonists, which not only helps lower blood sugar levels but also suppresses appetite and aids in weight loss. There are both oral and injectable forms of this medication.

This medication is vital for the man, but during his last visit to the pharmacy, he was told, “It will take 4-5 days for the medication to arrive, so we will contact you when it’s available.” He says, “It’s tough not being able to take it when I want.”

In reality, there is currently a shortage of GLP-1 medications, and there are cases where the necessary medication is not reaching the patients who need it. Dr. Hiromichi Ito, head of the Ito-Ooji Kandani Internal Medicine and Surgery Clinic, warns that this could lead to poor diabetes control, emphasizing the need to prevent such a situation.

During a press conference held by the Japan Medical Association on October 25th, one of the reasons cited for the shortage of GLP-1 medications is that people without diabetes are using them for weight loss purposes. “We are concerned that these drugs are being inappropriately used as ‘slimming pills.’ We want them to reach diabetes patients properly,” says Masaki Miyakawa, Executive Director of the Japan Medical Association.

GLP-1 has been approved as a medication for diabetes and is covered by insurance. However, in some clinics, it is prescribed as a form of elective treatment not covered by insurance. Some websites even promote it as part of a “medical diet.”

A 25-year-old woman from Aichi Prefecture obtained a prescription for GLP-1 medication through an online consultation, which cost approximately 13,000 yen per month. She reported feeling fatigue, dizziness, and a persistent anemic sensation while using the medication. She stopped it briefly but then resumed use, stating, “I want to lose weight. I will stop if it really becomes dangerous.”

On the other hand, medical organizations have sounded alarms regarding the use of GLP-1 for weight loss purposes because the potential side effects of such usage are not well understood. Dr. Hiromichi Ito, head of the Ito-Ooji Kandani Internal Medicine and Surgery Clinic, explains, “When used for cosmetic purposes, there can be risks involved. Adequate explanations and follow-ups regarding side effects and complications are often lacking.”

The government has also called for proper usage once again, with Chief Cabinet Secretary Matsumoto stating, “To ensure that diabetes patients in need can make appropriate use of these medications, the Ministry of Health, Labour and Welfare has requested wholesale drug distributors to prioritize supply to medical institutions that provide diabetes treatment and spread information about their proper use.”

The use of diabetes medications for the purpose of weight loss has raised various concerns, leading to multiple issues.

In Japan, GLP-1 is not covered by public insurance when used for purposes like weight loss. However, there are numerous cases where patients have suspicions of being prescribed these medications for insurance coverage by falsely claiming they have diabetes, resulting in lower costs.

The Japan Health Insurance Association (Kenporen) has analyzed detailed statements of medical fees received, revealing that, in the case of a woman in her 30s, medications for obesity treatment were prescribed alongside GLP-1. Additionally, while diabetes patients are typically seen by internists, the billing department for the service was somehow a dermatology clinic.

In another case involving a woman in her 20s, GLP-1 was prescribed along with medication for removing skin blemishes and treating acne. These cases did not involve the essential blood tests normally conducted in diabetes treatment.

Concerned about this anomaly, Kenporen investigated around 500,000 statements of medical fees and identified hundreds of patients who might have falsely claimed to have diabetes to receive prescription medications. Given the high prevalence of diabetes patients throughout Japan, this suggests the issue may extend beyond hundreds and into thousands.

Consequently, Kenporen has called for the appropriate use of insurance, with plans to provide information to the Ministry of Health, Labour and Welfare regarding hospitals strongly suspected of prescribing medications for insurance coverage under false pretenses.

“Given the current financial constraints on health insurance, it’s disheartening to see it being used for purposes other than its intended use. We would like people to refrain from this. In extreme cases, we may also provide information to the Ministry of Health, Labour and Welfare for potential investigations or administrative guidance,” says Masato Matsumoto, a director at Kenporen.

In the United States, GLP-1 is approved as a “treatment for obesity.”

GLP-1 is used abroad as well. In September of this year, Elon Musk posted on X (formerly Twitter), stating, “GLP-1 has an unbelievably effective weight loss effect.” In Europe and the United States, it has been approved for use as a medication for obesity, leading to a surge in popularity.

The Danish pharmaceutical company Novo Nordisk, which manufactures and sells GLP-1, briefly became the most valuable company in Europe by market capitalization. However, according to American media reports, the CEO of retail giant Walmart attributed a slight decrease in per capita food sales and calorie consumption to the impact of obesity medications. This has caused stock prices of companies like Walmart and beverage giant Nestle to decline, giving rise to what is termed the “obesity medication shock.”

While GLP-1 has been approved as a medication for obesity treatment overseas, it is known for its strong potential side effects, and its use is restricted to specific individuals. In the United States, it is typically prescribed to patients with a body mass index (BMI) of 30 or higher as a measure of obesity. To put this in perspective, in the case of the average height of Japanese men (around 170 centimeters), a BMI of 30 corresponds to a weight of about 87 kilograms, and for Japanese women of average height (around 158 centimeters), it equates to a weight of about 75 kilograms. Such individuals are considered to have a higher risk of health problems according to Japanese standards.

The Japan Medical Association emphasizes that there are notable differences between dietary habits in Japan and those in Europe and the United States. They state that obesity is less common in Japan compared to Western countries, and the use of GLP-1 by individuals who are not obese and do not have diabetes poses a significant danger.

Currently, there are websites promoting the use of GLP-1 as part of the “GLP-1 Diet,” citing its usage in Europe and the United States. However, given the potential side effects, such as dizziness, nausea, and even heart problems, it is crucial to ensure its appropriate and responsible use.