Resistance is futile… or maybe it’s fact

I had food for thought the other night while I was feeding my face at a drug rep dinner. The presentation was on the GLP-1 medicine Victoza, and even though I feel pretty up to speed on this med (we have fifty or more patients who take it, my wife takes it, and I even use it off-label myself), the dinner was at a place I like to eat, so of course I went.

Now, the quality of this kind of program varies a lot. The marketing logic behind a drug rep dinner is that if an important doctor speaks highly of a product, average doctors will be more likely to prescribe it. Oh, right. And to get the average doctors to listen to the important doctor in the first place, you need to offer them a free expensive meal. This marketing strategy has been scientifically proven to work, which is why Big Pharma throws a ton of money at important docs who are willing to take the dough. Of course, this means the speaker is literally bought and paid for, so I bring not only my appetite but a healthy dose of skepticism with me when I go to these things.

Sometimes the speakers are ballyhoo men, sometimes they are interesting and amazing. Sometimes they are entertaining speakers, sometimes they drone and put the audience to sleep with a heavy dose of PowerPoint sleeping pills.

Sometimes I learn something new, sometimes I don’t. So I never quite know what I’m going to get out of attending, but I can always count on the wine being free and flowing equally freely, and I often enjoy the company of the other participants—if not the program itself.

In this case, the speaker disappointed. Big time. His slides were out of date, and he didn’t know them well. He kept harping on the AACE guidelines and how they were so much better than the ADA guidelines, but his PowerPoint was showing the old guidelines. He was oblivious to the ongoing trials of the med he was peddling for both weight loss and type 1s. Hell, I could have done a better job. Of course, what average doc would listen to little ’ol un-certified me?

During the post-talk Q&A, over desert and yet more wine, a lady doc in attendance observed that when she starts patients on Victoza they do great for a month or two. Their blood sugars improve, their weight drops, their appetite curbs. Then they often lose traction. It’s almost like the drug stops working as well, she said. Then she asked the speaker: “Do you think there’s such a thing as GLP-1 resistance? Do you think our patients might be developing resistance to the Victoza?”

Wow! What a great question. What an astute observation, I thought to myself. I’ve seen the same thing that she was describing happen, although not often. Yet, never in a million years would it have occurred to me to think about the possibility of GLP-1 resistance. My ears perked up. Maybe I was about to get something other than free wine out of this dinner.

Doctor Important, without even taking two seconds to consider the question, waived his hand dismissively, “No. It’s all a patient compliance issue. The diabetics start eating too much again and overwhelm the effect of the medication.”

(((Sigh)))

Same old endo song and dance. It’s always the patient’s fault, no matter what. I hate the word compliance and it’s more evil twin: non-compliance. In my wine-fogged mind I briefly had a vision of every type 1 in the country arriving at their endo appointments wearing T-shirts that say: Comply This!

The lady doc dropped it. But I didn’t. When I got home I spent some time investigating the clinical research net (more commonly known as Google with Whiskey). I couldn’t find anything about people developing resistance to the meds, but GLP-1 resistance itself is actually a well-documented biological fact, and one theory is that it might even be the driving force that triggers gestational diabetes! So if some people are resistant to GLP-1, it only stands to reason that you could become resistant to the effects of an artificial “supersized” GLP-1 in a pretty baby-blue pen.

Maybe our speaker should have had some of the free-flowing wine himself. It’s been shown to be a good prescription for opening closed minds.