Friday Shorts: GLP-1 emergency visits and disparities; colorectal cancer screening, digital health fragmentation
May 30, 2025
A. Emergency department visits associated with GLP-1 medications
Researchers in the Annals of Internal Medicine reviewed a national public health surveillance database to determine likelihood of emergency department (ED) visits by patients that were on semaglutide (Ozempic, Wegovy and Rybelsus) in 2022-2023. They did not distinguish between prescription for diabetes and obesity, and did not include tirzepatide, which was not then in wide use. They estimated that there were about 24,500 emergency department visits in the U.S. associated with semaglutide during that time period, the equivalent of about 4 visits per 1,000 who were on the medication. Gastrointestinal side effects were responsible for two-thirds (69%) of visits. Low blood sugar was responsible for one in six of these emergency department visits.
ED visits for complications from GLP-1 prescriptions are relatively rare, and some could be prevented by better patient education about expectations of side effects.
B. Disparities in prescription of GLP-1 medications
Source: Kim, et al JAMA, April 29, 2025
GLP-1 drugs have enormous clinical benefits for those with obesity, and anecdotal reports suggest that these are more likely to be prescribed to patients who are socioeconomically advantaged. Researchers published an article in late April in JAMA using the database of providers that use Epic as their electronic health record to review GLP-1 prescription for obesity from 2020-2024. They determined that those who are women and live in zip codes with higher income are more likely to be prescribed these drugs. There was little difference between prescriptions for these medicines given to Black and White members. This database includes those on Medicare and Medicaid, and the researchers did not report on likelihood of prescription by insurance status.
C. Digital health therapies and fragmentation of care
Many people, as they age, have multiple diseases. This is especially true with metabolic disease, where obesity, diabetes, heart disease, liver disease, and kidney disease often travel together. Researchers in JAMA Network Open reviewed 148 digital health technologies that were either approved by the Food and Drug Administration (88 devices) or included in the United Kingdom’s Organisation for the Review of Care and Health Apps (80 apps). Fifty-seven of the digital health apps were applicable to people with diabetes.
They found that a hypothetical patient with a single chronic disease would need to access 13 apps and seven devices to receive the services that they found were valuable. The digital health apps and sensors necessary increased when a hypothetical patient had multiple conditions.
D. Cost of stool-based colorectal cancer screening
Source: Brennan, et al Annals of Internal Medicine, May 13, 2025
Colonoscopy is the “gold standard” for screening for colorectal cancer. However, some people are reluctant to have this screening test, which requires a bowel cleanout and likely a day and a half out of work. Fecal immunochemical (FIT) tests are less sensitive than Cologuard, and cost much less. A new version of Cologuard with increased sensitivity and fewer false positives was released in March.
Researchers published in the Annals of Internal Medicine this month used studies of FIT tests and both versions of Cologuard to model how many cases of cancer would be found and the screening cost per each case of colorectal cancer found. The Cologuard tests would each cost over $700,000 for each incremental cancer detected. The researchers used Medicare fee schedules, so the costs would be higher for employer-sponsored health insurance. The authors note that more patients are getting these genetic tests and fewer are getting FIT tests in recent years.
Here's a link to a review of available colorectal cancer screening tests.
Have a great weekend!