Expanding global access to GLP-1s: Challenges and opportunities

ore than 1 billion people worldwide are obese, and roughly 500 million have type 2 diabetes.These conditions are major risk factors for dementia, heart disease, and various cancers.Glucagon-like peptide-1 receptor agonists, commonly referred to as GLP-1s, have transformed the treatment of both obesity and type 2 diabetes.Yet despite their promise, global use of these therapies remains uneven.Access has largely been concentrated in high-income countries, even though low-and middle-income countries account for more than 80% of the world's population and a substantial share of the global burden of obesity and type 2 diabetes.Generic versions of the popular GLP-1 drug semaglutide became available in a number of countries in 2026, offering opportunities to substantially expand access.The likely emergence of newer GLP-1s with moredesirable attributes, however, may produce a segmented global market that gives rise to familiar tensions over access to newer, patentprotected therapies.Clinical trials have shown that GLP-1s, part of a broader category of incretin-based therapies, support weight loss, improve glycemic control, and reduce the risk of heart disease (1).Other potential uses are under investigation, including for cardiovascular disorders, neurodegeneration, liver disease, and addiction.The first GLP-1 receptor agonist to be approved in the US for both diabetes and weight management was liraglutide.An earlier drug in this class, exenatide, was approved for diabetes only.Semaglutide, marketed by Novo Nordisk for both diabetes and weight management, revolutionized obesity therapy and, in doing so, became one of the most commercially successful medicines in history (2).Newer incretinbased therapies target multiple gut hormones to produce greater metabolic effects.Tirzepatide, a dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist marketed by Eli Lilly, has overtaken semaglutide in prescription volume for both indications in many markets.These medicines are all polypeptides (i.e., amino acid chains) that mimic the natural GLP-1 hormone.In 2026, the US Food and Drug Administration (FDA) approved orforglipron, an oral, nonpeptide small-molecule GLP-1 receptor agonist, for chronic weight management.