The diabetes management landscape is in turmoil, and it’s leaving patients and healthcare providers scrambling to keep up. With essential medications like GLP-1 receptor agonists (GLP-1 RAs) finally back in stock, you’d think things would be returning to normal, but the reality is far more complicated. While the return of drugs like semaglutide (Ozempic) is a welcome relief, the impending discontinuation of certain basal insulins is adding a new layer of complexity to an already challenging situation. But here’s where it gets even more tangled: the shortages and discontinuations have created a ripple effect, leading to medication double-ups and leaving some patients with limited or no options. Australian Pharmacist dives into how the sector is navigating these turbulent waters.
The Return of Ozempic: A Double-Edged Sword
This year has seen a easing of shortages for popular diabetes medications, with Ozempic officially removed from the Therapeutic Goods Administration’s shortage list in July. However, the period of scarcity has left its mark. During the National Medicines Symposium 2025, Kirrily Chambers MPS, an Advanced Practice Pharmacist and credentialled diabetes educator, highlighted a concerning trend: patients often received multiple prescriptions for whichever medication was available at the time. For instance, when Ozempic was unavailable, patients were frequently prescribed sitagliptin (Januvia) alongside their usual semaglutide. And this is the part most people miss: when Ozempic returned, many patients continued both medications, unaware that their doctor had intended Januvia as a temporary substitute. This oversight raises serious safety concerns, as pharmacists now find themselves questioning, “Did the prescriber really intend for this patient to be on multiple therapies?”
Pharmacists are now playing a critical role in deprescribing, ensuring patients aren’t at risk of adverse effects or hospitalizations. Regular Diabetes MedsChecks, medication reconciliation, and Home Medicines Reviews are essential tools in this process. But the question remains: how can we better coordinate care to prevent such overlaps in the first place? Is the current system failing patients, or is this an unavoidable consequence of medication shortages?
Discontinuations: A Looming Crisis for Vulnerable Patients
The discontinuation of several diabetes medications, including insulin formulations like insulin detemir (Levemir) and devices, has left a significant gap in care. Associate Professor Margaret McGill AM, a nurse manager at Royal Prince Alfred Hospital’s Diabetes Centre, points out that older patients, who are increasingly being diagnosed with type 2 diabetes, are particularly affected. Many lack the dexterity to use newer devices, such as reusable pens with cartridges. But here’s where it gets controversial: the discontinuation of Levemir by December 2026 is causing widespread concern. While some patients may transition to glargine, those requiring twice-daily dosing face significant risks, including hypoglycemia during the day and hyperglycemia at night, which can lead to long-term complications. Is it fair to leave these patients with insulin pumps as their only option, especially when affordability is a barrier?
Distinguished Professor David Simmons, Chief Medical Officer at Diabetes Australia, emphasizes the challenges in finding suitable replacements. For example, gestational diabetes patients, who have limited time to master their treatment, often benefit from simpler devices. Yet, the focus on newer technologies risks leaving behind those who rely on traditional, user-friendly options. Are we prioritizing innovation at the expense of accessibility?
Finding the Right Therapeutic Approach: A Complex Puzzle
Selecting the right medication for a diabetes patient is far from straightforward. Dr. Gary Deed, Chair of the Diabetes Specific Interest Group at the Royal Australian College of General Practitioners, explains that it involves a complex algorithm considering factors like blood pressure, lipid levels, kidney function, and even emotional well-being. Renza Scibilia, a diabetes advocate living with type 1 diabetes, underscores the diversity of patient needs and understanding. And this is the part most people miss: there’s no one-size-fits-all solution. Effective communication and individualized care are paramount, yet they remain challenging to implement consistently. How can we ensure that every patient receives a tailored approach in a system stretched to its limits?
As the diabetes management landscape continues to evolve, one thing is clear: collaboration between patients, pharmacists, GPs, and specialists is more critical than ever. But the question lingers: Are we doing enough to address these challenges, or are we merely patching over deeper systemic issues? We’d love to hear your thoughts—share your experiences or opinions in the comments below. Is the current approach sustainable, or do we need a radical rethink?
