FARGO, N.D. (Valley News Live) – They go by names like Ozempic, Wegovy, and Mounjaro. GLP-1 medications have become some of the most talked-about drugs in the country, and the numbers prove it.
According to Epic Research’s GLP-1 Data Tracker, more than 25,000 out of every 100,000 patients with type 2 diabetes are now being prescribed a GLP-1 medication every quarter. For overweight or obese patients, that number tops 12,800 per 100,000, and among the broader adult population, more than 5,500 per 100,000 adults are receiving a GLP-1 each quarter as of Q1 2026.
The demand is being felt right here in the Red River Valley. Vanessa Coulter, APRN, CNP, a nurse practitioner at Essentia Health in Fargo, says her office fields multiple inquiries about GLP-1s every day, from patients as young as 12.
“Daily, we get inquiries or expressed interest, and people want to know more, which I think is good,” Coulter said.
But as prescriptions climb, so do questions about safety, long-term use, and the risks of cheaper, unregulated alternatives.
How do GLP-1s work?
GLP-1 receptor agonists were originally developed in the early 2000s to treat type 2 diabetes. Over time, researchers discovered the drugs also produced significant weight loss, and the list of approved uses has grown steadily since.
Coulter says the medications work through two key mechanisms.
“They work in the brain, and they regulate hormones, hunger signals. Not only do we not think about food, but when we eat, we feel full really fast,” she said. “They also work down in our gut, and they delay gastric emptying, so the food that you eat sits in your stomach for a really long time, keeping you full.”
Today, GLP-1s are FDA-approved for type 2 diabetes, obesity, fatty liver disease, and severe obstructive sleep apnea. Coulter says newer formulations, including drugs that combine GLP-1 with another peptide called GIP, are expanding the possibilities even further, with a triple-action medication currently in phase 3 trials.
“They’re not just meant for diabetes. That is the first indication, but actually, as we keep utilizing them, they get expanded indications,” she said.
For reference, Wegovy and Zepbound are currently FDA-approved for obesity, while Ozempic and Mounjaro are approved for type 2 diabetes.
Prescriptions are skyrocketing: here’s why
The surge in GLP-1 prescriptions reflects both expanding FDA approvals and growing public awareness. Coulter says the trend is multi-factorial.
“I think the expanding indications, the fact that we’re not just using these for diabetes, they’re for weight, they’re for the liver, they’re for sleep apnea. So these growing indications mean they’re of more interest to people who maybe have those conditions,” she said. “Anecdotally, I think both myself and my colleagues in primary care are going to say we’ve seen drastic increases in people inquiring about these medicines.”
Epic Research also found that among patients with polycystic ovary syndrome (PCOS), those treated with a GLP-1 saw a median one-year weight loss of 11.5%. Additionally, GLP-1 medications have been associated with a 23-44% reduced likelihood of dementia compared to other diabetes management medications.
Are they safe?
For the right candidate, Coulter says the answer is largely yes.
“They’re very safe medications and have little to no risks for the appropriate candidate,” she said. “Largely, the side effects are pretty minimal, usually what most people see out of the gate is gastrointestinal, so some nausea, maybe some vomiting, changes in bowel habits, whether it’s constipation or diarrhea.”
She says those side effects are most common when starting the medication or adjusting the dose, and typically improve over time.
However, GLP-1s are not recommended for everyone. Coulter says people with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 should not take them. They are also not used in people who are pregnant or breastfeeding, and caution is taken with patients who have a history of pancreatitis.
The muscle loss risk and the ‘quick fix’ myth
One of the biggest misconceptions Coulter hears is that GLP-1s are a quick fix that requires no lifestyle changes. She says that thinking can lead to real health consequences, including muscle mass loss.
“In reality, there’s no magic fix for any chronic medical conditions, especially weight; it has to be multifactorial,” Coulter said. “You have to make lifestyle changes, your diet, your exercise, and what you’re eating. So the risks are if you’re not dieting or eating appropriately, or exercising enough, you could lose some muscle mass.”
She says that risk can be significantly reduced through resistance and strength training, adequate protein intake, and proper nutrition.
Coulter also cautions patients against stopping the medication abruptly. She compares GLP-1s to blood pressure medication, a long-term treatment for a chronic condition, not a short-term solution.
“These medications are meant for long-term use, so that really means lifelong,” she said. “If you came to me and had high blood pressure and I put you on a medicine, once your blood pressure got normal, would you stop taking it? The answer is usually no.”
Notably, Epic Research data offers some reassurance on this front: two years after stopping a GLP-1, 56% of semaglutide patients, 52% of liraglutide patients and 55% of tirzepatide patients maintained at least some of their weight loss.
The danger of compounded GLP-1s
Cost is a major driver behind some patients’ choice to use compounded or online versions of GLP-1 medications. Some brand-name GLP-1s can cost more than $1,000 a month, and insurance coverage varies widely.
But Coulter says cutting corners on cost can come with serious, even life-threatening risks.
“Compounding is not regulated like our normal pharmaceuticals by the FDA, so there’s no monitoring or oversight by these big agencies,” she said. “It is very dangerous. Where are you getting this from? Who’s verifying that it has what it says it has in it and that it was made appropriately?”
Coulter referenced past cases of meningitis and deaths linked to improperly stored compounded medications as a cautionary example, and noted that overdosing risks increase when the checks and balances of a licensed pharmacy are not in place.
She says GLP-1 brand-name medications are currently not listed as being in shortage by the FDA and strongly advises against using compounding pharmacies. The FDA maintains a website where patients can verify whether a medication source is legitimate, but Coulter urges caution regardless.
What should patients do?
Coulter’s advice for anyone considering a GLP-1 is straightforward: talk to a trusted health care provider first.
“The most important thing is to talk to a trusted health care provider or professional who is prescribing these medications,” she said. “Understand what you’re taking, the expected duration, what are the potential side effects, what should I be watching for, what are things that I need to do in my day-to-day life to make sure that I’m doing what I can to be healthy, safe, and get the best results.”
She says the goal isn’t perfection, it’s balance.
“I think the motto of life is everything in moderation,” Coulter said. “We all need to be eating more balanced diets, emphasis on protein intake is important with these, fruits, vegetables, your fiber, whole grains. There are no restrictions or limitations on eating. It’s just finding that balance.”
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