ZAGREB, 1 Sept (Hina) - Croatia saw a 28% rise in the use of diabetes drugs that also aid weight loss in 2024, HALMED reports, with demand set to grow further as Wegovy, the first medicine approved solely for obesity, became available in May.
Medicines containing semaglutide and liraglutide regulate blood sugar and suppress appetite, and are prescribed to people with a body mass index (BMI) above 30, or between 27 and 29 if they face additional health risks such as pre-diabetes, high blood pressure or cardiovascular disease.
Most of these medicines are primarily indicated for type 2 diabetes, not weight loss, except Saxenda (liraglutide) and the recently available Wegovy (semaglutide). HALMED records the total number of packs dispensed, but does not distinguish between use for diabetes treatment and weight loss.
The increased demand cannot be explained by a rise in diabetes cases. According to the Croatian Institute of Public Health (HZJZ), there were 395,000 people with diabetes in Croatia in 2023 and 396,000 in 2024.
Because HALMED tracks medicines by active ingredient rather than brand name, its figures cover all authorised semaglutide products (Ozempic and Rybelsus) and liraglutide products (Saxenda, Victoza and Xultophy) on the Croatian market in 2023 and 2024.
In 2023, 207,636 packs of these medicines were dispensed, worth about €16.2 million. In 2024, the figure rose to 266,012 packs, worth nearly €21 million, a 28 per cent increase in volume and 30 per cent in value.
Wegovy was approved in the EU in 2022, but only became available in Croatia in May this year. HALMED will publish its first usage data next year.
In Croatia, diabetes medicines based on semaglutide and liraglutide are partly reimbursed by the state health insurer HZZO, with patients paying a supplement. By contrast, medicines prescribed solely for weight loss, such as Saxenda and Wegovy, are paid for in full by patients.
Prescription changes drive growth
Kristina Blaslov, endocrinologist and diabetologist at Zagreb's Centar Health Centre, said the rise in use reflects changes in prescribing criteria.
Medicines such as semaglutide, dulaglutide, liraglutide and tirzepatide act on hormones from the gut, mainly the small intestine, which are secreted not only in response to eating but also to the smell of food. "They slow down gastric emptying, act on the brain across the blood–brain barrier, and create a sense of satiety," she explained.
Blaslov expects semaglutide use to grow, as it is now prescribed not only for diabetes but also for obesity, with lower BMI thresholds introduced for patients with diabetes or elevated cardiovascular risk. Still, she stressed that for BMIs of 27 or 28, a proper diet and physical activity should be tried before medicines.
HALMED data show semaglutide-based medicines (Ozempic, Wegovy) are more popular than liraglutide-based ones (Saxenda, Victoza). In 2023, 34,707 packs of liraglutide were issued, compared with 29,582 in 2024.
"Both are given by injection, but semaglutide is simpler as it is taken once a week, while liraglutide requires daily dosing," Blaslov said, explaining semaglutide's wider uptake.
Healthy diet remains essential
"Obesity is linked to higher risks of stroke, heart attack and reduced mobility. Medicines accelerate weight loss, but it is crucial that patients also adopt basic lifestyle measures, because a balanced diet and three daily meals prevent weight regain once treatment stops," Blaslov warned. She added that long-term use may lead to a so-called plateau, when weight loss stalls, which is usually managed by switching medicines.
Darija Vranešić Bender, a nutritionist at Zagreb University Hospital Centre (KBC Zagreb), agreed, stressing these medicines are not a substitute for healthy eating.
"GLP-1 receptor agonists have, in recent years, fundamentally changed the approach to obesity treatment. Therapies such as semaglutide significantly reduce appetite and food intake, leading to weight loss of between five and 20 per cent of body weight, according to clinical trials. This powerful therapy has recently helped many patients who had struggled for decades to lose weight," she said.
The aim, she stressed, is weight loss while preserving health, muscle mass and bone density.
Risks of poor nutrition
Vranešić Bender recommends a nutrient-dense but low-energy diet, with enough protein from fish, eggs, dairy and legumes, alongside vegetables and whole grains. She underlined the importance of fibre and fluids for healthy digestion.
Common mistakes, she warned, include consuming too few calories, below 1,200 kcal a day for women and 1,800 for men, which can lead to exhaustion, muscle loss and nutrient deficiencies. "Side effects of these medicines can worsen nutritional deficits," she noted.
Another frequent mistake is skipping meals. "Many think they don't need to eat because the drugs suppress appetite, but that risks deficiencies. Others continue poor dietary habits, assuming the medicine alone solves obesity, which in the long run causes weight regain," she said.
In most cases, weight returns once therapy stops, precisely because healthy habits have not been adopted, Vranešić Bender concluded.
