What Exactly Did WHO Change?

WHO maintains a Model List of Essential Medicines, commonly called the EML.

In September 2025, WHO released the 24th edition of this list.

One of its important diabetes-related changes concerned medicines known as GLP-1 receptor agonists and related therapies.

But there is an important technical distinction.

WHO formally added semaglutide to the core Essential Medicines List as a square-box listing.

Under this listing, dulaglutide and liraglutide, which are also GLP-1 receptor agonists, and tirzepatide, which acts on both GLP-1 and GIP receptors, were named as therapeutic alternatives.

The square-box approach gives health systems flexibility when selecting medicines for their own essential-medicines lists and procurement programmes.

It may also encourage competition and potentially help improve affordability.

However, identifying medicines as therapeutic alternatives does not mean that they are clinically identical or interchangeable for every patient.

And the most important part of WHO's decision is not simply which medicines appear on the list.

It is who WHO identified as most likely to benefit from them.

Who Does WHO's Listing Specifically Apply To?

WHO's recommendation is for add-on glucose-lowering therapy in adults with type 2 diabetes who have both:

Every part of that description matters.

This is not simply:

“A person has type 2 diabetes, therefore they should receive a GLP-1 medicine.”

Nor is BMI ≥30 kg/m², by itself, the complete WHO criterion.

The recommendation identifies a specific high-risk population in whom WHO judged the expected overall health benefit of treatment to be particularly important.

What Does “Essential Medicine” Actually Mean?

The word essential can easily be misunderstood.

It does not mean that every person with a particular condition must take that medicine.

WHO's Essential Medicines List identifies medicines considered important for addressing priority healthcare needs of populations.

The list can help countries make decisions involving:

• medicine selection
• public-sector procurement
• medicine supply
• insurance and reimbursement
• treatment availability
• health-system priorities

WHO's Model Lists are used to guide medicine policies in more than 150 countries.

There is another important distinction.

An international WHO listing, a country's decision to purchase or reimburse a medicine, and a doctor's decision to prescribe it to an individual patient are three different things.

A medicine may be considered essential internationally while still being unavailable in a particular country, not publicly funded, unaffordable, or clinically unsuitable for a particular person.

WHO's objective is that essential medicines should ultimately be available at prices individuals and health systems can afford—but inclusion on the list does not automatically make that happen.

Why Did WHO Consider GLP-1-Based Therapies Important?

Type 2 diabetes is not only about a glucose number.

Over time, diabetes can be associated with serious complications, particularly involving the cardiovascular system and kidneys.

The WHO Expert Committee reviewed a substantial body of scientific evidence on GLP-1 receptor agonists and related therapies.

That evidence went beyond whether the medicines could lower glucose.

WHO considered evidence involving:

• glucose control
• cardiovascular outcomes
• kidney outcomes
• weight loss
• quality of life
• mortality

The evidence is not identical for every medicine or every outcome.

However, WHO concluded that the greatest expected overall benefit was among people with type 2 diabetes who already had established cardiovascular disease or chronic kidney disease and met the specified obesity criterion.

This broader picture is important.

The decision is better understood as being about long-term diabetes risk management, rather than simply lowering blood sugar or body weight.

Why Do Heart and Kidney Disease Matter So Much Here?

For someone living with type 2 diabetes, treatment decisions increasingly involve more than asking:

“How much will this medicine lower my glucose?”

Another important question is:

“Could this treatment also influence my risk of serious diabetes-related complications?”

This becomes particularly relevant when cardiovascular disease or chronic kidney disease is already present.

WHO's decision reflects this broader way of looking at diabetes care.

The evidence reviewed suggests that GLP-1-based therapies can improve glucose control and support weight loss while also influencing cardiovascular and kidney outcomes in appropriate people with type 2 diabetes.

WHO therefore placed particular importance on people in whom these serious complications were already part of the clinical picture.

In other words, the value of these medicines is not being judged solely by what happens to HbA1c.

What About Weight Loss?

Weight loss is one of the reasons medicines such as semaglutide and tirzepatide have attracted enormous public attention.

And weight loss is part of the evidence WHO considered.

But that should not obscure the context of this particular Essential Medicines decision.

The listing concerns add-on glucose-lowering therapy in a defined high-risk population with type 2 diabetes.

It is not a general WHO recommendation that anyone seeking weight loss should use these medicines.

WHO did not make this diabetes EML listing for obesity alone.

At the time of its review, the Committee also noted that evidence for some cardiovascular and mortality outcomes in people with obesity without diabetes was less mature.

What Does the WHO Decision Not Mean?

This distinction is important because these medicines already receive enormous public and social-media attention.

It Does Not Mean Everyone With Type 2 Diabetes Needs a GLP-1 Medicine

The WHO listing identifies a specifically defined high-risk population.

Individual treatment still depends on medical history, existing complications, current medicines, treatment goals, tolerability, affordability and clinical judgement.

It Does Not Mean GLP-1 Medicines Replace All Other Diabetes Treatment

WHO describes this use as add-on glucose-lowering therapy.

Diabetes management may involve nutrition and physical activity support together with different combinations of medicines depending on the individual.

A GLP-1 medicine does not automatically replace other treatments.

It Does Not Mean All Four Medicines Are Identical

Semaglutide is the formal square-box EML listing, with dulaglutide, liraglutide and tirzepatide named as therapeutic alternatives.

This approach provides flexibility for health systems.

It should not be interpreted as meaning that all four medicines have identical clinical evidence, effects or suitability for every person.

It Does Not Mean “Essential” Equals “Mandatory”

An Essential Medicines listing helps governments and health systems decide which treatments deserve priority consideration.

It is not an individual prescription.

It Does Not Turn These Medicines Into DIY Weight-Loss Treatments

These are prescription medicines with clinical indications, possible adverse effects, contraindications and monitoring considerations.

They should be used under appropriate medical supervision.

If They Are “Essential”, Why Are They Still So Difficult to Afford?

This is one of the most interesting tensions in WHO's decision.

WHO openly acknowledges that the high prices of medicines such as semaglutide and tirzepatide constrain access.

A medicine can therefore have sufficient clinical and public-health importance to be included on the Essential Medicines List while remaining financially inaccessible to many people who could potentially benefit from it.

WHO has highlighted strategies that could help improve access, including:

• prioritising people most likely to benefit
• encouraging greater competition
• supporting fair pricing
• increasing availability of quality-assured alternatives
• making treatment available through primary care
• improving access in underserved areas

The square-box listing and inclusion of therapeutic alternatives may also give countries greater flexibility in medicine selection and procurement.

Why Does Access Through Primary Care Matter?

WHO highlights the importance of making these therapies available through primary care, particularly in underserved areas.

That matters because type 2 diabetes is a long-term condition affecting hundreds of millions of people worldwide.

If an effective treatment can only be accessed through specialist centres or by people able to pay substantial out-of-pocket costs, its population-level impact remains limited.

Adding a medicine to the Essential Medicines List can help countries consider it within broader decisions around procurement, coverage and access.

But inclusion does not automatically mean that a medicine will immediately become available, reimbursed or affordable in every country.

What Could This Mean for Someone Living With Type 2 Diabetes?

For an individual patient, the WHO decision should probably prompt questions rather than assumptions.

If you have type 2 diabetes, it may be useful to understand not only your glucose numbers but also your broader cardiovascular and kidney health.

For someone who already has cardiovascular disease or chronic kidney disease, these considerations become particularly important.

The conversation with a healthcare professional does not necessarily need to begin with:

“Should I take semaglutide?”

A more useful starting point might be:

The answer may or may not involve a GLP-1-based medicine.

That remains an individualized clinical decision.

GLP-1 and Essential-Medicine Myths Worth Avoiding

Myth: “WHO now recommends semaglutide for everyone with type 2 diabetes.”

Fact: No. WHO's EML recommendation is for add-on glucose-lowering therapy in adults with type 2 diabetes who have established cardiovascular disease or chronic kidney disease and obesity defined as BMI ≥30 kg/m² with significant impact on physical health and/or quality of life.

Myth: “WHO individually added four identical medicines.”

Fact: Semaglutide is the formal core EML square-box listing. Dulaglutide, liraglutide and tirzepatide are specified therapeutic alternatives.

Myth: “Essential medicine means everyone should take it.”

Fact: The Essential Medicines List is a population and health-system tool. Individual prescribing remains a clinical decision.

Myth: “WHO added these medicines mainly because they cause weight loss.”

Fact: Weight loss is part of the evidence, but WHO also considered glucose control, cardiovascular and kidney outcomes, quality of life and mortality.

Myth: “If WHO calls the medicine essential, it must now be inexpensive.”

Fact: WHO specifically identifies high prices as an important barrier to access, particularly for semaglutide and tirzepatide.

Myth: “The listing means I should change my diabetes medication.”

Fact: No. A WHO population-level listing does not replace an individualized treatment plan. Medication changes should be discussed with an appropriate healthcare professional.

Questions Worth Asking Your Doctor

• Do I have established cardiovascular disease or chronic kidney disease?
• How well are my kidneys functioning?
• What is my overall cardiovascular risk?
• Does my current diabetes treatment address risks beyond glucose control?
• Would a GLP-1 receptor agonist or related therapy be appropriate for my particular diabetes profile?
• What benefits could I realistically expect?
• What side effects or risks would be relevant for me?
• How would this treatment fit with my existing diabetes medicines?
• Would my glucose need to be monitored differently?
• What would the likely long-term cost of treatment be?
• What alternatives are available if a GLP-1-based medicine is not appropriate or affordable for me?

Diafemme Perspective: The Bigger Story Isn't the Injection

GLP-1 medicines have become some of the most talked-about medicines in the world.

Much of that conversation revolves around weight.

WHO's 2025 Essential Medicines decision offers a useful reminder that the diabetes story is considerably broader.

For someone living with type 2 diabetes, increasingly important questions include:

What is happening to my heart?

What is happening to my kidneys?

What is my long-term risk?

And does my treatment address those risks as well as my glucose?

Frequently Asked Questions

Which GLP-1 medicine did WHO formally add to its Essential Medicines List in 2025?

WHO added semaglutide to the core Essential Medicines List as a square-box listing. Dulaglutide, liraglutide and tirzepatide were identified as therapeutic alternatives.

What does a “square-box” listing mean?

It allows specified medicines with similar therapeutic roles to be considered as alternatives when countries develop their own essential-medicines lists and procurement strategies. It does not mean that every alternative is identical or interchangeable for every patient.

Who is the WHO listing for?

The recommendation is for add-on glucose-lowering therapy in adults with type 2 diabetes who have established cardiovascular disease or chronic kidney disease and obesity defined as BMI ≥30 kg/m² with a significant impact on physical health and/or quality of life.

Does WHO recommend semaglutide for everyone with type 2 diabetes?

No. The EML recommendation identifies a much more specific high-risk population. Individual treatment decisions should be made with an appropriate healthcare professional.

Why did WHO include GLP-1-based therapy?

WHO reviewed evidence involving glucose control, cardiovascular and kidney outcomes, weight loss, quality of life and mortality. It considered the expected overall benefit greatest in the specified high-risk population.

Does the WHO decision mean these medicines are primarily weight-loss treatments?

No. Weight loss is one potential benefit, but this particular EML decision concerns add-on glucose-lowering treatment for a defined population with type 2 diabetes.

What does WHO mean by an “essential medicine”?

WHO's Essential Medicines List identifies medicines considered important for priority healthcare needs and helps countries make decisions around medicine selection, procurement, supply, coverage and reimbursement.

Are these medicines now affordable because WHO considers them essential?

Not necessarily. WHO specifically acknowledges that high prices, particularly for semaglutide and tirzepatide, remain a major barrier to access.

Should someone with type 2 diabetes ask their doctor about GLP-1 treatment?

Rather than assuming a particular medicine is needed, it can be useful to discuss overall cardiovascular and kidney risk with a healthcare professional. Whether a GLP-1-based treatment is appropriate depends on the individual's medical circumstances.

Diafemme's Takeaway

WHO's 2025 Essential Medicines update represents an important development in how newer diabetes treatments are being considered globally.

But precision matters.

Semaglutide was formally added to the core EML as a square-box listing, with dulaglutide, liraglutide and tirzepatide identified as therapeutic alternatives.

And the listing is not for everyone with type 2 diabetes.

It concerns add-on glucose-lowering therapy for adults with type 2 diabetes who have established cardiovascular disease or chronic kidney disease and obesity—defined as BMI ≥30 kg/m² with significant impact on physical health and/or quality of life.

The reasoning also extends well beyond weight loss.

WHO considered evidence involving glucose control, cardiovascular and kidney outcomes, weight loss, quality of life and mortality.

At the same time, WHO acknowledges a major unresolved problem:

Access.

A medicine can have strong clinical evidence and be considered important to global health while still remaining financially out of reach for many people who could potentially benefit from it.

So perhaps the most useful way to understand WHO's decision is this:

GLP-1-based therapies have become important tools for some people at particularly high risk from type 2 diabetes. Identifying who is most likely to benefit—and making effective treatment genuinely accessible—are just as important as the medicines themselves.