Real-World Study Shows Semaglutide Helps Patients with Both Diabetes and Obesity Lose Weight and Improve Blood Sugar

What the researchers found

Semaglutide treatment produced significant real-world improvements across all key diabesity outcomes. Mean body weight decreased from 110.4 kg at baseline to 99.9 kg at 12 months and 96.8 kg at latest follow-up (approximately 13.6 kg total loss). HbA1c improved from 82 mmol/mol at baseline to 67 mmol/mol at 12 months and 71 mmol/mol at latest follow-up.

Insulin requirements also decreased, with mean daily doses dropping from 95 units at baseline to 76.5 units at latest follow-up — a roughly 20% reduction. Side effects were mild and primarily gastrointestinal, improving with continued use.

Why it matters

Clinical trials often include carefully selected patients who may not represent the broader population. This real-world study confirms that semaglutide's benefits translate to typical clinical practice, where patients have longer diabetes histories, multiple comorbidities, and varying adherence. The sustained weight loss and blood sugar improvement over 2.6 years is particularly encouraging for a condition that often worsens over time.

How the study worked

This was a retrospective real-world study at a large US academic hospital. Researchers reviewed electronic medical records of 106 patients with type 2 diabetes and obesity who were prescribed semaglutide between January 2019 and May 2023. They tracked weight, HbA1c, insulin dose adjustments, and side effects at 6 months, 12 months, and at the latest available follow-up. Mean treatment duration was 2.6 years.

What this study cannot tell us

This is a retrospective, single-center, observational study without a control group, so improvements cannot be definitively attributed to semaglutide alone. The sample size of 106 patients is modest. There may be selection bias in which patients were prescribed semaglutide. HbA1c appeared to slightly worsen from 12 months to latest follow-up (67 to 71 mmol/mol), which could indicate diminishing effect over time. Adherence data was not reported. The study did not assess cardiovascular or renal outcomes.

How to read the evidence

This is a retrospective, single-center observational study without a control group, which provides lower-quality evidence than randomized trials. However, its value lies in demonstrating real-world effectiveness over a longer treatment period (2.6 years average) than most clinical trials offer.

When this study was published

Published in 2024 using patient data from 2019–2023, this study reflects current clinical practice with semaglutide for diabesity management.

The bigger picture

As GLP-1 receptor agonists become central to managing the intersection of diabetes and obesity, real-world evidence is essential for understanding long-term outcomes, practical side effect profiles, and patient selection. This study adds to a growing body of evidence showing that the peptide-based therapy semaglutide delivers clinically meaningful results outside of the controlled trial setting.

Questions still open

• Why did HbA1c slightly increase between the 12-month measurement and the latest follow-up, and does this suggest waning efficacy over time?
• How do these real-world outcomes compare to semaglutide's performance in patients without insulin dependence?
• What percentage of patients were able to completely discontinue insulin during semaglutide treatment?

Common questions

Read the original research

Semaglutide for the management of diabesity: The real-world experience.

World journal of methodology, 14(3), 91832

Citation

Alkhalifah, Mohammed; Afsar, Hafsa; Shams, Anindya; Blaibel, Dania; Chandrabalan, Vishnu; Pappachan, Joseph M. (2024). Semaglutide for the management of diabesity: The real-world experience.. World journal of methodology, 14(3), 91832. https://doi.org/10.5662/wjm.v14.i3.91832