Semaglutide Maintains Weight Loss Through 24 Months in Real-World Diabetic Patients — Injectable and Oral Forms Both Effective | Research

The takeaway

In 175 real-world patients with type 2 diabetes and obesity, injectable semaglutide produced 15.9 kg weight loss at 24 months while oral semaglutide achieved 10.7 kg at 12 months, with both forms maintaining weight loss long-term and significantly reducing HbA1c.

-15.9 kg at 24 months with injectable semaglutide
Weight loss didn't plateau — injectable semaglutide users continued losing weight from 10.4 kg at 6 months to 15.9 kg at 24 months in real-world practice, demonstrating sustained and progressive benefit with continued treatment.

What the researchers found

**Injectable semaglutide (n=129):**

- 6 months: -10.4 kg weight, -3.9 kg/m² BMI, -1.9% HbA1c

- 12 months: -9.3 kg weight, -3.4 kg/m² BMI, -1.5% HbA1c

- 24 months: -15.9 kg weight, -5.8 kg/m² BMI, -1.5% HbA1c

**Oral semaglutide (n=46):**

- 6 months: -6.7 kg weight, -2.6 kg/m² BMI, -1.5% HbA1c

- 12 months: -10.7 kg weight, -3.9 kg/m² BMI, -0.8% HbA1c

Notably, weight loss was maintained and even continued to increase through 24 months with injectable semaglutide — contradicting concerns about weight plateau or regain during extended treatment. The oral formulation showed comparable effectiveness to injectable at 12 months despite initial slower weight loss.

Why it matters

Real-world data fills a critical gap between clinical trial efficacy and actual clinical practice. Patients in trials are carefully selected and monitored, while real-world patients have comorbidities, variable adherence, and diverse lifestyles. This study confirms that semaglutide's weight loss and glycemic benefits persist in everyday practice, and that weight continues to improve through 24 months — addressing the common patient concern of 'will it keep working?'

How the study worked

Retrospective real-world study of 175 patients with type 2 diabetes and obesity/overweight treated with injectable semaglutide (n=129) or oral semaglutide (n=46) in clinical practice. Weight, BMI, and HbA1c were measured at baseline, 6, 12, and 24 months (24-month data available for injectable group only).

What this study cannot tell us

This is a retrospective study without randomization between injectable and oral groups — the groups differed in age, sex distribution, and baseline characteristics. There's no placebo comparison. The 24-month data is only available for injectable semaglutide, preventing long-term comparison with the oral form. Dropout and adherence data are not clearly reported. Specific semaglutide doses are not detailed. The single-center Italian population may not be representative of all patient groups.

How to read the evidence

This is a Level II retrospective observational study without randomization or placebo control. While it provides valuable real-world effectiveness data, the lack of randomization between injectable and oral groups and the absence of a control arm limit causal conclusions. The consistent results across multiple timepoints strengthen confidence in the findings.

When this study was published

Published in 2025, this study provides up-to-date real-world evidence reflecting current semaglutide prescribing practices and formulations available.

The bigger picture

This study contributes to the growing body of real-world evidence showing that semaglutide's clinical trial results translate to practice. The comparison between injectable and oral forms is particularly valuable as more patients and clinicians consider the convenience of oral semaglutide. The finding that injectable semaglutide produced progressive weight loss through 24 months (not a plateau at 6-12 months) suggests that the metabolic benefits compound over time with continued use.

Questions still open

Will oral semaglutide maintain comparable effectiveness to injectable through 24 months and beyond?
What happens to weight when semaglutide is discontinued in real-world practice — do patients regain?
Are there patient characteristics that predict better response to injectable versus oral semaglutide?

Common questions

Does semaglutide keep working long-term or does it stop after a few months?

This real-world study provides reassuring evidence: injectable semaglutide users kept losing weight from 6 months (10.4 kg) through 24 months (15.9 kg). There was no plateau or weight regain during continued treatment. Oral semaglutide showed a similar pattern, with weight loss increasing from 6.7 kg at 6 months to 10.7 kg at 12 months. The key is continued use — the benefits depend on staying on the medication.

Is the oral pill as effective as the injection?

In this study, oral semaglutide produced slower initial weight loss (6.7 kg vs 10.4 kg at 6 months) but caught up substantially by 12 months (10.7 kg oral vs 9.3 kg injectable). The authors conclude the two forms have comparable effectiveness, though injectable semaglutide may work faster initially. For patients who prefer not to inject, the oral pill appears to be a viable alternative that achieves similar long-term results.

Read the original research

Real-world effectiveness of Semaglutide treatment on weight loss maintenance after weight loss in patients with obesity or overweight and diabetes.

Eating and weight disorders : EWD, 30(1), 2

View on PubMed ↗Publisher’s paper ↗

Citation

Del Prete, Michela; Gavazzi, Lidia; Disoteo, Olga Eugenia; Vignati, Federico; Di Sacco, Gianleone; Muratori, Fabrizio. (2025). Real-world effectiveness of Semaglutide treatment on weight loss maintenance after weight loss in patients with obesity or overweight and diabetes.. Eating and weight disorders : EWD, 30(1), 2. https://doi.org/10.1007/s40519-024-01711-2