In 168 type 2 diabetes patients in Bulgaria, one year of semaglutide treatment reduced median weight from 100 to 91.5 kg and HbA1c from 7.8% to 6.9%.
8.5 kg median weight lossPatients went from a median of 100 kg to 91.5 kg after one year of semaglutide in routine clinical practice
What the researchers found
After one year of subcutaneous semaglutide treatment (titrated from 0.25 mg to 1 mg weekly), 168 type 2 diabetes patients showed significant improvements across all measured metabolic parameters. Median weight decreased from 100.0 kg to 91.5 kg (p<0.001), median BMI from 33.6 to 30.9 kg/m² (p<0.001), and HbA1c from 7.80% to 6.90% (p<0.001).
At baseline, 92.3% of patients had obesity (BMI ≥30), with 53.6% in Obesity Class 1. After treatment, 81 patients transitioned to lower obesity classes, though 15 remained in Class 3 obesity.
Why it matters
Clinical trials show semaglutide works well under controlled conditions, but real-world data from routine practice is essential to confirm those benefits hold up. This Bulgarian study adds to the growing body of evidence that semaglutide delivers meaningful weight loss and blood sugar improvements in everyday clinical settings, including in Eastern European healthcare systems where access patterns may differ.
How the study worked
Retrospective analysis of 168 type 2 diabetes patients receiving dispensary monitoring at a specialized endocrinology hospital in Sofia, Bulgaria. Clinical data including comorbidities, HbA1c, weight, and BMI were collected from medical records at baseline and after one year. Patients followed a standard titration protocol: 0.25 mg weekly for four weeks, then 0.5 mg, then 1 mg maintained for the remainder of the year.
What this study cannot tell us
This was a retrospective study without a control group, making it impossible to separate semaglutide's effects from other interventions or natural progression. The study was conducted at a single specialized hospital, which may represent a more closely monitored population than typical practice. Only one year of follow-up was available, so long-term sustainability of results is unknown. The abstract does not report dropout rates or adverse events.
How to read the evidence
This is a retrospective real-world study from a single center without a control group. While it provides valuable evidence that semaglutide works outside of clinical trials, the lack of randomization and blinding limits the strength of causal conclusions.
When this study was published
Published in 2025 with data from routine clinical practice, this study provides current real-world evidence for semaglutide effectiveness in a European population.
The bigger picture
Real-world evidence studies like this one are crucial for validating that clinical trial results translate to diverse patient populations and healthcare settings. As semaglutide becomes available in more countries, data from different healthcare systems helps build confidence in its effectiveness and informs local prescribing guidelines and reimbursement decisions.
Questions still open
- Will the weight loss and HbA1c improvements be maintained beyond one year in this patient population?
- What clinical characteristics predict the best vs. poorest responses to semaglutide in real-world settings?
- How do these results compare to real-world semaglutide outcomes in other Eastern European countries?
Common questions
How much weight can I expect to lose on semaglutide?
What is the standard dosing schedule for semaglutide?
Read the original research
Predictive factors for HbA1c and weight loss associated with semaglutide treatment in type 2 diabetes mellitus: real-world clinical evidence.
Frontiers in endocrinology, 16, 1621892
Citation
Milushewa, Petya; Mitreva, Yoanna; Chakarova, Nevena; Tankova, Tsvetalina; Naseva, Emilia; Petkova, Valentina. (2025). Predictive factors for HbA1c and weight loss associated with semaglutide treatment in type 2 diabetes mellitus: real-world clinical evidence.. Frontiers in endocrinology, 16, 1621892. https://doi.org/10.3389/fendo.2025.1621892