Switching from dulaglutide to semaglutide in a patient with schizophrenia, obesity, and poorly controlled diabetes reduced HbA1c and body weight for 6 months, with the patient reporting suppressed hunger.
6-month sustained improvementSemaglutide maintained HbA1c and weight control for 6 months in a patient with schizophrenia where HbA1c had been as high as 10.2% on other treatments
What the researchers found
A 50-year-old woman with type 2 diabetes, obesity, and schizophrenia had poorly controlled HbA1c (8.0-10.2%) on multiple diabetes medications including dulaglutide, with repeated hospitalizations for suicide attempts via drug overdose. Switching to semaglutide 0.5 mg with multidisciplinary support (including cognitive-behavioral therapy) resulted in: patient-reported hunger suppression, sustained HbA1c improvement, and sustained body weight reduction maintained for 6 months. Semaglutide was remarkably more effective than dulaglutide in this case.
Why it matters
People with schizophrenia have 2-3x higher rates of diabetes and obesity, largely driven by antipsychotic medications. They are often excluded from clinical trials and underserved in metabolic care. Demonstrating that semaglutide can effectively control appetite, weight, and blood sugar in this population — where other GLP-1 drugs failed — is clinically significant for the millions of people living with serious mental illness and metabolic comorbidities.
How the study worked
Single-patient case report documenting the switch from dulaglutide to semaglutide in the context of inpatient hospitalization with a multidisciplinary team approach including cognitive-behavioral therapy. Outcomes tracked over 6 months post-initiation.
What this study cannot tell us
This is a single case report — the lowest level of clinical evidence. The improvement cannot be attributed solely to semaglutide, as the multidisciplinary team approach (including CBT) was initiated simultaneously. The 6-month follow-up is relatively short. The patient's psychiatric stability during this period is not detailed. The suicide attempt history raises safety considerations about prescribing injectable medications in this population.
How to read the evidence
This is a single case report, the lowest tier of clinical evidence. While the outcome is notable, the concurrent multidisciplinary intervention confounds attribution and the finding cannot be generalized without larger studies.
When this study was published
Published in 2022, this case report is part of the early wave of clinical observations about semaglutide in psychiatric populations, predating larger studies now underway.
The bigger picture
The intersection of mental illness and metabolic disease is one of psychiatry's biggest challenges. Antipsychotic-induced weight gain affects up to 70% of patients and doubles cardiovascular mortality risk. GLP-1 drugs, particularly semaglutide, are increasingly being studied for antipsychotic-induced weight gain and metabolic syndrome in psychiatric populations. This case adds to the growing rationale for these trials.
Questions still open
- Would semaglutide show consistent benefits for metabolic control across a larger population of patients with schizophrenia?
- Is the appetite-suppressing effect of semaglutide specifically beneficial in counteracting antipsychotic-induced hunger?
- What safety protocols should be in place for prescribing GLP-1 drugs to patients with histories of medication overdose?
Common questions
Why is diabetes so hard to manage in people with schizophrenia?
Why did semaglutide work when dulaglutide didn't?
Read the original research
Semaglutide is effective in type 2 diabetes and obesity with schizophrenia.
Diabetology international, 13(4), 693-697
Citation
Noda, Kaoru; Kato, Takehiro; Nomura, Nao; Sakai, Mayu; Kubota, Sodai; Hirose, Tokuyuki; Liu, Yanyan; Takahashi, Yoshihiro; Takao, Ken; Mizuno, Masami; Hirota, Takuo; Suwa, Tetsuya; Horikawa, Yukio; Yabe, Daisuke. (2022). Semaglutide is effective in type 2 diabetes and obesity with schizophrenia.. Diabetology international, 13(4), 693-697. https://doi.org/10.1007/s13340-022-00590-1