Efficacy and safety of once-weekly Semaglutide for weight management in adults with overweight or obesity with or without type 2 diabetes: A real-world clinical trial in Bangladesh

Abstract

Introduction: Semaglutide has shown substantial weight reduction in trials, but real-world evidence from South Asian populations is scarce. We evaluated the efficacy and safety of once-weekly semaglutide 2·4 mg over 26 weeks in adults with overweight or obesity, with and without type 2 diabetes mellitus (T2DM). Methods: In this single-arm, non-randomised study, adults (≥18 years) with obesity (BMI ≥30 kg/m²) or overweight (BMI 25–29·9 kg/m²), with or without T2DM, received semaglutide initiated at 0·25 mg and escalated to 2·4 mg by week 16. The primary endpoint was percentage change in bodyweight at week 26. Secondary outcomes included changes in BMI, waist circumference, blood pressure, glycaemic and lipid parameters, and obesity-specific quality of life (OSQoL), alongside proportions achieving ≥5%, ≥10%, ≥15%, and ≥20% weight loss. Analyses followed intention-to-treat principles using linear mixed models. Results: Among 435 participants (154 T2DM, 281 non-T2DM; mean age 38.7, SD 11.1 years; 76% female), mean weight reduction at 26 weeks was −9.5% (95% CI −10.1 to −8.8%), greater in non-T2DM than T2DM (−9.7% vs −9.2%; p=0.044). Overall, 87% achieved ≥5% weight loss, 59% ≥10%, 23% ≥15%, and 7% ≥20% and all were statistically significant. BMI decreased by −4·0 kg/m² and waist circumference by −7·3 cm. Blood pressure declined (−6·5/−3·3 mmHg), and HbA1c decreased by −1·2% in T2DM. OSQoL improved by 10·0 points. Common adverse events were gastrointestinal; two serious events occurred. Conclusions: In this cohort, semaglutide 2·4 mg was associated with clinically meaningful weight loss and acceptable tolerability over 26 weeks. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2026;5(Suppl 1): S30]