SEMAGLUTIDE: Weight loss, glycaemic control and safety profile in obese patients with and without type-II diabetes-An experience from Karachi, Pakistan.

OBJECTIVE: To assess the efficacy and safety of Semaglutide (a GLP-1 receptor agonist) in obese patients with and without Type-II Diabetes Mellitus. METHODS: This observational analytic cohort study was conducted in a private medical institute in Karachi Pakistan; from August 2022 to January 2023. A total of 65 obese individuals >18 years of age, with or without T2D were included. Semaglutide was started with an initial dose of 0.25 mg with an increase in dose to 0.5 mg, 1 mg and 2 mg with gap of 4 weeks between each dose escalation. Patients were kept on the maximally tolerated dose, not exceeding 2 mg/week. Patients were evaluated on the first and second follow-up at 3 and 6 months respectively, for the same parameters as noted at the initial visit, along with documentation of any adverse effect. RESULTS: Out of 65 patients, 49.2% were female and 50.8% were male. Mean age was 49.16 ± 14.20 years. 47.7% of the patients had hypertension, 46.2% had diabetes mellitus, 35.4% had dyslipidemia and 13.8% had ischemic heart disease. All patients were using 0.5 mg of semaglutide after three months, however by six months 33.8% were using 1 mg, and 24.6% were on 2 mg, whereas 40% decided to adhere to 0.5 mg and only 1.5% decided to reduce the dose to 0.25 mg due to adverse effects. Patients reported start of the first adverse effect by 3.44 ± 2.27 weeks of starting the drug. By the end of three months, 55.4% of patients in our study reported adverse effect, which declined to 34.5% by the end of six months, and the majority being mild to moderate and the most frequent side effects were gastrointestinal in origin. There was no significant difference in side effect profile in between those with and without diabetes mellitus. The average weight loss was 5.81 ± 2.64 kg and 9.86 ± 3.54 kg after three and six months respectively and the amount of weight loss was almost equal in those with and without T2D. A significant decline was observed in the average HbA1c levels, body mass index (= <0.001), systolic blood pressure (= <0.001), diastolic blood pressure (= <0.001), total cholesterol (= <0.001), high-density lipoprotein (= <0.001), low-density lipoprotein (= <0.001), triglycerides (= <0.001) and alanine transaminase levels (= <0.001). CONCLUSION: Semaglutide showed substantial weight, HbA1c and cholesterol reductions in those with or without type-II diabetes.