Evaluation of the effectiveness of semaglutide in providing metabolic control and correction of insulin resistance in patients with type 2 diabetes mellitus in real clinical practice

RELEVANCE. Type 2 diabetes mellitus (DM2) is closely related to obesity and insulin resistance (IR). Semaglutide, glucagon-like peptide-1 receptor agonist, exhibits pronounced effects on glycemic control and body weight. However, data on its effect on various surrogate IR indices in routine practice are limited.

AIM. To evaluate the effect of semaglutide (Semavic®) on metabolic control and IR in patients with DM2 and obesity who did not achieve the target values of carbohydrate metabolism on metformin monotherapy.

MATERIALS AND METHODS. The prospective study included 31 patients aged 40–65 years with DM2, BMI 30.0–39.9 kg/m² and HbA_1c 7.0–9.0% on metformin treatment; 28 patients completed a 24-week follow-up. Anthropometric parameters, bioimpedance body composition, HbA_1c, fasting glycemia, insulin, C-peptide, free fatty acids were evaluated. HOMA-IR, QUICKI, TyG, Adipo-IR indices, C peptide/insulin molar ratio were calculated.

RESULTS. After 24 weeks of semaglutide therapy, there was a significant decrease in body weight (median -8.2% or 8.58 kg), BMI, waist circumference and fat mass as well as an improvement in carbohydrate metabolism: HbA_1c had decreased from 7.63% to 6.25%, 85.7% of patients reached HbA_1c <7.0%. There was a significant decrease of HOMA-IR, TyG, Adipo-IR indices, an increase of QUICKI and C peptide/insulin molar ratio indicating a decrease of IR in the liver, adipose and peripheral tissues. Adverse events were observed in a small proportion of patients and were mainly of a temporary dyspeptic nature.

CONCLUSIONS. Semaglutide in patients with DM2 and obesity in real clinical practice provides a significant reduction of body weight, improves glycemic control and leads to multicomponent reduction of IR with a favorable safety profile.

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