Can once-weekly administered semaglutide reduce adipose tissue and fat in patients with type 2 diabetes?

This study assessed the effect of subcutaneous semaglutide (Ozempic) on body composition in patients with type 2 diabetes (T2D). The data showed significant weight loss in these patients after 3 months of semaglutide treatment based on reduced visceral adipose tissue (VAT) thickness and fat mass (FM).

T2D is commonly associated with a group of health conditions that include high blood pressure, increased blood sugar, excess body fat around the waist, and abnormal levels of blood cholesterol and triglycerides (a type of fat). Excessive amounts of VAT (fat tissue around organs) increases the risk of insulin resistance, T2D, and heart disease. Therefore, a major goal in T2D management involves the loss of VAT while retaining lean body mass (BM), skeletal muscle mass (SMM), and strength.

Semaglutide is a medication that acts like the hormone glucagon-like peptide 1 (GLP-1). GLP-1 is found to be abnormally low in patients with T2D. By mimicking the effects of GLP-1, subcutaneous semaglutide helps control appetite and blood glucose. It also results in body weight (BW) loss and reduced risk of heart conditions. However, its effect on body composition in a real-life setting in patients with T2D remains unclear.

This study included 40 patients with T2D. All patients were receiving metformin therapy. Patients were given once-weekly subcutaneous semaglutide over 26 weeks. Follow-up visits occurred at the beginning of the study, after 3 months, and after 6 months. A dose of 0.25 mg of weekly semaglutide was given during the first visit. If well-tolerated, this dose was maintained for 3 consecutive weeks, then increased to 0.5 mg weekly. After 3 months, a weekly dose of 1 mg was administered. Body composition, VAT, muscle strength, and laboratory assessments were performed.

Decreases in VAT, fat mass index (FMI), and BW were observed at follow-up. After 3 months of treatment, VAT, skeletal muscle index (SMI), fat-free mass index (FFMI), waist circumference, and HbA1c (a measurement of blood glucose control over the past 2-3 months) levels were reduced, then became stable at 6 months. Significant weight loss was mainly due to FMI and VAT reduction.

This study found that subcutaneous semaglutide given weekly resulted in adequate glucose control, improved insulin resistance, and improved body composition after 6 months of treatment, in a real-world setting.

The study did not include a control group for direct comparisons. This makes it difficult to determine real benefits. Information on diet was lacking. The muscle strength of legs was not assessed.