Sustained Weight Loss With Semaglutide: A Real-World Breakthrough for Type 2 Diabetes

Oct 04, 2023

In a groundbreaking development for individuals battling type 2 diabetes, real-world data from Israel has illuminated the potential of semaglutide (Ozempic, Novo Nordisk), a once-weekly glucagon-like peptide 1 receptor agonist (GLP-1 RA).

The findings reveal that semaglutide not only significantly improves A1c levels but also leads to sustained weight loss for up to three years in adults with type 2 diabetes. These revelations come as a ray of hope for individuals grappling with the long-term management of this chronic condition.

Semaglutide’s Impact on A1c and Weight

The study, led by Dr. Avraham Karasik from the Institute of Research and Innovation at Maccabi Health Services, Tel Aviv, Israel, demonstrated remarkable results. After just six months of treatment with semaglutide, participants experienced a substantial reduction in both A1c levels (by -0.77%) and body weight (by -4.7 kg). These initial improvements were maintained for up to three years, particularly among those patients who diligently adhered to the therapy.

Dr. Karasik emphasized the clinical significance of these results, stating that the improvements seen after six months were on par with those observed in randomized trials. However, the pivotal aspect of this study lies in the fact that these effects endured for an extended period, thereby supporting semaglutide’s viability as a long-term solution for type 2 diabetes management.

Real-World Validation of Semaglutide

Esther Walden, RN, deputy head of care at Diabetes UK, expressed her appreciation for the study’s alignment with findings from randomized controlled trials. She noted that these real-world data suggest that the improvements in blood sugar control and weight loss can indeed be sustained in the longer term for adults with type 2 diabetes who adhere to semaglutide as prescribed.

Why Real-World Data Matters

Dr. Karasik emphasized the significance of real-world data in contrast to the controlled environments of clinical trials. In Israel, where once-weekly semaglutide has gained popularity, a sizable sample size was available, providing ample opportunity for a retrospective study. This study aimed to address the questions surrounding the durability of the drug’s effects and how patient adherence impacts its efficacy.

The Role of Patient Adherence

One key takeaway from the study was the direct correlation between patient adherence and the effectiveness of semaglutide. Patients who consistently adhered to the therapy demonstrated a higher positive effect. Dr. Karasik stressed that the drug only works when taken, underscoring the importance of medication compliance in the management of type 2 diabetes.

Study Details

The study encompassed an impressive 23,442 patients, with 6,049 of them being followed up for two years or more. Key baseline statistics included a mean A1c of 7.6%-7.9%, a body mass index (BMI) of 33.7-33.8, and a high prevalence of metformin and insulin use among participants. Notably, the study included patients who had previously been treated with another GLP-1 RA before switching to semaglutide.

Primary and Secondary Outcomes

The primary outcome of the study was the change in A1c from baseline to various time points, ranging from 6 to 36 months. Additionally, the study examined key secondary outcomes such as changes in body weight and A1c in patient subgroups, including those who remained on therapy and those with different baseline characteristics.

Long-Term Sustained Effects

The study revealed impressive results, with A1c levels decreasing by a mean of 0.77% and body weight decreasing by 4.7 kg after just six months of semaglutide treatment. These improvements persisted throughout the three-year follow-up period in approximately 1,000 patients.

High Adherence Yields Better Results

Among the participants who used semaglutide for at least two years, those with high adherence (PDC of at least 80%) experienced significant A1c reductions of 0.76% after 24 months and 0.43% after 36 months. Additionally, their body weight was reduced by 6.0 kg after 24 months and 5.8 kg after 36 months. Patients with lower adherence levels demonstrated less pronounced improvements.

Key Takeaways

As expected, patients who were new to GLP-1 RA therapy experienced more significant reductions in A1c levels and body weight compared to those who had prior experience with these medications. This further underscores the potential of semaglutide as a promising option for patients seeking better control of their type 2 diabetes.

Unusual Observations and Encouraging Outlook

Interestingly, the study noted that some patients who stopped taking semaglutide did not immediately regain weight, indicating a potential residual effect after treatment discontinuation. While this phenomenon differs from the findings of randomized controlled trials, it poses intriguing questions for further investigation.

Dr. Karasik concluded by highlighting the study’s encouraging aspect: unlike many drugs where the effects diminish over time, semaglutide showed no such trend. This adds to the growing body of evidence supporting the drug’s suitability for the long-term management of type 2 diabetes.


The real-world data from Israel’s extensive study of semaglutide provide compelling evidence of its enduring benefits for individuals with type 2 diabetes. With sustained improvements in A1c levels and weight loss over three years, semaglutide offers renewed hope for those seeking a long-term solution to managing this challenging condition. Patient adherence emerges as a pivotal factor, reinforcing the importance of medication compliance in achieving optimal outcomes. As researchers delve deeper into the potential residual effects post-treatment, semaglutide continues to shine as a beacon of promise in the ever-evolving landscape of type 2 diabetes management.