Semaglutide-Induced Weight Loss and Metabolic Changes in Bangladeshi Adults with Obesity: A Prospective Study in Diabetic and Non-Diabetic Populations

Abstract

Background: Obesity and type 2 diabetes mellitus (T2DM) are escalating public health crises in Bangladesh, yet real-world pharmacotherapy data remain scarce. Glucagon-like peptide-1 receptor agonists, particularly semaglutide, have demonstrated substantial weight loss and metabolic benefits in global trials, but prospective evidence from Bangladesh is lacking. This study aimed to evaluate the efficacy and safety of once-weekly subcutaneous semaglutide in Bangladeshi adults with obesity, stratified by diabetic status.

Methods: This prospective, single-center, observational cohort study was conducted at Bangladesh Institute of Health Science (BIHS) General Hospital, Dhaka, from July 2024 to June 2025. Fifty obese adults (BMI ≥25 kg/m²) were enrolled and stratified into diabetic (n=30) and non-diabetic (n=20) groups. Semaglutide was initiated at 0.25 mg subcutaneously weekly and escalated to a maximum tolerated dose of 2.4 mg over 16 weeks. Anthropometric, glycemic, blood pressure, lipid profile, and safety parameters were assessed at baseline, 3 months, and 6 months.

Results: Mean weight loss was 9.92±3.48 kg (10.8%) at 6 months (p<0.001), with 82% achieving ≥5% and 56% achieving ≥10% weight loss. Overall HbA1c decreased from 7.08±2.10% to 5.82±1.25% (p<0.001); diabetic patients showed greater reduction          (-1.83%, p<0.001). Significant improvements were observed in BMI, systolic/diastolic blood pressure, total cholesterol, LDL, HDL, triglycerides, and ALT (all p<0.001). Gastrointestinal adverse effects occurred in 52% at 3 months, declining to 34% at 6 months; all were mild-to-moderate, and no serious adverse events or discontinuations occurred. Patient satisfaction was high (78%).

Conclusion: Once-weekly subcutaneous semaglutide up to 2.4 mg is highly effective and well-tolerated in Bangladeshi adults with obesity, producing substantial weight loss, glycemic improvement, and favorable cardiometabolic changes. These findings provide essential local evidence to guide clinical practice in Bangladesh.

Bangladesh J Medicine 2026; 37(3): 239-245