Oral semaglutide improves glycemic control and lowers blood lipids: evidence from a real-world study

Background The increasing global prevalence of type 2 diabetes necessitates innovative treatment strategies to mitigate not only hyperglycemia but also its associated cardiovascular risks. Oral semaglutide, a glucagon-like peptide-1 receptor agonist, has shown high efficacy in lowering glucose and inducing weight loss in randomized trials. However, evidence of its beneficial effects in daily clinical practice is limited. In this study we determined the real-world effectiveness of oral semaglutide and investigated whether it impacts metabolic parameters beyond glucose and weight control in patients with moderate to high cardiovascular risk. Methods In a single-center outpatient setting, 53 patients with type 2 diabetes treated with oral semaglutide were retrospectively analyzed. Changes in anthropometric measurements and laboratory parameters over a follow-up period of 3–9 months were assessed. Results Oral semaglutide significantly improved glycemic control and facilitated weight loss, with 50% of patients achieving a body weight loss of ≥5% in a real-world setting. Moreover, oral semaglutide treatment reduced alanine aminotransferase and hepatic steatosis index significantly. In patients on stable lipid-lowering therapy, we observed a significant reduction in total cholesterol and low-density lipoprotein cholesterol levels following treatment with oral semaglutide. Effects on liver inflammation were associated with glucose and weight control, whereas lipid-lowering effects were associated only with glucose control. Conclusion This real-world study demonstrates oral semaglutide efficacy beyond glucose and weight control suggesting its potential in comprehensive cardiovascular risk management in individuals with type 2 diabetes. Research to optimize the clinical use of oral semaglutide in diabetes care and cardiovascular risk reduction may further increase its beneficial effects.