SEMAGLUTIDE VERSUS INSULIN GLARGINE IN TYPE 2 DIABETES WITH FATTY LIVER DISEASE

Abstract

Objective: To compare the effects of semaglutide and insulin glargine on glycaemic control, body weight, and liver enzymes in patients with type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD) following secondary failure to oral hypoglycemic agents (OHA). Methods: A 12-weekrandomized comparative study was conducted at Islamabad, Pakistan. Adults aged 30–65 years with T2DM, MASLD, and secondary OHA failure were randomized to semaglutide once weekly (Group 1, n=60) or subcutaneous insulin glargine once daily (Group 2, n=60) for 12 weeks. Outcomes parameters included HbA1c, body weight, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and adverse effects, assessed at baseline and week 12. Within-group and between-group comparisons used paired and independent sample t-tests (p≤0.05). Results: Both therapies showed significant improvements in HbA1c, AST, and ALT. Semaglutide produced greater reductions in HbA1c (10.82±0.70% to 9.84±0.64%), body weight (94.91±6.47 to 89.55±6.00 kg), AST (46.09±3.01 to 40.32±2.99 U/L), and ALT (82.16±15.72 to 71.15±15.61 U/L) compared with insulin glargine, which produced modest glycemic and hepatic improvement but was associated with weight gain. Between-group comparisons at week 12 favored semaglutide for all primary outcomes. Mild gastrointestinal effects were more frequent with semaglutide; weight gain, hypoglycemia, and injection-site reactions were observed with insulin glargine. No serious adverse events or treatment discontinuations occurred. Conclusion: Semaglutide demonstrated superior glycaemic, weight, and hepatic outcomes as compared to insulin glargine in T2DM patients with MASLD following secondary OHA failure, with a favorable safety profile over 12 weeks.