Introduction: Subcutaneous once-weekly semaglutide (Sema-OW) (0.5, 1.0 mg) has been available in Malaysia since 2020, but is currently not listed in the MOH Medicines Formulary. MOH clinicians prescribe Sema-OW for limited patient numbers, on a “named patient basis” following a closely regulated application process, permitting use once multilevel approval is obtained. Our study aims to report on the glycemic and weight-lowering outcomes of SemaOW in a real-world MOH clinical setting. Methodology: A retrospective, single-arm, observational study was conducted in Hospital Putrajaya and Hospital Kuala Lumpur. The study population comprised adults with type 2 diabetes mellitus (T2DM) treated with Sema-OW for at least 6 months with hemoglobin A1c (HbA1c) and weight parameters available in their medical records. The primary endpoint was HbA1c change at 6 months. The secondary endpoints were the changes in HbA1c and weight from baseline to 12 months, proportion of patients achieving HbA1c <7%, and different levels of HbA1c reduction in 6 and 12 months (<0.5, 0.5–<1.0, 1–<2, ≥2%). Changes in concomitant glucose-lowering medications were additionally observed. Results: The cohort comprised 45 patients, with a mean age and disease duration of 53.3 and 16.3 years, respectively. Baseline mean weight was 100.3 kg, and body mass index (BMI) was 36.8 kg/m², with 88% in the obese BMI category. Baseline HbA1c was 7.9%, and HbA1c reduction was 0.74% at 6 months and 0.84% at 12 months. The proportions of patients achieving HbA1c reduction of <0.5, 0.5–<1.0, 1.0– <2.0, and ≥2.0% were 8.9, 26.7, 26.7, and 8.9%, respectively. The mean weight reduction from baseline was 4.93 kg at 6 months and 6.73 kg at 12 months. Concomitant insulin therapy was observed in 44%, with 31% reduction in total daily insulin requirement at the end of the study, along with simplification of insulin regimens. Conclusion Combination therapy with Sema-OW improved glycemic control with weight loss and enabled treatment deintensification in people with T2DM in Malaysian public tertiary diabetes care.
semaglutide ; Hospitals, Public ; Diabetes Mellitus

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used in the management of type 2 diabetes mellitus (T2DM) and obesity because of their glucoselowering and weight reduction benefits. However, realworld outcomes may differ from clinical trial data. Methodology: This retrospective cohort study included adults with T2DM and obesity initiated on oral semaglutide or injectable dulaglutide at Hospital Sultan Haji Ahmad Shah between 2023 and 2025. Baseline and approximately 6-month follow-up data were obtained from electronic medical records. Outcomes included weight, body mass index (BMI), glycated hemoglobin A1c (HbA1c), total daily insulin dose (TDD), low-density lipoprotein (LDL), and gastrointestinal adverse effects. Results are presented as median (interquartile range, IQR). Results: A total of 22 patients were included, with a median age of 45 years (IQR 39.3–54.5); 13 (59.1%) were male. Thirteen patients (59.1%) received oral semaglutide and nine (40.9%) received injectable dulaglutide. In the semaglutide group, median HbA1c changed from 8.1% (7.4–9.1) to 8.2% (7.1– 9.3), weight from 95.4 kg (84.0–99.1) to 89.6 kg (79.0–100.0), BMI from 33.9 kg/m² (31.4–40.8) to 33.6 kg/m² (31.2–35.6), TDD from 64 IU/day (20–82) to 46 IU/day (18–48), and LDL from 2.2 mmol/L (1.6–2.3) to 2.3 mmol/L (1.3–3.0). In the dulaglutide group, median HbA1c improved from 7.6% (7.4–9.6) to 6.9% (6.5–8.4), weight from 117.0 kg (101.0–121.0) to 111.0 kg (105.0–119.0), BMI from 41.0 kg/ m² (40.0–49.0) to 42.5 kg/m² (38.0–48.0), TDD from 33 IU/ day (30.5–34.0) to 34 IU/day (30.5–34.0), and LDL from 2.2 mmol/L (1.8–2.9) to 2.6 mmol/L (2.0–4.0). Gastrointestinal side effects occurred in 4/13 (30.8%) oral semaglutide users and 0/9 dulaglutide users. Conclusion Injectable dulaglutide showed greater improvement in HbA1c, while both groups demonstrated variable effects on weight, BMI, insulin requirement, and LDL in routine practice.
Adult ; dulaglutide ; semaglutide ; Diabetes Mellitus, Type 2 ; Obesity

Introduction: Semaglutide has shown clinically meaningful effects on weight and glycemic control in randomized trials, but realworld evidence from Malaysian public healthcare settings remains limited. Local data are particularly relevant because access to glucagon-like peptide-1 receptor agonists may be influenced by cost and availability. We evaluated the realworld effectiveness of once-weekly semaglutide in adults with obesity and type 2 diabetes mellitus (T2DM) managed in routine clinical practice at a Malaysian district hospital. Methodology: We conducted a retrospective observational study of adults with obesity and T2DM treated with once-weekly semaglutide at a single district hospital. Demographic, anthropometric, metabolic, and cardiovascular parameters were collected at baseline and follow-up. The primary outcomes were percentage weight change and the proportions of patients achieving at least 5% and at least 10% weight loss. Secondary outcomes included changes in body mass index (BMI), glycated hemoglobin A1c (HbA1c), blood pressure, lipid parameters, and insulin requirements. Paired analyses were performed to compare pre-treatment and post-treatment values. Results: Eight patients were included (mean age 45 years; 63% women; 88% Malay). All had T2DM and hypertension, while most had dyslipidemia. Mean baseline weight was 116.0 ± 22.7 kg, and mean BMI was 43.5 ± 9.0 kg/m². After a mean treatment duration of 23 months, mean weight decreased to 102.9 ± 23.8 kg, representing a mean reduction of 13.1 kg or 11.5%. Six patients (75%) achieved at least 5% weight loss, and four (50%) achieved at least 10% weight loss. Mean BMI decreased to 38.4 ± 8.4 kg/m². Mean HbA1c improved from 8.9 ± 1.9% to 6.3 ± 0.9%. Systolic and diastolic blood pressure declined from 153 ± 22 to 134 ± 17 mmHg and from 91 ± 17 to 82 ± 10 mmHg, respectively. Total cholesterol, low-density lipoprotein cholesterol, and triglycerides also improved. Among insulin-treated patients, all discontinued insulin during follow-up. No treatment discontinuations due to adverse effects were recorded. Conclusion In this small real-world cohort, semaglutide was associated with meaningful weight loss, improved glycemic control, favorable cardiometabolic changes, and successful insulin deintensification. These findings support its use in routine obesity-diabetes care, although larger prospective studies are needed.
Adult ; semaglutide ; Diabetes Mellitus, Type 2 ; Hospitals, District ; Obesity