抄録
Objective: Semaglutide, a GLP-1 receptor agonist (GLP-1RA), improves blood glucose control and promotes weight loss. This study aimed to elucidate the background characteristics, glycemic control outcomes, and body composition changes in patients who were administered semaglutide injections at St. Marianna University Hospital (Kawasaki, Japan), particularly focusing on evaluating the fibrosis-4 (FIB-4) index to investigate its potential association with weight loss outcomes.
Materials and Methods: We retrospectively analyzed 31 patients who received semaglutide injections between June 2021 (start of availability of the drug) and February 2022 (announcement of temporary production suspension). We reviewed patient data, including weight, body composition via impedance analysis, HbA1c levels, and the FIB-4 index. Additionally, the parameters of patients who achieved ≥3% weight reduction at 12 weeks were compared with those who did not.
Results: The cohort (51.6% men, median age 52 years) included 2 drug-naïve patients, 6 with no prior GLP-1RA use, and 23 previously treated with GLP-1RAs. Pre-treatment, the mean weight was 84.7 kg, BMI 32.0 kg/m2, body fat percentage 39.0%, and HbA1c 7.5%. The FIB-4 index averaged 1.2. At 12 weeks, 48.4% achieved HbA1c <7% and weight reduction averaged -1.8 kg (-2.5%), with fat loss (-1.4 kg, -4.9%) outweighing minimal muscle loss (-0.3 kg, -0.4%). Weight loss continued at 24 weeks (-3.0%). Patients achieving ≥3% weight loss at 12 weeks had a significantly lower FIB-4 index (0.9 [0.6, 1.1]) compared to non-responders (1.5 [0.9, 2.1]; p=0.01).
Conclusion: Middle-aged, obese patients with poor glycemic control experienced significant improvements with semaglutide, particularly at 12 weeks, with sustained fat loss up to 24 weeks. Fat loss was more pronounced than muscle mass reduction. A lower baseline FIB-4 index correlated with greater weight loss success, suggesting liver fibrosis may limit weight loss outcomes. Further studies on hepatic factors influencing semaglutide's effects are warranted.
