Presentation (CTI)

OBJECTIVES: Obesity and type 2 diabetes mellitus (T2DM) are closely linked through shared pathophysiological mechanisms that affect glucose metabolism and insulin resistance. Contemporary glucose-lowering therapies, particularly sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RAs), are widely recommended for patients with T2DM who are overweight or obese due to their favorable effects on body weight and cardiovascular outcomes. However, whether baseline obesity status influences the magnitude of glycemic response to these agents in real-world clinical practice remains unclear.
METHODS: This multicenter retrospective observational study included adults with T2DM initiated on either SGLT-2i or GLP-1RA across three major healthcare institutions in Riyadh, Saudi Arabia. Patients were stratified into obese (BMI ≥30 kg/m²) and non-obese (BMI <30 kg/m²) groups. Changes in HbA1c, body weight, and BMI were evaluated at 3-, 6-, 9-, and 12-month follow-up windows using standardized time intervals. Between-group comparisons were performed using independent t-tests.
RESULTS: A total of 1,016 patients were included, of whom 73.4% were classified as obese. Obese patients experienced significantly greater reductions in body weight and BMI at 3, 6, 9, and 12 months compared with non-obese patients. In contrast, both groups demonstrated clinically meaningful and comparable reductions in HbA1c across all follow-up periods, with no statistically significant differences observed between BMI categories. Modest reductions in blood pressure were noted, and renal function remained stable throughout follow-up in both groups.
CONCLUSIONS: These findings suggest that while obesity may enhance weight-related benefits, HbA1c response to these therapies appears broadly consistent across BMI categories, supporting treatment decisions guided by therapeutic goals rather than obesity status alone.