Semaglutide: research, uses and evidence

Semaglutide is a long-acting GLP-1 receptor agonist approved for type 2 diabetes, chronic weight management and cardiovascular risk reduction. In the STEP 1 trial, adults without diabetes lost an average of 14.9% of body weight over 68 weeks on the 2.4 mg weekly dose, compared with 2.4% on placebo.

Structure

31-residue GLP-1 analog. Aib at position 8 resists DPP-4 cleavage; a C18 fatty diacid on Lys26 binds albumin and gives a half-life of about one week.

How it works

Semaglutide binds the GLP-1 receptor, the same receptor as the gut hormone glucagon-like peptide-1. It increases glucose-dependent insulin release, lowers glucagon, slows gastric emptying and acts on appetite-regulating areas of the hypothalamus and brainstem. Native GLP-1 is broken down by DPP-4 in about two minutes; semaglutide’s modifications extend its half-life to roughly 165 hours.

Research use cases

Areas where Semaglutide has been studied. Inclusion here does not mean it works for that purpose.

Glycaemic control in type 2 diabetes
Chronic weight management in obesity and overweight with comorbidities
Reduction of major adverse cardiovascular events in people with established cardiovascular disease and overweight
Chronic kidney disease progression in type 2 diabetes
Ongoing research in MASH (fatty liver disease), heart failure with preserved ejection fraction, and addiction

What the research found

Weight loss (STEP 1)

1,961 adults with obesity or overweight and no diabetes received 2.4 mg weekly or placebo for 68 weeks alongside lifestyle intervention. Mean weight change was −14.9% versus −2.4%, and 86% of treated participants lost at least 5% of body weight.¹

Cardiovascular outcomes (SELECT)

In 17,604 adults with cardiovascular disease and overweight but no diabetes, semaglutide 2.4 mg reduced the composite of cardiovascular death, heart attack and stroke by 20% over a mean follow-up of about 40 months.²

Kidney outcomes (FLOW)

In people with type 2 diabetes and chronic kidney disease, semaglutide 1 mg lowered the risk of major kidney events by 24%. The trial was stopped early for efficacy.³

Weight regain after stopping

In the STEP 1 extension, participants regained about two thirds of the weight they had lost within a year of stopping treatment, which supports the view that these drugs treat obesity as a chronic condition.⁴

Safety and open questions

Gastrointestinal effects (nausea, diarrhoea, vomiting, constipation) are the most common and are usually worst during dose escalation. Labelled warnings include a boxed warning for thyroid C-cell tumours seen in rodents, plus pancreatitis, gallbladder disease, hypoglycaemia when combined with insulin or sulfonylureas, acute kidney injury from dehydration, and diabetic retinopathy complications. It is contraindicated in people with a personal or family history of medullary thyroid carcinoma or MEN 2.

Regulatory status

FDA-approved (Ozempic, 2017; Rybelsus, 2019; Wegovy, 2021). Prescription only.

Status was accurate when this page was last reviewed on October 26, 2026. Regulations change; check with the relevant authority before relying on it.

Semaglutide: common questions

Is semaglutide a peptide?

Yes. It is a 31-amino-acid analog of human GLP-1 with two key changes: an Aib substitution that blocks DPP-4 breakdown and a fatty-acid side chain that binds albumin. Those changes stretch its half-life from minutes to about a week.

What is the difference between Ozempic and Wegovy?

Both contain semaglutide. Ozempic is approved for type 2 diabetes at doses up to 2 mg weekly. Wegovy is approved for chronic weight management and cardiovascular risk reduction at a 2.4 mg weekly maintenance dose. Rybelsus is an oral tablet formulated with the absorption enhancer SNAC.

What is “semaglutide sodium”?

It usually refers to a salt form sold outside the approved supply chain. Salt forms add mass, so 5 mg of a salt contains less than 5 mg of the active peptide. See our guide on semaglutide salt forms.

Is Semaglutide approved for human use?