Comparative effectiveness of semaglutide and dulaglutide combined with hypocaloric diet in newly diagnosed type 2 diabetes: a retrospective real-world study

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used in early T2D management due to their glycemic and weight-reducing effects. However, real-world comparative data in newly diagnosed treatment-naïve individuals remain limited. This retrospective real-world study evaluated 106 adults aged 18–75 years with newly diagnosed T2D who initiated semaglutide (1.0 mg) or dulaglutide (1.5 mg) between December 2023 and December 2024. All patients received concurrent hypocaloric dietary intervention (1,200–1,400 kcal/day). Clinical and biochemical parameters were assessed at baseline and 6 months, with additional weight assessments at 3 months. Multivariable analyses were performed to adjust for baseline differences. Both treatment groups demonstrated significant reductions in HbA1c, fasting blood glucose, liver enzymes, and lipid parameters at 6 months. After adjustment for baseline covariates, semaglutide was associated with greater weight reduction and LDL cholesterol improvement, whereas HbA1c reduction was comparable between groups. Mild increases in pancreatic enzyme levels were observed in both groups, with higher elevations in the dulaglutide group. Gastrointestinal adverse events were common but generally mild. In this retrospective real-world cohort receiving structured dietary intervention, both semaglutide and dulaglutide improved glycemic control and metabolic parameters in newly diagnosed T2D. Semaglutide demonstrated superior weight reduction, while glycemic effects were similar. Baseline differences and the retrospective design should be considered when interpreting these findings. Not applicable.