Translating Guidelines into Practice: A Prospective Real-World Study of a Romanian Cohort Treated with GLP-1 RAs

Background/Objectives: Obesity and type 2 diabetes mellitus (T2DM) have a continuously increasing prevalence and often co-exist, exacerbating cardiometabolic risk. GLP-1 receptor agonists (GLP-1 RAs) are recommended as first-line therapy for patients with T2DM and excess weight, particularly when cardiovascular risk is present. This study assessed the real-world effectiveness of available GLP-1 RAs in Romania on glycemic control, body weight reduction (BWR), and waist circumference (WC) in T2DM patients with excess weight. Methods: A prospective observational study was conducted on 311 adults with T2DM (glycated hemoglobin (HbA1c) > 7.2%, body mass index (BMI) ≥ 25 kg/m²). Patients received exenatide, semaglutide (either oral or injectable), or dulaglutide and were monitored for a period of 6 months. Parameters assessed included HbA1c, body weight, BMI, and WC. Results: All treatments significantly improved the patients' HbA1c, BMI, and WC (p < 0.05). Dulaglutide had the most significant impact on HbA1c (-6.69 ± 0.91%), while injectable semaglutide led to the most notable BWR (-4.60 ± 2.74 kg) and WC reduction, especially among male patients. No significant differences in treatment effect were observed concerning the patient's age, gender, or T2DM duration. Conclusions: In real-world clinical practice, GLP-1 RAs provide significant metabolic benefits and should be considered as part of individualized treatment strategies for T2DM patients who are overweight or obese.