By Dr. Asnat Raziel, specialist in obesity treatment, metabolic health and healthy longevity; Director of the Multidisciplinary Center for Obesity Treatment, Assia Medical, Assuta Ramat HaChayal
Wegovy and diabetes: what you need to know
Wegovy and diabetes is a combination that concerns many of my patients. Most people with type 2 diabetes also have excess weight, and weight loss improves blood sugar control. Wegovy is a weekly injection for treating obesity, and it also has a clear effect on blood sugar. In this article I will explain what the studies show and how Wegovy differs from Ozempic. I will also cover what to watch out for.
What is Wegovy and how does it work?
The active ingredient in Wegovy is semaglutide. It belongs to the GLP-1 family, meaning it mimics a natural hormone the gut releases after a meal. This hormone boosts insulin release when blood sugar is high. It also reduces sugar release from the liver and slows stomach emptying. In addition, it acts on the brain and increases the feeling of fullness.
According to official information on Wegovy and the FDA label, Wegovy is approved for weight loss and weight maintenance in adults with obesity. It is also approved for adults with overweight and at least one related disease. Type 2 diabetes is one of these diseases. Moreover, Wegovy is approved to lower the risk of cardiovascular events in adults with heart disease and overweight.
Wegovy and diabetes: how it differs from Ozempic
Ozempic and Wegovy contain the same active ingredient. The difference lies in the dose and the purpose. Ozempic is approved for treating type 2 diabetes, at up to 2 mg per week. In contrast, Wegovy is intended for treating obesity, and the usual maintenance dose is 2.4 mg per week.
The dose rises gradually: you start at 0.25 mg per week and increase it every four weeks. This way the body adapts and side effects ease. According to the current FDA label, adults can later go up to 7.2 mg per week if they need more weight loss. Keep in mind that you must not combine the two drugs, or any other GLP-1 drug. A similar drug also exists as a pill, and I wrote about it in my article on Rybelsus and weight loss.
Wegovy and diabetes in the STEP 2 trial
The STEP 2 trial tested Wegovy in adults with overweight or obesity and type 2 diabetes. It enrolled 1,210 patients from 12 countries, for 68 weeks. All participants also received lifestyle support.
Participants on Wegovy lost 9.6% of their weight on average. By comparison, the placebo group lost 3.4%. Almost 69% of patients on Wegovy lost at least 5% of their weight. In addition, glycated hemoglobin (HbA1c, average blood sugar over the past three months) fell by 1.6 percentage points, compared with 0.4 on placebo.
One figure deserves attention. People with diabetes usually lose less weight than people without diabetes. For example, in the STEP 1 trial, which enrolled people without diabetes, average weight loss was 14.9%. Therefore, realistic expectations are part of the treatment.
Wegovy and diabetes: protecting the heart and kidneys
Diabetes raises the risk of heart disease and kidney disease. In the SUSTAIN-6 trial, Ozempic cut the risk of a major cardiac event by 26% in high-risk patients with diabetes. The event occurred in 6.6% of patients on the drug, compared with 8.9% on placebo.
In the SELECT study, Wegovy reduced cardiovascular events by 20%. However, that study enrolled 17,604 people with heart disease and overweight, but without diabetes. Furthermore, the FLOW trial tested semaglutide 1 mg in patients with diabetes and kidney disease. The drug lowered the risk of major kidney events by 24%. As a result, the FDA also approved Ozempic for slowing kidney disease in diabetes, in January 2025.
Wegovy and diabetes: what to watch out for
Digestive side effects
Nausea, diarrhea, constipation and vomiting are common, mainly at the start of treatment and during dose increases. In STEP 2, 63.5% of patients on Wegovy reported digestive effects, compared with 34.3% on placebo. Most were mild to moderate. I covered this in detail in my article on the side effects of Wegovy.
Low blood sugar
On its own, Wegovy only rarely causes low blood sugar. On the other hand, combining it with insulin or with sulfonylurea drugs raises the risk. Therefore, your doctor may lower the dose of those drugs, and home glucose monitoring is important.
The retina
A rapid drop in blood sugar can temporarily worsen diabetic retinopathy, meaning damage to the blood vessels of the retina. In SUSTAIN-6, researchers saw more retinal complications in the drug group. For this reason, anyone with retinopathy needs close eye follow-up.
Wegovy and diabetes: who is it right for?
The decision to treat is a personal one. It depends on weight, blood sugar control, other medications and underlying conditions. A patient with diabetes and significant excess weight may benefit from a drug that treats both conditions together. I have written at length about the link between obesity and type 2 diabetes. It is also worth knowing the other options, for example Mounjaro for type 2 diabetes.
Before starting, it is worth having tests and preparing a nutrition and activity plan. In our clinic we combine drug treatment with nutritional support and preserving muscle mass. In addition, it is important to pay attention to mood during treatment.
Bottom line
Overall, Wegovy and type 2 diabetes is a combination that studies have examined well. The drug lowers weight and improves blood sugar control, and semaglutide drugs have also shown heart and kidney protection. However, weight loss in diabetes is usually more modest, and you need follow-up of blood sugar, eyes and side effects. If you are unsure, build the plan together with a doctor who knows both fields.
This article provides general information and is not personal medical advice. For any question about your treatment, please consult your doctor.
Questions and answers
Is Wegovy approved for treating diabetes?
Wegovy is approved for weight loss, including in people with type 2 diabetes. For treating diabetes itself, Ozempic is approved, which contains the same active ingredient at a lower dose.
How much weight do people with diabetes lose on Wegovy?
In the STEP 2 trial, average weight loss was 9.6% of body weight at 68 weeks, compared with 3.4% on placebo.
Can I take Wegovy together with insulin?
Yes, but only under a doctor’s guidance. The combination raises the risk of low blood sugar, so doctors sometimes lower the insulin dose.
Can I combine Wegovy and Ozempic?
No. They contain the same active ingredient, and you must not combine two GLP-1 drugs.
References
Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes
Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes
WEGOVY (semaglutide) prescribing information
Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes
FDA approves new indication for Ozempic to lower kidney risks in type 2 diabetes, CKD
