Long-term semaglutide (3+ years) — need advice — Semaglutide (Ozempic / Wegovy)

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Sep 2024

Baltimore, MD

Dec 5, 2024 at 10:39 PM#1

I promised I'd come back and share my labs after 6 months, so here we go. For context: 45M, started at 267lbs, now 224lbs (43lbs lost). T2D diagnosed 2022, also had NAFLD and hypertension. Currently on sema 1.7mg.

Marker	Baseline (Sept 2025)	6 Months (Jun 2026)	Reference Range	Change
A1C	7.8%	5.6%	<5.7%	↓ 2.2 pts
Fasting Glucose	168 mg/dL	94 mg/dL	70-100	↓ 44%
Fasting Insulin	28.4 μIU/mL	11.2 μIU/mL	2.6-24.9	↓ 61%
Total Cholesterol	242 mg/dL	189 mg/dL	<200	↓ 22%
LDL	158 mg/dL	112 mg/dL	<100 optimal	↓ 29%
HDL	38 mg/dL	52 mg/dL	>40	↑ 37%
Triglycerides	312 mg/dL	138 mg/dL	<150	↓ 56%
ALT	62 U/L	28 U/L	7-56	↓ 55%
AST	48 U/L	24 U/L	10-40	↓ 50%
CRP (hs)	6.8 mg/L	1.4 mg/L	<3.0	↓ 79%
Blood Pressure	148/92	128/82	<130/80	↓ improved
Creatinine	1.1 mg/dL	1.0 mg/dL	0.7-1.3	→ stable

My doctor was genuinely emotional at this appointment lol. He said in 20 years of practice he's never seen metabolic markers improve this dramatically in 6 months without bariatric surgery.

The NAFLD is essentially resolved based on my liver enzymes and a follow-up ultrasound. He's talking about taking me off my blood pressure medication at our next visit.

I'm still on metformin but we're discussing tapering that too since my A1C is now in the non-diabetic range. Lifestyle changes alongside the medication: walking 30-45 min daily, high protein diet (~130g/day), no alcohol.

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Dr.AddMedPHL

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Mar 2024

Philadelphia, PA

Dec 5, 2024 at 11:09 PM#2

Bro. THAT TRIGLYCERIDE DROP. 312 → 138?! That's insane. And your hs-CRP going from 6.8 to 1.4 is massive — that's a huge reduction in systemic inflammation.

These are the results that make me rage when people call GLP-1 meds "vanity drugs." This isn't about looking good in a swimsuit, this is about not dying of a heart attack at 55.

Incredible work man. 👏

Last edited: Dec 6, 2024 at 1:09 AM

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pat_auckland

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Jun 2024

Auckland, NZ

Dec 5, 2024 at 11:39 PM#3

Excellent results. A few clinical notes for context:

The triglyceride reduction of 56% is above what the STEP trials typically showed (~17-20% average), suggesting you may have been particularly responsive to the metabolic effects, or your dietary changes (especially cutting alcohol) contributed significantly. Alcohol is a major driver of elevated triglycerides.

The liver enzyme normalization is consistent with emerging data on semaglutide for NAFLD/NASH. There are actually ongoing trials (the ESSENCE trial) specifically studying semaglutide for NASH resolution.[1]

Regarding metformin discontinuation — I'd recommend discussing with your doctor keeping it even if A1C is normal. There's growing evidence that metformin has independent cardioprotective and potentially anti-aging effects beyond glucose control. Plus, the combination may help prevent weight regain.

One lab I'd recommend adding at your next visit: a fasting lipid panel with LDL-P (particle number) and Lp(a). Standard LDL-C doesn't tell the whole story, especially with rapid weight loss.

[1] Newsome PN, et al. "Semaglutide for NASH." N Engl J Med. 2021;384(12):1113-1124.

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hans_munich

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Jul 2024

Munich, DE

Dec 6, 2024 at 12:09 AM#4

Saving this post. I'm 3 months in and my labs aren't as dramatic but trending in the same direction. Your CRP drop gives me hope — my inflammation markers are still high.

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