Impact and Effectiveness of Once-Weekly Semaglutide in Achieving Glycemic Targets among Public Health Care Patients with Type 2 Diabetes in Chile: A Multicenter Prospective Study

Introduction and Objective: Glycemic control remains suboptimal in Chile, where only 30-35% of adults with type 2 diabetes (T2D) achieve HbA1c <7% in routine practice. Patients treated in the public system face no access to advanced therapies and high rates of obesity. Objective: To determine whether once-weekly semaglutide, compared with prior standard therapy, improves achievement of HbA1c <7% at 24 weeks in adults with inadequately controlled T2D in the Chilean public healthcare system. Methods: Prospective, open-label, multicenter study conducted across 3 public hospitals. Inclusion criteria: ≥18 years, T2D, HbA1c 7-11%, stable T2D treatment 6 months prior, fundus examination 12 months prior. Exclusion criteria: prior GLP-1 RA use, T1D, severe renal/hepatic impairment, pregnancy, or contraindications. Patients received semaglutide 0.5-1.0 mg weekly for 24 weeks. Primary outcome: proportion achieving HbA1c <7%. Secondary outcomes: change in HbA1c, fasting plasma glucose (FPG), weight, waist circumference, and insulin dose changes. Continuous variables were reported as mean (SD) or median and range. Categorical variables were presented as number and proportion of the total study population. Results: Of 104 enrolled, 92 completed week 24. Baseline: mean age 61 years; HbA1c 8.6%±0.7. At week 24, 56.4% achieved HbA1c <7%. HbA1c decreased -1.6% (SD 1); FPG -26.2 mg/dL (SD 61.3). Weight decreased -5.3 kg (SD 4.3); 60.9% achieved ≥5% loss. Waist circunference decresed 5.7 cm(SD 5.7) Insulin doses decreased progressively. Basal insulin: The mean difference between the dose reduction was 8.0 IU (+8.2) with a median of 6 IU. Prandial insulin: The mean difference in dose reduction was 9.7 IU (+ 5.8) with a median of 10 IU. Gastrointestinal adverse events were most common and mild/moderate. Conclusion: Once-weekly semaglutide enabled more than half of public-system patients to reach HbA1c <7%. These findings support GLP-1 RA incorporation in Latin American public health systems. Disclosure: K. Elgueta: Speaker's Bureau; Current; Novo Nordisk. M. Estica Rivas: None. C. Vargas Reyes: None. F. Gattini: Research Support; Ended; Novo Nordisk. J.J. Godoy: None. P. Salort Chavez: None.