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Clinical trials

STEP 2: semaglutide for obesity with type 2 diabetes

Weight management in a population that typically loses less weight — people who also have type 2 diabetes.

Reviewed 2026-06-04 Physician-reviewed How we research

Quick Answer

STEP 2 (Lancet, 2021) tested once-weekly semaglutide 2.4 mg for weight management in adults with obesity and type 2 diabetes over 68 weeks. Mean weight reduction was about 9.6% with semaglutide 2.4 mg versus about 3.4% with placebo, alongside improved blood glucose — somewhat less weight loss than in people without diabetes, as expected. Compounded semaglutide is not FDA-approved.

Key Facts

  • Adults with obesity and type 2 diabetes; 68 weeks
  • Mean weight change: about −9.6% (2.4 mg) vs −3.4% (placebo)
  • Blood glucose (A1c) also improved
  • Weight loss is typically lower in diabetes than without it
  • Studied the branded product; compounded semaglutide is not FDA-approved

Why diabetes makes weight loss harder

People with type 2 diabetes generally lose less weight on any intervention than people without it, partly due to the disease and some of its medications. STEP 2 asked specifically how semaglutide 2.4 mg performs for weight management in adults who have both obesity and type 2 diabetes.

Design and results

Participants received semaglutide 2.4 mg, a lower 1.0 mg dose, or placebo for 68 weeks. Mean weight reduction with 2.4 mg was about 9.6%, versus about 3.4% with placebo — meaningful, though lower than the ~15% seen in STEP 1 participants without diabetes. Glycemic control also improved.

Why it matters

For patients managing both conditions, STEP 2 supported semaglutide as an option that can produce clinically meaningful weight loss and improve blood glucose at once — relevant because excess weight worsens diabetes and vice versa.

Caveats

Trial averages are not individual guarantees, and results vary widely. STEP 2 studied the branded product; compounded semaglutide is not FDA-approved and was not the subject of these trials.

Frequently asked questions

How much weight did people with diabetes lose in STEP 2?

About 9.6% on average with semaglutide 2.4 mg over 68 weeks, versus about 3.4% with placebo.

Why was weight loss lower than STEP 1?

People with type 2 diabetes typically lose less weight than those without it, so somewhat smaller average reductions are expected.

References

  1. Davies M, et al. Semaglutide 2.4 mg once weekly in people with overweight or obesity and type 2 diabetes (STEP 2). Lancet. 2021;397:971-984.
  2. Wilding JPH, et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1). N Engl J Med. 2021;384:989-1002.
  3. U.S. Food and Drug Administration. Wegovy, Ozempic and Rybelsus (semaglutide) prescribing information. Novo Nordisk.

Citations are for educational reference; this article summarizes published research in plain language and is not medical advice.

Bottom Line

STEP 2 showed semaglutide 2.4 mg reduced weight by about 9.6% in people with obesity and type 2 diabetes while improving glucose — meaningful, and typically somewhat less than in people without diabetes.

Related from the Journal

STEP 1

Weight loss without diabetes.

SUSTAIN program

Glucose outcomes in diabetes.

BP & lipids

Other cardiometabolic effects.

Compounded semaglutide is not FDA-approved as a finished drug product. Compounded medications may be prescribed only when clinically appropriate and must be evaluated by a licensed prescriber. Branded medications such as Wegovy and Ozempic are FDA-approved products; compounded semaglutide is different and should not be described as FDA-approved, “generic Wegovy,” or “generic Ozempic.”
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