Diabetes Obes MetabType 2 DiabetesCohortNovember 27, 2025

PIONEER REAL Saudi Arabia: A multicentre, prospective, real-world study of once-daily oral semaglutide use in adults with type 2 diabetes in Saudi Arabia.

ElBadawi H, Albalkhi N, Al Kadhim I, Elsadig A, Baltzis D, Hatahet MH, Ismail M, Khader S, Rasmussen CL, Scheuer SH, Shalaby A, Almehthel M

View on PubMed DOI: 10.1111/dom.70317

Key Finding

Saudi adults with type 2 diabetes taking oral semaglutide for 34-44 weeks saw their HbA1c drop by 1.0 percentage point and lost an average of 4.4 kg (9.7 pounds), with nearly 62% reaching their blood sugar target.

What This Study Found

Think of HbA1c like a report card for your blood sugar over the past 3 months - the lower the better. This real-world study followed 192 Saudi adults with type 2 diabetes who started taking oral semaglutide pills (not injections) in regular doctor visits, like watching how a new medication performs outside the controlled environment of a clinical trial. These weren't people starting from scratch - they had an average HbA1c of 8.0%, which is like having a C- grade when you need a B+ (under 7%) to protect your organs from diabetes damage. After about 9 months of treatment, the results were impressive: participants dropped their HbA1c by a full percentage point (like going from a C- to a solid B), and lost nearly 10 pounds on average. Their waist circumference also shrank by 4.3 cm - imagine your belt getting looser by almost two belt holes. What makes this study particularly valuable is that it shows oral semaglutide works just as well in routine Saudi medical practice as it did in carefully controlled research studies, proving the medication's benefits translate to real-world healthcare settings.

Statistics Decoded

The p < 0.0001 for all major outcomes means these results definitely weren't due to chance - like flipping a coin and getting heads 10,000 times in a row. When 61.9% of participants reached HbA1c levels under 7%, that means if you lined up 100 people taking this medication, about 62 would hit their blood sugar target. The combination success rates are even more telling: 21.9% achieved both significant HbA1c improvement (≥1% drop) AND meaningful weight loss (≥3% of body weight), while 17.1% hit the even higher bar of ≥5% weight loss alongside diabetes improvement. The treatment satisfaction scores jumping by 8.7 points (DTSQs) and 14.9 points (DTSQc) both with p < 0.0001 means patients genuinely felt much better about their diabetes treatment - this wasn't just wishful thinking. Only 49.5% stayed on the medication by study end, which reflects real-world challenges like side effects, cost, or switching to other treatments, giving us an honest picture of how oral semaglutide performs outside perfect clinical trial conditions.

Why This Matters

This proves that oral semaglutide delivers meaningful diabetes control and weight loss benefits in Middle Eastern populations receiving routine medical care, not just in controlled clinical trials. For doctors treating Saudi patients, this real-world evidence supports oral semaglutide as an effective option that patients are satisfied with, though they should expect about half of patients may switch treatments during the first year.

Original Abstract

PIONEER REAL Saudi Arabia investigated real-world clinical outcomes associated with the use of once-daily oral semaglutide in adults with type 2 diabetes (T2D). This was a 34- to 44-week multicentre, prospective, open-label study in adults with T2D, who were treatment-naive to injectable glucose-lowering medication and initiated oral semaglutide in routine clinical practice. The primary endpoint was change from baseline to end of study (EoS) in glycated haemoglobin (HbA1c). Secondary and exploratory endpoints included changes in body weight (BW) and waist circumference (WC) from baseline to EoS. Treatment satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire-status (DTSQs) and change (DTSQc) tools. In total, 192 participants initiated oral semaglutide. At baseline, mean (standard deviation) age was 51.7 (10.91) years, mean HbA1c was 8.0% (1.51) and mean BW was 90.5 kg (15.68). In total, 139 participants completed the study. Estimated mean (standard error [SE]) changes (95% confidence interval) in HbA1c and BW were -1.0%-points (0.09; p < 0.0001) and -4.4 kg (0.51; p < 0.0001), respectively. Estimated mean (SE) change in WC was -4.3 cm (0.62; p < 0.0001). At EoS, 61.9% of participants had HbA1c levels <7%, with 21.9% and 17.1% achieving HbA1c reductions of ≥1% alongside BW reductions of ≥3% or ≥5%, respectively. Treatment satisfaction increased significantly (mean change in DTSQs +8.7 and DTSQc 14.9; both p < 0.0001). At EoS, 49.5% of participants remained on oral semaglutide, of whom 47.4% were receiving the 14.0 mg dose. This real-world population of adults with T2D in Saudi Arabia experienced clinically significant reductions in HbA1c and BW, increased treatment satisfaction and a favourable safety profile, consistent with previously published PIONEER REAL studies.