eng Oriental Scientific Publishing Company Biomedical and Pharmacology Journal 0974-6242 2025-06-30 18 2 1545 1558 10.13005/bpj/3192 65889 article Abid Shaheer 1 Mahir Jallo 2 Shahid Akhtar 3 Department of Biomedical Sciences, College of Medicine, Gulf Medical University, United Arab Emirates. Department of Internal Medicine, Thumbay University Hospital, United Arab Emirates. Department of Clinical Biochemistry, Thumbay Labs, United Arab Emirates The objective of the study was to find out the effect of semaglutide add-on to metformin on the visceral adiposity index and markers of visceral adipose tissue activity in type 2 diabetic patients based on body mass. A total of 90 patients with type 2 diabetes (both genders aged 30-60 years) were included in the study. The participants were divided into three groups based on their Body Mass Index (BMI), which includes the subjects with normal body weight (BMI between 18.5 - 24.9 kg/m²), overweight (BMI between 25 - 29.9 kg/m²) and obesity (BMI ≥30 kg/m²). Enzyme-linked immunosorbent assay was used to analyze serum leptin and adiponectin. Visceral Adiposity Index (VAI) was determined by the formula: Waist Circumference/(39.68 + [1.88 × BMI]) × Triglycerides/1.03 × 1.31/High-Density Lipoproteins. VAI showed minimal changes with metformin alone but decreased significantly with semaglutide add-on (p < 0.05), with the greatest reduction in the obesity group (-0.70). Leptin levels remained unchanged after metformin but significantly declined following semaglutide treatment (p < 0.05). The reduction was most pronounced in the obesity group (-5.10 ng/mL), followed by overweight (-3.40 ng/mL) and normal-weight individuals (-2.60 ng/mL). Adiponectin levels increased significantly post-semaglutide add-on therapy (p < 0.05). The greatest increase was observed in the obesity group (+3.70 μg/mL), followed by overweight (+3.30 μg/mL) and normal-weight participants (+3.30 μg/mL). Semaglutide presents a promising long-term solution for reducing the visceral adiposity index and enhancing metabolic health by modulating markers of visceral fat activity in patients with poorly controlled type 2 diabetes. This study highlights the importance of personalized treatment approaches, suggesting that semaglutide can be strategically utilized to prevent excess fat accumulation in the abdominal cavity. https://biomedpharmajournal.org/vol18no2/effect-of-semaglutide-add-on-to-metformin-on-visceral-adiposity-index-and-markers-of-visceral-adipose-tissue-activity-in-type-2-diabetic-patients/ Adipokine Adiponectin Diabetes Leptin Obesity