Imaging in Semaglutide Study

Prior treatment

• Previous intolerance or allergy to any semaglutide-based therapy.
• History of prior intolerance to any GLP-1RA or GIP/GLP-1RA.
• History of myocardial infarction or coronary revascularization (percutaneous intervention or coronary artery bypass) within 30 days prior to screening.
• Current use of glucocorticoid therapy (≥5 mg prednisone or equivalent).
• Self-reported weight loss \> 10 lbs in the 90 days prior to screening.
• Use of other mediation, on or off-label, for the primary intent of weight loss within 90 days prior to screening.
• Prior participation in the Endocrinology and Metabolism Institute's Integrated Weight Management Program within the past 3 months.
• Major surgical procedures or significant traumatic injury within 30 days prior to the enrollment date.

Other illness

• Contraindication to MRI (e.g. claustrophobia, implanted devices including cardiac pacemaker and cardioverter-defibrillators), circumference of largest calf \> 17inch/43cm (max size to fit into the MR coil).
• History of hospitalization for heart failure within the past 30 days, or NYHA class IV
• Secondary etiologies for sarcopenia (e.g., gastrointestinal malabsorption, myopathies, severe neurological conditions).
• History of bariatric or metabolic surgery or related procedures.
• Uncontrolled lung disease (e.g., severe asthma or COPD).
• Uncontrolled thyroid disease.
• History of malabsorptive disorders, such as celiac disease or Crohn's disease.
• Conductive implanted devices (e.g., cardiac pacemaker, cardioverter-defibrillators).
• Any medical or surgical condition that, in the opinion of the principal investigator, may make the participant unfit for the trial (e.g., psychiatric disorders, malignancy).
• Any condition, unwillingness, or inability, not otherwise covered by exclusion criteria, which might jeopardize the subject's safety or compliance with the protocol.

Lab values

• Glomerular Filtration Rate (eGFR) within the past 120 days is not available.
• Cholestatic liver disease or inadequate hepatic function (AST/ALT \> 3.0 x ULN).

Other

• Unwillingness or uncertainty to commit to the duration of the study.
• Mental incapacity or language barriers preventing informed consent and compliance.
• Pregnancy, plans for pregnancy in the next 12 months, or lactating/nursing females.
• Active smoking.
• Excessive alcohol consumption, defined as ≥3 drinks per day.
• Personal commitments that may limit optimal participation (e.g., work, travel, caregiving responsibilities).
• Liver cirrhosis.
• Presence of metal in the eye

• Gender: men and women
• Ethnicity: all ethnic groups
• Age between 45 and 75 years
• BMI ≥ 30 kg/m2 and BMI \< 45 kg/m2
• Diagnosis of Type 2 Diabetes (T2D) with HbA1c levels between 7% and 10.5%.
• Starting subcutaneous semaglutide for clinically indicated T2D management.
• Ability and willingness to participate in the study for its full duration.
• Provision of informed consent for participation in research.