Objective:To explore the effect of semaglutide combined with metformin in the treatment of obese type 2 diabetes(T2DM)and its impact on insulin resistance and body mass.Methods:124 obese T2DM patients were included and divided into two groups based on different treatment methods,with 62 cases in each group.The control group was treated with metformin alone,while the study group received additional treatment with semaglutide on top of the control group,both groups were treated for 3 months.The blood glucose indicators[fasting blood glucose(FPG),2-hour postprandial blood glucose(2hPG),glycated hemoglobin(HbA1c)levels],insulin resistance indicators[fasting insulin(FINS),pancreatic beta cell function index(HOMA-β),insulin resistance index(HO-MA-IR)],weight loss effects[waist circumference,body mass,body mass index(BMI)],adiponectin levels,and blood lipid indicators[low-density lipoprotein cholesterol(LDL-C),triglycerides(TG),total cholesterol(TC),and high-density lipoprotein cholesterol(HDL-C)levels]were compared between the two groups.Results:After treatment,the levels of FPG,2hPG,HbA1c,FINS,HOMA-IR,waist circumference,body mass,BMI,and serum levels of TC,TG,and LDL-C in both groups decreased(P<0.05),and the study group were lower than the control group(P<0.05).The HOMA-β,adiponectin,and HDL-C levels increased in both groups(P<0.05),and the study group were higher than the control group(P<0.05).Conclusion:The combination therapy of semaglutide and metformin can more effectively control blood glucose in obese T2DM patients,improve insulin resistance,enhance weight loss,and regulate adiponectin and lipid metabolism levels.