Effects of the Short-Acting GLP-1 Analogue Beinaglutide on Liver Fat and Visceral Adiposity in T2DM with MASLD: A 24-Week Single-Arm Exploratory Pilot Study

Aims: This exploratory pilot study evaluated the pharmacodynamic effects of beinaglutide, a prandial human GLP-1 analogue, on liver fat content (LFC) and visceral adiposity in adults with T2DM and MASLD. Methods: In this prospective, single-arm study, 20 participants with newly diagnosed T2DM and MRI-defined steatosis (LFC>5.56%) received subcutaneous beinaglutide (0.2 mg TID) for 24 weeks. The primary endpoint was change in LFC measured by 1 H-MRS. Secondary outcomes included visceral fat volume (VFV) changes via AI-assisted automated MRI segmentation, and metabolic biomarkers. Results: Sixteen participants completed the per-protocol follow-up. After 24 weeks, LFC significantly decreased from 14.56±5.74% to 9.30±6.30% (relative reduction: ≈36%, P < 0.001). VFV declined by ≈22% (P < 0.001). Significant improvements occurred in HbA1c (8.91±1.95% to 6.44±1.02%, P < 0.001) and body weight (﹣6.8±4.0kg, P < 0.001). Weight loss strongly correlated with reductions in LFC (r 2 =0.666) and VFV (r 2 =0.838). Adverse events were primarily mild-to-moderate gastrointestinal symptoms; no serious adverse events occurred. Conclusions: In this pilot study utilizing precision imaging, 24-week beinaglutide treatment was associated with significant reductions in hepatic and visceral fat burden and improved glycemic control. These findings support the metabolic efficacy of prandial GLP-1 therapy and warrant validation in larger randomized controlled trials.