To conduct a meta-analysis on the efficacy and safety of mazdutide in weight loss for both diabetic and non-diabetic obese individuals.

By searching domestic and international literature databases from the establishment of the database to January 2026, randomized controlled trials involving both diabetic and non-diabetic populations and using mazdutide intervention were included. A standardized process and a double-blind quality control system by two researchers were adopted to observe weight loss efficacy-related indicators and safety.

A total of 10 studies were included, involving 2,321 patients. Overall, mazdutide achieved greater weight loss compared to the control group, and a dose-response gradient was observed. Stratified meta-analysis by follow-up time showed that the weight loss effect generally increased with the extension of follow-up. It was confirmed that the weight loss benefit of mazdutide may be related to the follow-up duration (MD=-6.57%, 95%CI: -8.18%~-4.96%; I²=94%; Z=8.00, P<0.0001). In terms of safety outcomes, mazdutide significantly increased the risk of gastrointestinal adverse reactions. Regarding hypoglycemia, no statistically significant difference was found between the two groups (RR=1.64, 95%CI: 0.94~2.84; I²=0%; Z=1.75, P=0.08). Begg's test did not suggest publication bias (Z=-0.17, P=0.87), and Egger's regression intercept test also did not show statistical significance (P=0.27).

Mazdutide demonstrated statistically significant weight loss effects in both diabetic and non-diabetic obese individuals, with a dose-dependent trend. Given the high heterogeneity in some analyses and the limited follow-up duration, the extent of efficacy and long-term benefits still require further research for confirmation.