SPOT-DM

1. Signed and dated written informed consent.

2. Adult (≥18 years) recipients of a living or deceased donor kidney transplant

3. Between 4- and 12-weeks post kidney transplant

4. Stable kidney function defined as an eGFR > 30 ml/min/1.73m2 (CKD-EPI)

5. At risk for PTDM at the time of transplant based on the following criteria:

1. BMI ≥ 25 kg/m2, or

2. Fasting plasma glucose 6.1-6.9 mmol/L (impaired fasting glucose), or

3. 2hr OGTT plasma glucose 7.8-11.0 (impaired glucose tolerance), or

4. HbA1C 5.5-6.4% (at risk for DM or prediabetes).

1. Established diagnosis of type 1 or type 2 DM as per Diabetes Canada (including the need for glucose-lowering therapy for hyperglycemia at the time of screening)

2. Kidney-Pancreas transplant recipient

3. Acute coronary syndrome, transient ischemic attack or stroke within 30 days prior to screening

4. History of pancreatitis

5. Personal or family history of medullary thyroid cancer or MEN2B

6. Women who are pregnant, nursing or plan on becoming pregnant whilst in the trial

7. Use of GLP1RA in the 30 days prior to screening

8. Contraindication to MRI (applicable only to those undergoing the optional MRI assessments)

9. With known or suspected hypersensitivity to semaglutide or related products

10. Patient not able to understand and comply with study requirements, based on Investigator's judgment.

11. Any other clinical condition that, based on Investigator's judgement, would jeopardize patient safety during trial participation or would affect the study outcom

12. History of glucose-galactose malabsorption syndrome