💉 Once-weekly basal insulin is here. MHRA has authorised Onswik (efsitora) for #T2D 🏛️NICE: an option, but use the least expensive suitable basal, NPH included. Likely role: people who need help to inject. UK price confidential. Awaiting final TA + ICB pathways. 🔗gov.uk/government/news/mhra-… 🔗frontiersin.org/journals/end…

🚨Retatrutide TRIUMPH-1 (NEJM) 80 wk weight: ⤵️25% on 12 mg vs -3.9% placebo. ⤵️28.3% headline = efficacy estimand. 👉9 vs 12 mg near identical; only 54% still on 12 mg at wk 80 ⚠️⚡️Dysaesthesia, hypotension, MACE 9 v 1 (small n) Treat to target, not max dose❓ 🔗 nejm.org/doi/full/10.1056/NE…

🚨#Tirzepatide and AF: signal or noise? 🫀 🆕 JAHA meta-analysis (10 RCTs, n=6,515): AF OR 2.20 (0.81–6.75), any arrhythmia OR 1.84 (1.04–3.90) 🔹Only 38 AF events, mostly from SUMMIT 🔸Semaglutide: 541 events, OR 0.83 (0.70–0.98) 👉Different class, different signal❓ 🔗ahajournals.org/doi/10.1161/… 🔗academic.oup.com/eurjpc/adva…

#ESCcongress2025 💊 STAREE in NEJM: atorvastatin 40mg vs placebo, 9,971 adults aged 70+, 5.9 yrs 📉 Major CV events HR 0.70 ✅ NNT 37 ⚖️ Disability-free survival HR 0.94 (0.84–1.05) ❌ 📊 CV death HR 1.00 Fewer heart attacks. Not a longer or more independent life

💊 The 82-year-old on a statin since their 60s. No ASCVD, no symptoms, no evidence either way SAGA/SITE finally randomised it 🔬 📊 3-yr mortality 7.9% continue vs 7.2% stop ✅ Non-inferior (−0.68%, CI −3.95 to 2.60) ❗ No QoL gain from stopping Shared decision, not a rule 🔗thelancet.com/journals/lanhl…

🚨 Obicetrapib gets a positive CHMP opinion 🎉 @EMA_News 👉 A new lipid⤵️ 🔧 Oral once-daily CETP inhibitor: 🟢 LDL-C ↓33% (↓49% + ezetimibe) 🟢 Lp(a), ApoB & non-HDL all ↓ ⚠️ No CVOT yet, so lipid-lowering only 'til PREVAIL. A 4th-line option to hit targets? #CKM #CVRM 🔗ema.europa.eu/en/news/meetin…

What does metformin actually add in prediabetes beyond delaying diabetes❓ JAMA, 21-yr DPP/DPPOS follow-up (n=1,173): 🔹 Lifestyle reduced multimorbidity (≥2 long-term conditions): HR 0.79 🔸 Metformin did not: HR 0.91 (NS) 🔹 High-cost dyads: lifestyle HR 0.57. Metformin no signal Layered on: no CV, mortality, cancer or frailty signal for metformin in prediabetes. Lifestyle has hard outcome data in Da Qing (CV events, mortality, +1.44 yr life expectancy). And "lifestyle" here isn't a pamphlet. DPP was 16 individual sessions, 2 yr of monthly follow-up, structured ≥7% weight loss, ≥150 min/wk activity. Not soft. The clinical question shifts: 👉Less "should we start metformin?" 👉More "what structured support gives this person the best chance over the next 20 years?" 🔗 doi.org/10.1001/jama.2026.84…

#ADA2026 #Zenagamtide (Amycretin) Delivers in #T2D 💥 Dual GLP-1 + amylin agonist shows impressive HbA1c & weight reductions with no apparent weight-loss plateau 🧪 Phase 2b (n=226; T2D on metformin ± SGLT2i) 🩸 HbA1c:  ⤵️1.41%(10mg) − 1 .71% (40 mg) vs ⤵️0.14% (pbo) 🎯 HbA1c ≤6.5% achieved:  76% (40 mg) vs 14% (pbo) 📉 Mean weight loss at 36 wks: ⤵️12.9(10mg) − 14.6% (40 mg) vs ⤵️2.1% (pbo) 📊 CGM metrics improved across all doses 🤢 GI AEs were the most common, with rates broadly consistent with GLP-1 and amylin therapies 💡 Notably, the 20 mg group had only 8w at maintenance dose and the 40 mg group only 4w, yet weight loss curves were still trending downward at 36w 👉 One of the strongest combinations of glycaemic and weight efficacy seen to date in T2D❗️ 📌 Poster 1730-P

🚨 DiRECT 5-yr data in Diabetic Medicine 👉Primary care low-energy diet: 6.1 kg weight loss, 10% T2D remission at 5 yr (46% → 36% → 10%). 💰Modelled cost dominance over usual care. Lifetime QALY +0.08, cost -£496. 10% reads as failure to some. It isn't. Obesity and T2D are chronic relapsing conditions. Remission ≠ cure. The clinical point worth flagging: 🔹 Patients pursue remission to come off meds. Fair 🔸 Remission isn't licence to drop evidence-based CV prevention 🔹 NICE increasingly puts metformin + SGLT2i as starting point for many adults with T2D 🔸 Statins still matter. CTT: ~22% major vascular event reduction per 1 mmol/L LDL fall 🔹 BP and lipid control need reassessing after remission, not assuming resolved Incretins offer larger weight loss and hard CV data in selected groups (SUSTAIN-6,SELECT, FLOW). DiRECT doesn't. It's a tool. Use it wisely. 🔗 doi.org/10.1111/dme.70306