The edition · Diabetes & Endocrinology
Twenty-five years on, lifestyle kept the illnesses away and metformin did not
The Diabetes Prevention Program's Medicare follow-up finds a lasting cut in multimorbidity from lifestyle alone. A once-weekly insulin-plus-semaglutide combination beats daily glargine on HbA1c, weight and hypoglycaemia. And the 2026 lipid guideline makes 21.5 million more adults statin-eligible.
The edition in brief
Today's edition leads with the longest look yet at what diabetes prevention actually buys. In the Diabetes Prevention Program's Medicare follow-up, adults randomised to intensive lifestyle a quarter-century earlier were less likely to accumulate multiple chronic conditions (hazard ratio 0.79, 95% CI 0.68-0.93). Metformin showed no such effect (HR 0.91, 0.78-1.07). COMBINE 4 tested IcoSema, a once-weekly combination of insulin icodec and semaglutide, against daily glargine U100 in 485 insulin-naive adults with type 2 diabetes and a baseline HbA1c near 9.5%. IcoSema lowered HbA1c a further 0.88 percentage points, avoided the 3.81 kg weight gain seen with glargine, and roughly halved clinically significant or severe hypoglycaemia. On regulation, no new diabetes drug approval or safety communication appeared today; the week's FDA activity was routine labelling supplements to metformin combinations already on the market. The substantive change is the 2026 dyslipidaemia guideline, which a national survey analysis estimates makes 21.5 million more US adults eligible for a primary prevention statin, most of them younger and at lower risk. Diabetes remains a statin indication in its own right. A meta-analysis of 32 trials separates tirzepatide from semaglutide on blood pressure: tirzepatide cuts hypertension-related adverse events but raises hypotension-related ones, and the risk rises with dose. A cohort of 326,115 mothers finds recurrent gestational diabetes carries a near tenfold later diabetes risk, highest in Asian women. Real-world continuous glucose monitoring across 86,779 people shows time in range falling on Sundays and Mondays and in the evenings: small in size, consistent in direction, and a reason to read the week rather than the fortnightly average.
Lifestyle cut multimorbidity 25 years on; metformin did not
Tell patients with prediabetes that a structured lifestyle programme, not metformin, is what has been shown to reduce the burden of chronic illness decades later.
A once-weekly injection beat daily glargine on HbA1c, weight and hypoglycaemia
In insulin-naive type 2 diabetes on oral therapy with HbA1c above 8%, a weekly basal insulin plus GLP-1 combination is now a credible first injectable, giving lower HbA1c without weight gain and with less hypoglycaemia.
Nothing new approved today; the lipid guideline is the change that matters
Nothing new was approved today; under the 2026 lipid guideline expect more of your non-diabetic primary prevention patients to qualify for a statin, while your patients with diabetes qualify exactly as they already did.
Tirzepatide lowers blood pressure enough to cause hypotension
Before every tirzepatide dose escalation, record a sitting and standing blood pressure and ask whether the existing antihypertensives still need their current doses.
A second gestational diabetes pregnancy raises later diabetes risk tenfold
Record every previous pregnancy affected by gestational diabetes, and screen a woman with two or more of them as intensively as you would someone with prediabetes.
Time in range falls on Sundays and recovers mid-week
When time in range disappoints, find out which days and which hours it disappoints on before changing any dose.
Read the week, not just the fortnightly average
Open the ambulatory glucose profile at the weekly view first, and spend the consultation on the worst day and the worst three hours rather than on the fortnightly average.
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