The edition · Diabetes & Endocrinology
Once-weekly insulin plus GLP-1 beats daily glargine at insulin start
COMBINE 4 gives better HbA1c, weight and hypoglycaemia in one weekly injection. The Diabetes Prevention Program at 25 years says lifestyle, not metformin, holds down chronic disease. And Cochrane finds the case for bariatric surgery in diabetes rests on thinner evidence than most counselling assumes.
The edition in brief
Today's lead is COMBINE 4, a 40-week phase 3b trial in 485 insulin-naive adults with type 2 diabetes. Once-weekly IcoSema, insulin icodec and semaglutide in one pen, lowered HbA1c by 0.88 percentage points more than daily glargine U100, produced a 4.61 kg weight advantage and roughly halved clinically significant or severe hypoglycaemia. The drug is not available in India, but the principle it tests — pairing a GLP-1 receptor agonist with basal insulin at initiation rather than starting basal alone — is available now. Long-term follow-up of the Diabetes Prevention Program links 1,173 participants to Medicare data through 2021. Intensive lifestyle was associated with a fifth less multimorbidity than placebo; metformin showed no difference. The benefit held when diabetes was removed from the definition. Regulatory news is quiet: no new diabetes approvals or safety communications, only supplements to existing metformin combinations. The substantive item is the 2026 AHA/ACC lipid guideline, which a new analysis estimates makes 21.5 million more US adults eligible for primary prevention statins, most younger and at lower risk. People with diabetes were already eligible and are unaffected. A Cochrane network meta-analysis of 18 studies confirms bariatric surgery improves weight, waist circumference and HbA1c at five years, but rates the evidence for complete diabetes remission, complications and mortality as very uncertain. Two research items: a 326,115-woman cohort in which recurrent gestational diabetes carried a near tenfold later diabetes risk, highest in Asian women, who also recurred most often at 53%; and a meta-analysis quantifying the haematocrit rise on SGLT2 inhibitors, with polycythaemia reaching 9.7% in real-world data. The pearl: split the CGM download by day of week before changing a dose.
A once-weekly injection beats daily glargine at insulin start
When a patient on maximal oral therapy needs insulin, pairing a GLP-1 receptor agonist with basal insulin gives better HbA1c, weight and hypoglycaemia outcomes than basal insulin alone — now shown head to head in a once-weekly form.
Lifestyle, not metformin, held down chronic disease 25 years on
In prediabetes, put the effort into a structured lifestyle programme — 25 years on it was associated with less accumulated chronic disease, and metformin was not.
A quiet regulatory day, and a lipid guideline that adds 21.5 million statin candidates
No new diabetes approvals or safety communications today; the 2026 US lipid guideline makes 56.6% of adults aged 30 to 79 statin-eligible, but people with diabetes were already eligible and nothing changes for them.
Cochrane on bariatric surgery in diabetes: real benefits, very uncertain sizes
Bariatric surgery reliably improves weight, waist circumference and HbA1c in type 2 diabetes at five years, but the evidence for complete remission, fewer complications and lower mortality remains very uncertain — counsel accordingly.
Recurrent gestational diabetes carries a near tenfold later diabetes risk, highest in Asian women
Treat a second episode of gestational diabetes as a strong signal of future type 2 diabetes — in Asian women the risk after recurrence was around twelvefold — and screen these women at the first antenatal visit of any later pregnancy.
SGLT2 inhibitors raise haematocrit, and in some patients enough to matter
Check a full blood count before starting an SGLT2 inhibitor and again at review — haematocrit rises by about 2 percentage points, and in real-world use close to one in ten patients crossed into polycythaemia.
Read the CGM download by day of the week, not just as an average
Before changing a dose on the strength of a CGM download, split the report into weekdays and weekend days — a pattern confined to two days a week needs a behavioural fix, not a bigger basal dose.
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