Half of all gastroparesis sits in a diabetes clinic, and the drug list is where to start

The edition in brief

Today's lead is a JAMA review of gastroparesis, which matters to diabetologists for a simple reason: type 2 diabetes accounts for 51.7% of cases and type 1 a further 5.7%, so most gastroparesis is managed, or missed, in a diabetes clinic. The review names glucagon-like peptide-1 (GLP-1) receptor agonists alongside opioids, cannabis and anticholinergics as drugs to stop before anything else, which makes a medication review the first step in any patient with persistent nausea, vomiting or early satiety. Diagnosis needs scintigraphy showing more than 10% retention at four hours, graded mild, moderate or severe, with treatment following the grade. SYNCHRONIZE-1 reported survodutide, a second glucagon and GLP-1 dual agonist, at 13.0% weight loss over 76 weeks in 725 adults with obesity, against 5.4% on placebo. The 3.6 mg and 6.0 mg doses barely separated, and gastrointestinal symptoms affected 8 or 9 in 10 participants. It is investigational; nothing changes in clinic. An Australian registry linkage of 5,202 children found that type 1 diabetes diagnosed before age 7 carried substantially lower 20-year complication risk than diagnosis at 13 to 16, with adjusted hazard ratios of 0.16 for peripheral neuropathy and 0.25 for severe retinopathy. Age at diagnosis, not duration alone, should drive surveillance. Two small trials report effects large enough to distrust: remote ischaemic conditioning cut albuminuria 37.9% against sham in 40 Indian patients over 8 weeks, and selenium claimed a 1.2 point HbA1c fall in 50 patients over 8 weeks. Both are research-stage. The regulatory sweep found nothing new today.