The edition · Diabetes & Endocrinology
Glargine gave no glycaemic edge over human insulin in low-resource type 1 care
A trial in Bangladesh and Tanzania found no advantage for insulin glargine over isophane. Weight returns at about 1 kg a month once semaglutide or tirzepatide stops. And metformin still does not prevent gestational diabetes.
The edition in brief
The day's biggest item is a negative trial with real consequences for how money is spent. HumAn-1 randomised 400 children and young adults with type 1 diabetes in Bangladesh and Tanzania to insulin glargine or usual care with isophane or premixed insulin. At six months, blinded continuous glucose monitoring showed no difference in time below 3.0 mmol/L (adjusted difference 0.22%, 97.5% CI -0.83 to 1.27) and none in time in target range (0.55%, 97.5% CI -2.78 to 3.89). Time in range sat near 40% in both arms, which says the limiting factor is monitoring, education and supply rather than the basal insulin molecule. A Bayesian re-analysis of six discontinuation studies puts weight regain after stopping semaglutide or tirzepatide at 1.04 kg per month, with half the lost weight back by about seven and a half months. Stopping needs a plan, not a follow-up appointment in a year. A meta-analysis of 21 studies in gestational diabetes found continuous glucose monitoring gave modestly better glycaemic measures than fingerprick testing, with fewer caesarean deliveries, less macrosomia and less neonatal hypoglycaemia, but also 21% more medication use. An individual-participant meta-analysis of 2,297 pregnancies confirms metformin does not prevent gestational diabetes, though it lengthened gestation and cut preterm birth. Pooled trial data found no overall heart failure signal for gliptins, with saxagliptin the exception. No new regulatory action today.
Analogue insulin gave no glycaemic advantage over human insulin in low-resource settings
In cost-constrained type 1 care, switching from human isophane to glargine bought no measurable glycaemic benefit at six months — spend the money on monitoring and education instead.
Weight comes back at about 1 kg a month once a GLP-1 drug is stopped
Anyone stopping semaglutide or tirzepatide should be told to expect about 1 kg of regain per month and be reviewed within two months, not at the next annual visit.
Continuous glucose monitoring in gestational diabetes: small glycaemic gains, better outcomes, more medication
Continuous glucose monitoring in gestational diabetes improves glucose modestly and neonatal outcomes more, but expect roughly a fifth more women to need medication — target it at the higher-risk pregnancies rather than using it universally.
Metformin does not prevent gestational diabetes, but it does lengthen pregnancy
Stop using metformin as prophylaxis against gestational diabetes in high-risk pregnancies — pooled individual patient data show no effect on the diagnosis itself.
Gliptins as a class carry no heart failure signal — saxagliptin remains the exception
Gliptins as a class show no heart failure signal, so continue sitagliptin, linagliptin or vildagliptin — but move patients with heart failure off saxagliptin.
Read the cycle before you change the ratios
When a menstruating patient's glucose worsens for a fortnight, check the cycle phase before changing any settings — luteal insulin resistance is real, repeatable, and best handled with a temporary adjustment.
No new regulatory action today
Nothing new from regulators today — the July incretin consensus statement on protein, resistance exercise and psychological support during weight loss remains the guidance to work from.
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