Analogue insulin gives no glycaemic edge over human insulin in low-resource settings

The edition in brief

The lead finding today is a randomised trial that will be uncomfortable for anyone who assumes analogue insulin is automatically the better choice. HumAn-1 randomised 400 children and young adults with type 1 diabetes in Bangladesh and Tanzania to insulin glargine or to continue human isophane or premixed insulin. At 6 months, measured on blinded continuous glucose monitors, there was no difference in time below 3 mmol/L (adjusted mean difference 0.22%, 97.5% CI -0.83 to 1.27) or in time in target range (0.55%, 97.5% CI -2.78 to 3.89). Both groups sat at about 40% time in range, which is the more important number: the analogue did not fix a system problem. A Scandinavian registry study of 322,597 SGLT2 inhibitor treatment episodes puts hard numbers on ketoacidosis risk. Incidence was 2.43 per 1000 person-years, and risk was concentrated in identifiable patients: HbA1c 83 mmol/mol or above (OR 15.37), malnutrition (OR 10.54), previous ketoacidosis (OR 10.40) and BMI under 20 (OR 9.98). Infection preceded a third of cases. Risk did not fade after the first months. An individual-participant meta-analysis of 2,297 pregnancies found metformin did not prevent gestational diabetes, but did prolong gestation slightly and lowered preterm birth (adjusted OR 0.64). On regulation, no new approval or safety communication appeared in today's sweep. The standing item is a set of Class II recalls of compounded semaglutide vials for particulate contamination. Finally, an analysis of 598,883 adults across 82 low- and middle-income countries found waist circumference and relative fat mass classified diabetes better than BMI in people whose BMI sits in the normal-to-overweight band.