The edition · Diabetes & Endocrinology
Glargine gave children in low-resource settings no advantage over human insulin
A randomised trial in Bangladesh and Tanzania found insulin glargine no better than human isophane on either co-primary glycaemic outcome, a Bayesian re-analysis put half the weight lost on semaglutide or tirzepatide back within seven and a half months of stopping, and 48 trials found no signal of gastrointestinal cancer with SGLT2 inhibitors.
The edition in brief
The most useful finding today is a negative one. HumAn-1 randomised 400 children and young people aged 7-25 with type 1 diabetes in Bangladesh and Tanzania to insulin glargine or usual care with human isophane or premixed 70/30. At six months, blinded continuous glucose monitoring showed no difference in either co-primary outcome: time in very low range differed by 0.22% (97.5% CI -0.83 to 1.27) and time in target range by 0.55% (97.5% CI -2.78 to 3.89). Serious adverse events were uncommon in both groups. Where cost decides what a family can sustain, this supports human insulin as a defensible choice rather than a compromise. A Bayesian re-analysis of six studies and 1,776 participants quantified what happens after GLP-1 therapy stops: 15.35 kg lost at cessation, regained at 1.04 kg per month, with half the loss back by 7.5 months and baseline weight by 15 months. The longer projections are extrapolations, but the early slope is measured and steep enough to plan around before stopping. On safety, 48 randomised trials totalling 48,765 patients found no association between SGLT2 inhibitors and gastrointestinal neoplasms (OR 1.10, 95% CI 0.84-1.44, I-squared 0%), with no site-specific signal. Half the trials followed patients for a year or less, so this is reassurance rather than proof. Regulatory news is real today: a generic dapagliflozin approval from an Indian manufacturer, and a Class II recall of compounded semaglutide vials for particulate matter. A twelve-month extension of the Omnipod 5 trial held time in range at 62.3% with HbA1c down 1.14 points.
Glargine gave no glycaemic advantage over human insulin in low-resource settings
In children and young people with type 1 diabetes in low-resource settings, insulin glargine gave no measurable advantage over human isophane insulin on hypoglycaemia or time in range, so cost and continuity of supply should drive the choice.
Half the weight comes back within eight months of stopping semaglutide or tirzepatide
Tell patients stopping semaglutide or tirzepatide that regain begins straight away at about 1 kg a month, with half the weight lost back within eight months, and arrange a maintenance plan before treatment ends.
No gastrointestinal cancer signal with SGLT2 inhibitors across 48 trials
Pooled randomised evidence shows no increase in gastrointestinal cancer with SGLT2 inhibitors, but follow-up was too short to settle long-term risk, so reassure without overstating it.
Generic dapagliflozin approved, and a recall of compounded semaglutide vials
A new generic dapagliflozin approval makes the drug cheaper again, and an ongoing Class II recall of compounded semaglutide vials for particulate contamination is a reason to ask every patient on semaglutide whether they are using a vial rather than a pen.
Automated insulin delivery held its gains through a full year
The glycaemic gains from automated insulin delivery held for a full year, with time in range up 17.9 points and HbA1c down 1.14 points, so the improvement is durable rather than an early-trial effect.
Ask about the menstrual cycle before chasing a luteal-phase rise
When a menstruating patient on automated insulin delivery reports a recurring week of highs, map it against the cycle before changing settings, because insulin needs genuinely rise in the luteal phase and the algorithm does not know it.
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