Surgery still beats the injection on the cardiovascular endpoints

The edition in brief

A PRISMA network meta-analysis of 43 studies and 932,380 patients with obesity compared bariatric surgery, GLP-1 receptor agonists and control. Against control, surgery reduced major adverse cardiovascular events (HR 0.66, 95% CI 0.60-0.74), heart failure (HR 0.45, 0.38-0.53) and myocardial infarction (HR 0.53, 0.45-0.63). GLP-1 receptor agonists reduced MACE (HR 0.85, 0.77-0.94) with non-significant effects on heart failure and myocardial infarction. Heterogeneity was high, from 66% to 93%, and most contributing data are observational. A decentralised observational study of donated real-world data from 77 menstruating adults with type 1 diabetes using automated insulin delivery covered 380 cycles. Total daily insulin dose and carbohydrate intake peaked in the luteal phase alongside higher mean glucose and reduced time in range. A hierarchical Bayesian model estimated insulin sensitivity 2.6% higher in the early follicular phase (credible interval 0.3 to 5.0) and 2.6% lower in the midluteal phase (-5.2 to -0.1). The pattern held in 84.7% of participants with substantial individual variation. The FDA has listed Class II recalls dated 19 August 2026 of compounded semaglutide multi-dose vials from Apollo Care LLC across multiple strengths, for particulate matter identified as nylon/polyamide and silk or proteinaceous material. Status is ongoing. A new-user cohort of 411,188 adults with type 2 diabetes on GLP-1 receptor agonists who started an opioid found 30-day motility-related gastrointestinal events in 0.51% starting oxycodone, 0.35% hydrocodone and 0.33% tramadol. Oxycodone carried higher risk than hydrocodone (RR 1.48, 95% CI 1.30-1.69) and tramadol (RR 1.55, 1.33-1.79).