Metformin lowers rifampicin exposure by a quarter

The edition in brief

A population pharmacokinetic analysis nested in a randomised trial of adjunctive metformin for HIV-associated tuberculosis studied 78 adults without diabetes, 43 of them on metformin 500 mg twice daily. Metformin reduced isoniazid bioavailability by 15.6% and rifampicin bioavailability by 24.0%, cutting mean rifampicin exposure over 24 hours from 35.9 to 27.1 mg.h/L; pyrazinamide was unaffected, and simulations suggested an extra 150 mg of rifampicin would compensate. The American Association of Clinical Endocrinology has issued an updated consensus statement on diabetes technology in adults, covering continuous glucose monitoring, automated insulin delivery, other delivery devices and emerging continuous ketone monitoring, framed around shared decision making. The FDA has recorded a supplement to the licence for TRIJARDY XR, the empagliflozin, linagliptin and metformin fixed-dose combination, one of several such supplements dated 11 August 2026; the record does not state its subject. In 2,761 Australian adolescents with type 1 diabetes followed across 5,487 visits from 1990 to 2019, retinopathy fell from 40% to 20% and then plateaued, and both twice-daily insulin regimens and greater HbA1c variability were independently associated with complications. In 3,173 adults with two to four 24-hour urine collections each, the highest quartile of sodium excretion carried 2.66 times the risk of developing type 2 diabetes over a median 13.6 years, while potassium excretion showed no association.