The edition · Diabetes & Endocrinology
Orforglipron's higher maintenance dose earns its place — and India's price falls change who can be offered a GLP-1
A six-trial meta-analysis separates the 12 mg and 36 mg maintenance doses of oral orforglipron; a policy analysis puts numbers on what generic competition has done to SGLT2 inhibitor and GLP-1 prices in India; a compounder's semaglutide vials are recalled for particulate matter; and weekly ketone testing looks enough to stratify DKA risk.
The edition in brief
Six randomised trials totalling 3,459 adults with obesity, with and without type 2 diabetes, were pooled to compare the two commonest maintenance doses of orforglipron, an oral non-peptide GLP-1 receptor agonist. The 36 mg dose produced greater falls in body weight, BMI, HbA1c and waist circumference than 12 mg, with comparable adverse events; the abstract reports significance levels rather than pooled point estimates, and the trials were not powered for rare or long-term harm. A Diabetes Care policy analysis from Indian authors reports roughly 60-90% price reductions for SGLT2 inhibitors and GLP-1 receptor agonists in India after patent expiry, with 15- to 65-fold differences between Indian generic prices and US list prices; supply in rural areas and quality variation between branded generics remain unresolved. The FDA has posted an ongoing Class II recall of multiple strengths of compounded semaglutide multi-dose vials from one firm for particulate matter identified as nylon/polyamide and silk/proteinaceous material. A multicentre study of 1,028 adults with type 1 diabetes and 3,441 CGM profiles over three years found that older age and chronic kidney disease were associated with glycaemic improvement without more hypoglycaemia, while severe beta-cell failure attenuated it. A simulation on 1,410 EASE trial participants found once-weekly well-day capillary ketone testing kept prediction accuracy for one-month DKA risk comparable to twice-weekly testing. The edition closes on that testing frequency, and carries a clinic pearl on calculating the triglyceride-glucose index from tests already ordered.
Orforglipron 36 mg beats 12 mg on every metabolic outcome measured, with adverse events comparable
Titrate orforglipron to the 36 mg maintenance dose where tolerated; 12 mg leaves measurable weight and HbA1c benefit unclaimed.
Indian prices for SGLT2 inhibitors and GLP-1 receptor agonists have fallen 60-90% since patent expiry
Re-check current generic prices before deciding a patient cannot afford an SGLT2 inhibitor or GLP-1 receptor agonist — the figure you remember is probably out of date.
FDA Class II recall: compounded semaglutide multi-dose vials withdrawn for particulate matter
Ask patients on semaglutide where their product comes from; a compounded multi-dose vial is not the licensed pen and is not covered by the same quality controls.
Three years of CGM in type 1 diabetes: the groups you expect to do worst are not the ones who fail to improve
Set glycaemic targets from the patient's own CGM trajectory, not from their age or CKD label — those groups improved without more hypoglycaemia.
The triglyceride-glucose index needs no test you have not already ordered
Where fasting triglycerides and glucose are already on the chart, the TyG index gives a free read on insulin resistance without a fasting insulin assay.
Weekly well-day ketone testing predicts one-month DKA risk as well as twice weekly
Ask for one well-day capillary ketone test a week rather than two — the prediction holds and the request is one patients will keep.
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