Technology guidance widens, and two trials test what the numbers really mean

The edition in brief

The American Association of Clinical Endocrinology has issued a consensus statement on diabetes technology in adults, covering continuous glucose monitoring, automated insulin delivery and emerging continuous ketone monitoring. It is guidance rather than new trial evidence, but it is the document a service will be measured against when deciding who gets a sensor. A prespecified secondary analysis of SELECT found that semaglutide lowered high-sensitivity CRP by 37.8% at 104 weeks in 17,604 patients with atherosclerotic disease and overweight or obesity but not diabetes. The fall began by week 4 to 8, before meaningful weight loss, and occurred even in those who lost no weight, which points to an anti-inflammatory contribution to the MACE reduction rather than weight loss alone. This is modelling of a biomarker, not a separate outcome trial. In 1,356 Framingham participants without diabetes, blinded CGM measures tracked cardiometabolic risk beyond fasting glucose and HbA1c: one standard deviation more time above 140 mg/dL was associated with a 2% higher 10-year cardiovascular risk estimate and 21 to 26% higher odds of hypertension and dyslipidaemia after adjusting for fasting glucose. The design is cross-sectional. A small crossover study in twelve youngsters with type 1 diabetes on multiple daily injections found higher early-night time in range after a carbohydrate-plus-protein bedtime snack than carbohydrate-plus-fat (91.2% vs 71.4%), with no difference in hypoglycaemia events. A Scottish registry followed 140 adults after a first Charcot diagnosis: 87.9% had an emergency admission, 31.4% an amputation and 37.9% died over a median 4.6 years. One year after baricitinib was stopped in BANDIT, the C-peptide advantage had gone.