GLP-1 receptor agonists: the renal signal is now the larger one

The edition in brief

Today's diabetology desk leads with a systematic review and meta-analysis of 20 placebo-controlled trials of GLP-1 receptor agonists in type 2 diabetes (83,004 patients), which found a 13% relative reduction in major adverse cardiovascular events and a 20% reduction in the composite renal outcome — the kidney effect being the largest of the set, while heart failure hospitalisation and revascularisation did not reach significance. A multidisciplinary perspective piece sets out a path to registrational trials of SGLT inhibitors for heart and kidney disease in type 1 diabetes, arguing surrogate endpoints could make such trials feasible, with diabetic ketoacidosis as the limiting risk. A phase 3 trial of the oral agent HTD1801 in 407 participants with type 2 diabetes reported an HbA1c difference of −0.7% against placebo at 24 weeks, durable to 52 weeks, with diarrhoea the main adverse event. An analysis from the TrialNet Pathway to Prevention study shows that stimulated measures combining glucose and C-peptide separate single-autoantibody-positive relatives into groups with over 50% two-year progression risk and under 10% five-year risk. A clinical pearl covers recognising euglycaemic ketoacidosis. The edition closes with the PROMPT cluster-randomised trial, in which an electronic best-practice advisory raised referrals to diabetes self-management education from 1.2% to 12.9%, sustained at 18 months once standing orders let nursing staff act on the prompt.