A dual agonist pushes weight loss past 18%, and neuropathy gets an objective signal

The edition in brief

Four findings shape today's diabetology desk. Mazdutide, a glucagon and GLP-1 receptor dual agonist, produced least-squares mean weight reduction of 18.1% at 16 mg by 32 weeks against 0.9% with placebo in a 179-participant US phase 2 trial, with a fifth of the 16 mg group stopping for mostly gastrointestinal adverse events. A meta-analysis of eleven cohorts found high long-term glucose variability associated with peripheral artery disease at RR 1.42 (95% CI 1.21 to 1.66), but with I-squared of 91% and a stronger signal in shorter follow-up, which points to confounding rather than a clean dose-response. A Taiwanese joint consensus sets out how to handle bone health in diabetes: screen earlier, expect standard fracture risk calculators to underestimate, and weigh the skeletal effects of glucose-lowering drugs when choosing them. A systematic review of tube feeding found diabetes-specific formulas lowered mean blood glucose by 0.54 mmol/L in critical care at moderate certainty and HbA1c by 0.92 percentage points in long-term care at low certainty, with no outcome benefit established. The edition closes on PDN-Sensory, a 91-participant randomised trial in which 10 kHz spinal cord stimulation delivered pain response in 27 of 34 treated participants versus 2 of 50 on medical management alone, alongside blinded improvement in the modified Toronto Clinical Neuropathy Score and a small gain in intraepidermal nerve fibre density. The nerve fibre finding is the part that is new; it is six months of data and does not yet establish disease modification.