Empagliflozin's benefit holds across every subgroup Medicare could slice

The edition in brief

Today's diabetology edition leads with EMPRISE, a propensity-matched Medicare analysis of adults aged 65 and over with type 2 diabetes. Empagliflozin was associated with lower major adverse cardiovascular events (HR 0.77), heart failure hospitalisation (HR 0.72) and all-cause mortality (HR 0.66) than DPP-4 inhibitors, and lower heart failure hospitalisation than GLP-1 receptor agonists (HR 0.88). No effect heterogeneity appeared by age, sex, race, ethnicity or socioeconomic factors; absolute benefit was largest in those with established cardiovascular disease. A Swedish national register study of 34,155 adults with type 1 diabetes found each additional year of age at diagnosis associated with 1.7% lower all-cause mortality, and a more than threefold excess mortality where diagnosis fell between birth and age 10. A meta-analysis of ten longitudinal studies associated higher pancreatic fat with incident type 2 diabetes, though the pooled estimate was unstable and driven substantially by one ultrasound-based study. A controlled feeding trial of the DASH4D diet in 101 adults showed small but consistent falls in fructosamine, fasting glucose and HbA1c. The edition closes on a review of what happens when GLP-1 receptor agonists and tirzepatide are stopped: weight regain, deteriorating cardiometabolic risk factors, and the possibility that repeated cycles of starting and stopping do their own harm. The practical thread through the edition is that persistence, not initiation, is where much of the benefit is won or lost.