Organ protection moves to the front of type 2 diabetes care

The edition in brief

The 2026 ADA–EASD consensus on type 2 diabetes shifts the goal from lowering glucose to protecting organs: it advocates SGLT2 inhibitors and GLP-1-based therapies earlier, potentially from diagnosis, and earlier combination of the two where cardiovascular disease, chronic kidney disease or heart failure coexist. Lifestyle, weight and psychological support are treated as core care. In SYNCHRONIZE-2, a phase 3 trial of 752 adults with type 2 diabetes and obesity, the glucagon–GLP-1 dual agonist survodutide cut weight by 8.2% (3.6 mg) and 9.8% (6.0 mg) versus 3.9% on placebo at 76 weeks, with HbA1c falling about 0.8–0.9 points; gastrointestinal effects were common but mild. It is investigational and not yet available in India. DIABIL-2, a phase 2b trial in 141 people with new-onset type 1 diabetes, found low-dose interleukin-2 did not preserve C-peptide at 12 months (geometric mean ratio 1.06, 95% CI 0.56–2.01) despite expanding regulatory T cells — a clean negative that redirects type 1 immunotherapy away from IL-2 monotherapy. A clinic pearl: as SGLT2 inhibitors move first-line, pair every prescription with sick-day rules and ketone checking, because euglycaemic ketoacidosis hides behind a normal glucose. Finally, a pooled analysis of SELECT, FLOW and SOUL (30,787 participants) found semaglutide reduced a major kidney composite (hazard ratio 0.84, 95% CI 0.77–0.91) across people with and without diabetes, supporting its use for cardiorenal protection beyond glucose and weight — with cost the main barrier in India.