Once-weekly insulin, oral GLP-1 and the limits of kidney surrogates

The edition in brief

Six sections for the diabetology and endocrinology desk. The updated 2026 ADA/EASD consensus on adult type 1 diabetes broadens care beyond glucose and devices to delaying therapies, complication screening, obesity and cardiovascular risk. A meta-analysis of 17 trials in 29,192 adults with diabetic chronic kidney disease found SGLT2 inhibitors lowered HbA1c, weight and blood pressure but left eGFR and albuminuria unchanged over months, with more volume-depletion events; the proven cardiorenal protection comes from long-term outcome trials, not these surrogates. ACHIEVE-J, a 52-week open-label safety study of oral orforglipron in 401 Japanese adults, found gastrointestinal effects drove dose-dependent discontinuations and no severe hypoglycaemia. A prespecified SELECT analysis of 7,594 people on semaglutide for at least a year showed median peak weight loss of 12.5% at around 19 months, with baseline features explaining under 10% of the variation. A clinical pearl covers sick-day rules for SGLT2 inhibitors and euglycaemic ketoacidosis. The practice-changer is COMBINE 4: once-weekly IcoSema, combining basal insulin icodec with semaglutide, cut HbA1c by 0.88 percentage points more than daily glargine over 40 weeks, reduced weight rather than raising it, and roughly halved clinically significant or severe hypoglycaemia.