Empagliflozin's benefit held in the over-75s, and childhood-onset type 1 carries the steepest excess risk

The edition in brief

In older Medicare beneficiaries with type 2 diabetes, starting empagliflozin rather than a DPP-4 inhibitor was associated with fewer major cardiovascular events (HR 0.77), fewer heart failure admissions (HR 0.72) and lower all-cause mortality (HR 0.66), with no difference in relative effect by age, sex, race or income; absolute benefit was largest in those with established cardiovascular disease. Against GLP-1 receptor agonists the advantage was confined to heart failure admissions (HR 0.88). In the Swedish National Diabetes Register, each year later that type 1 diabetes began was associated with about 2% lower all-cause mortality, and onset before age 10 carried the highest excess risk against matched controls: all-cause mortality HR 3.23 and cardiovascular mortality HR 5.73. In the SEARCH for Diabetes in Youth study, the widely used insulin dose-adjusted HbA1c threshold of 9 or below had 61% sensitivity for C-peptide-defined partial remission overall and only 45% in children with overweight or obesity. A Diabetes Care perspective notes that most automated insulin delivery systems are not built for pregnancy targets and reduce insulin when glucose sits in the range pregnancy aims for. A network meta-analysis of 27 small trials found both orders of combined aerobic and resistance training improved HbA1c and lipids, with no reliable difference between them. All of the outcome data today are observational or low-certainty except the exercise trials, and none changes a guideline on its own.