Automated insulin delivery reaches insulin-treated type 2 diabetes

The edition in brief

The twiist-T2D pivotal trial put 307 adults with insulin-treated type 2 diabetes on an automated insulin delivery (AID) system for 13 weeks. HbA1c fell from 8.1% to 7.4% (change -0.7%, 95% CI -0.9 to -0.6) and time in range 70-180 mg/dL rose from 57% to 73%, with low hypoglycaemia, one episode of diabetic ketoacidosis and no severe hypoglycaemia. It was single-arm, so the comparison is with each person's own baseline. An international position statement covers inpatient use of continuous glucose monitoring (CGM), pumps and AID in non-critically ill adults, from selection criteria and alarm settings to imaging and discharge planning. In the phase 2 ZUPREME 1 trial, once-weekly petrelintide, an amylin analogue, gave placebo-adjusted weight loss of 6.2% to 8.1% at 28 weeks in adults with obesity but without diabetes, with mostly mild nausea. A meta-analysis of seven Indian studies put sarcopenia in type 2 diabetes at about one in four, though certainty was very low and the prediction interval ran from 7% to 66%. The FDA approved an insulin aspart product, Garzulys, under a biologics licence on 15 September. The pearl: when glucose swings without explanation on insulin, look at and feel the injection sites before changing the dose.