The edition · Diabetes & Endocrinology
Type 2 consensus moves organ protection to the start; low-dose IL-2 fails to hold β-cell function
The 2026 ADA/EASD report advocates SGLT2 inhibitors and GLP-1-based therapy from diagnosis in suitable people. A phase 3 dual agonist and a phase 2b immunotherapy trial add the day's evidence.
The edition in brief
The 2026 ADA/EASD consensus report on type 2 diabetes broadens the aim from glucose lowering to long-term organ protection and advocates earlier use, potentially from diagnosis, of SGLT2 inhibitors and GLP-1-based therapies, with earlier combination where cardiovascular disease, kidney disease or heart failure coexist. In SYNCHRONIZE-2, a phase 3 trial of 752 adults with type 2 diabetes and obesity, once-weekly survodutide (an investigational glucagon/GLP-1 dual agonist) gave 8.2% and 9.8% weight loss at 76 weeks against 3.9% with placebo, with HbA1c falling 0.8 to 0.9 points versus 0.2; gastrointestinal events were more frequent. DIABIL-2, a phase 2b trial in 141 people with newly diagnosed type 1 diabetes, found that low-dose interleukin-2 expanded regulatory T cells but did not preserve C-peptide at 12 months (geometric mean ratio 1.06, 95% CI 0.56 to 2.01). A meta-analysis of 10 observational studies found no clearly detectable increase in adverse pregnancy outcomes after GLP-1 receptor agonist exposure around conception, though the authors state this does not establish safety. A type 1 diabetes genetic risk score added to MODY panel testing identified probable type 1 diabetes in 16.1% of unsolved MODY referrals and helped triage testing in children under 10. A pearl on sick-day rules for SGLT2 inhibitors closes the edition.
ADA/EASD 2026: protect organs early, not only lower glucose
Consider SGLT2 inhibitors and/or GLP-1-based therapy early, selected by the person's organ risks rather than by HbA1c alone.
Survodutide: 8 to 10% weight loss in type 2 diabetes with obesity
Dual glucagon/GLP-1 agonism produced clinically meaningful weight loss in type 2 diabetes, but the drug is not yet a prescribing option.
Low-dose IL-2 expanded Tregs but did not preserve C-peptide in new type 1 diabetes
Low-dose IL-2 alone did not preserve beta-cell function at 12 months; do not offer it outside a trial.
GLP-1 receptor agonists before conception: no clear signal, no proof of safety
Observational data show no clear harm from periconceptional GLP-1 exposure, but they do not prove safety; keep advising planning and review before conception.
Sick-day rules: SGLT2 inhibitors and the ketone check
Give every person on an SGLT2 inhibitor a written sick-day plan and revisit it at each review.
A type 1 genetic risk score can sharpen MODY testing, especially in young children
When MODY testing is unrevealing, consider type 1 diabetes, and discuss a genetic risk score with your laboratory, particularly for children under 10.
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