The edition · Diabetes & Endocrinology
SGLT2 inhibitors before pregnancy: reassuring overall, but the data are thin
A pooled look at first-trimester SGLT2 exposure, a glucagon–GLP-1 agonist in type 2 diabetes, a failed immunotherapy in new type 1 diabetes, and a genetic score that sorts out unsolved MODY referrals.
The edition in brief
A meta-analysis of three cohorts (669 exposed pregnancies) found early SGLT2 inhibitor exposure was not associated with major congenital malformations compared with insulin (RR 0.94, 95% CI 0.68–1.29), but certainty was low to very low and one Korean cohort raised a possible cardiac signal for exposure in weeks 4–10. The practical message is unchanged: plan pregnancy, switch before conception, and do not panic after inadvertent exposure. In SYNCHRONIZE-2, once-weekly survodutide gave 8–10% weight loss at 76 weeks versus 3.9% with placebo in adults with type 2 diabetes and obesity, with HbA1c falling about 0.8–0.9 points; gastrointestinal effects were common. DIABIL-2, a phase 2b trial of low-dose IL-2 in newly diagnosed type 1 diabetes, expanded regulatory T cells but did not preserve C-peptide at 12 months. A Diabetes Care study of 1,129 insulin-treated MODY referrals estimated that about one in five actually had type 1 diabetes; a type 1 genetic risk score identified probable type 1 diabetes in 16% of genetically unsolved cases and, in children under 10, could avoid more than half of MODY tests without missing a case.
SGLT2 inhibitors in early pregnancy: no clear malformation signal, low certainty
Stop SGLT2 inhibitors once pregnancy is known and plan the switch before conception, but counsel calmly after inadvertent exposure.
Survodutide in type 2 diabetes with obesity: about 8–10% weight loss at 76 weeks
Survodutide gave placebo-adjusted weight loss of about 4–6 points in type 2 diabetes, but it is investigational and untested against existing agents.
Low-dose IL-2 hit its target but did not preserve C-peptide in new type 1 diabetes
Low-dose IL-2 alone does not preserve β-cell function after diagnosis of type 1 diabetes.
Check for ketones in a pregnant woman with diabetes who is vomiting
In pregnancy, ketoacidosis can occur with modest glucose, so test ketones whenever a woman with diabetes is unwell.
One in five insulin-treated MODY referrals may have type 1 diabetes
When a MODY panel comes back negative in an insulin-treated patient, consider type 1 diabetes, especially in a child.
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