The edition · Diabetes & Endocrinology
ADA–EASD 2026 moves organ protection to the point of diagnosis
The new type 2 consensus, a triple agonist that took a quarter of body weight off, reassuring but thin data on GLP-1 exposure around conception, and an inflammatory marker that treatment did not touch.
The edition in brief
The 2026 ADA–EASD consensus report on type 2 diabetes widens its scope from glucose to the whole set of long-term conditions that come with the disease. It advocates SGLT2 inhibitors and GLP-1-based therapies earlier, potentially from diagnosis, for organ protection, and combination of the two in people with cardiovascular disease, chronic kidney disease or heart failure, alongside lifestyle, sleep, psychological support and weight management. In TRIUMPH-1, 2,339 adults with obesity but without diabetes lost 23.7% and 25.0% of body weight on retatrutide 9 mg and 12 mg over 80 weeks, against 3.9% on placebo, with gains in knee osteoarthritis pain and sleep apnoea severity; gastrointestinal effects were the commonest adverse events. A meta-analysis of ten observational studies (8,325 exposed pregnancies) found no clear rise in miscarriage, malformations or other adverse outcomes after GLP-1 receptor agonist exposure in the six months before a positive test, though the authors stress this does not establish safety. In a BARI 2D analysis of 2,277 people with type 2 diabetes and coronary disease, suPAR was unchanged by a year of intensive treatment while hs-CRP fell, and suPAR predicted death, myocardial infarction or stroke (HR 1.40 per SD) independently of hs-CRP.
Retatrutide: about 24–25% weight loss at 80 weeks in obesity without diabetes
Retatrutide gave a placebo-adjusted weight loss of about 20 points over 80 weeks, but it remains investigational.
GLP-1 agonist exposure around conception: no clear harm signal, not proof of safety
After inadvertent GLP-1 agonist exposure around conception, stop the drug and counsel calmly; planned pregnancies still need it stopped beforehand.
suPAR stayed raised after a year of intensive treatment in BARI 2D, and predicted events
suPAR marks inflammatory risk that standard intensive treatment did not lower, but it is a research marker, not a test to order.
Tirzepatide and oral contraceptives: cover the dose steps
Women on an oral contraceptive need back-up contraception for four weeks after starting tirzepatide and after every dose increase.
ADA–EASD 2026: organ-protective drugs earlier, potentially from diagnosis
Consider SGLT2 inhibitors or GLP-1-based therapy from diagnosis for organ protection, and the two together where cardiorenal disease is present.
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