Semaglutide's kidney benefit holds across three trials, and a weekly insulin–GLP-1 start beats glargine

The edition in brief

Pooling participant-level data from SELECT, FLOW and SOUL (30,787 people with CKD or atherosclerotic disease, with or without diabetes), semaglutide reduced a kidney composite including cardiovascular death by 16% (HR 0.84, 0.77–0.91) and a kidney-only composite by 20% (HR 0.80, 0.69–0.92) over about 3.5 to 4 years. The analysis was prespecified but the three trials used different doses and routes and were funded by the manufacturer. COMBINE 4, an open-label 40-week trial in 485 insulin-naive adults with HbA1c of 8% or more on oral agents, found once-weekly IcoSema (insulin icodec plus semaglutide) lowered HbA1c 0.88 points more than daily glargine U100, with 4.6 kg less weight and about half the rate of clinically significant hypoglycaemia. In 963 older adults with about 43 years of type 1 diabetes in DCCT/EDIC, 64% screened at intermediate or high risk of obstructive sleep apnoea and 43% reported poor sleep; each 1% higher HbA1c was associated with 15–20% higher odds of a sleep problem. A meta-analysis of ten trials (2,827 participants) found CBT for sleep improved sleep quality and lowered HbA1c by 0.35%, but heterogeneity was very high. The pearl covers when to screen for sleep apnoea in diabetes clinic.