After metabolic surgery, diabetes duration and insulin use predict who stays in remission

The edition in brief

In ARMMS-T2D, 262 people with type 2 diabetes randomised to metabolic-bariatric surgery or medical-lifestyle care were followed for a median of 11 years. Remission (HbA1c below 6.5% off all glucose-lowering drugs) occurred in 58% after surgery and 3% with medical care. Shorter diabetes duration, no insulin use and greater weight loss at one year predicted remission; longer duration and more drug classes predicted relapse. A prespecified SELECT analysis of 7,594 people on semaglutide found baseline characteristics explained under 10% of the variation in peak weight loss, so response cannot be forecast at the first visit. In the DiGest trial baseline data, women with gestational diabetes eating under 120 g of carbohydrate a day had slightly less time above range and slightly lower birth-weight centiles, but also lower fibre and micronutrient intake. A single-centre study of 12 insulin-treated adults on nocturnal parenteral nutrition linked CGM-guided insulin adjustment with more time in range, weight gain and higher albumin. The FDA lists Class II recalls of compounded tirzepatide and semaglutide syringes and vials from two US compounders for lack of sterility assurance. The pearl covers what remission means and what monitoring must continue.