Retatrutide cut sleep apnoea severity well beyond placebo, and a remission formula misses youth with obesity

The edition in brief

Two nested phase 3 trials (TRIUMPH-1-OSA and TRIUMPH-2-OSA, NEJM, 21 October) found that once-weekly retatrutide reduced the apnoea-hypopnoea index by about 14 to 24 more events per hour than placebo over 80 weeks in adults with moderate-to-severe obstructive sleep apnoea and a BMI of 27 or more, with smaller effects in those with type 2 diabetes. Retatrutide is investigational and not approved anywhere. The FDA enforcement list carries Class II recalls of compounded semaglutide and tirzepatide (some combined with cyanocobalamin) from two US compounders for lack of assurance of sterility. An Israeli registry cohort of 4,299 people diagnosed with type 1 diabetes before 35 found mortality about 3.7 times that of matched controls, with a larger relative excess in women, and a smaller excess for those diagnosed after 2010. A SEARCH for Diabetes in Youth analysis found the widely used IDAA1c ≤9 definition of partial remission had 61% sensitivity overall and 45% in youth with overweight or obesity, so it under-calls preserved beta-cell function in heavier children. The pearl covers screening for sleep apnoea in people with type 2 diabetes and obesity.