Earlier organ protection anchors the 2026 ADA/EASD type 2 report

The edition in brief

The 2026 ADA/EASD consensus on type 2 diabetes, published on 2 October, shifts the emphasis from glucose alone to organ protection: SGLT2 inhibitors and/or GLP-1-based therapy are advocated earlier, potentially from diagnosis, and combining the two should be considered in people with cardiovascular disease, chronic kidney disease or heart failure. In type 1 diabetes with obesity, a 16-week phase 2 trial of acmopatide, a biased GLP-1/GIP agonist, in 111 adults gave modest HbA1c gains (placebo-adjusted −0.3% at the 4.1 mg dose) but 3–7% weight loss and lower insulin doses, with no ketoacidosis or severe hypoglycaemia; it is too small and short to change care. The FDA lists Class II recalls of compounded tirzepatide and semaglutide combined with cyanocobalamin from one US pharmacy for lack of sterility assurance. A meta-analysis of 21 observational studies linked antipsychotic exposure in pregnancy (RR 1.43) and antidepressant exposure (RR 1.19) with gestational diabetes, strongest for second-generation antipsychotics. The HAPO follow-up found that insulin-deficient, insulin-resistant and mixed GDM subtypes all carried about two to three times the risk of later dysglycaemia 10–14 years after delivery.