Shorter diabetes duration and no insulin predict lasting remission after metabolic surgery

The edition in brief

ARMMS-T2D pooled four randomised trials of metabolic-bariatric surgery against medical-lifestyle care in 262 people with type 2 diabetes. Over a median 11 years, 58% of the surgical group reached remission against 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. The message is timing: refer early, before insulin, if surgery is on the table. TRIUMPH-1, published in NEJM on 29 September, tested the triple agonist retatrutide in 2,339 adults with obesity without diabetes: weight fell 23.7% and 25.0% at 9 mg and 12 mg against 3.9% with placebo over 80 weeks, with gains in knee pain and sleep apnoea. It is not a licensed drug. The FDA lists a Class II recall of compounded tirzepatide and semaglutide syringes from one US firm for lack of sterility assurance. A DiGest secondary analysis linked carbohydrate intake below 120 g a day in gestational diabetes to modestly less time above range, but also to lower fibre and micronutrient intake. An Australian registry of 5,202 people with childhood-onset type 1 diabetes found onset before age 7 was associated with lower complication risk over 20 years than onset at 13 to 16.