A triple agonist lowers apnoea severity, while a health-worker programme fails to prevent diabetes

The edition in brief

In two nested phase 3 trials (NEJM, 21 October), retatrutide, an investigational GIP, GLP-1 and glucagon receptor agonist, reduced the apnoea-hypopnoea index by about 14 to 24 events per hour more than placebo at 80 weeks in adults with moderate-to-severe obstructive sleep apnoea and obesity, with or without type 2 diabetes. It is not licensed anywhere. ATTAIN-J (Lancet Diabetes & Endocrinology, 30 October) found once-daily oral orforglipron lowered weight by 5.9 to 8.7% against 0.6% on placebo over 72 weeks in 238 Japanese adults, with the 36 mg dose adding no weight benefit over 12 mg but more nausea-related stopping. A German prospective cohort split recent-onset adult type 1 diabetes into classic, mixed (antibody-positive, insulin-resistant, better beta-cell function) and antibody-negative subtypes; the mixed group appeared about six years earlier on the beta-cell decline curve and had higher retinopathy risk. The FDA lists Class II recalls of compounded semaglutide and tirzepatide syringes from one US pharmacy over lack of sterility assurance. A pragmatic cluster-randomised trial of a 12-month community health worker programme for prediabetes did not reduce incident diabetes (5.9% vs 4.3%) and did not change HbA1c or weight, though it increased clinic visits. The pearl covers when to check GAD antibodies in an adult labelled type 2.