The edition · Diabetes & Endocrinology
Weekly ketone checks may be enough to flag DKA risk, and what fixed-ratio insulin combinations add
A Diabetes Care analysis finds once-weekly well-day ketone testing predicts next-month DKA about as well as twice weekly. A network meta-analysis ranks basal insulin–GLP-1 combinations, and SGLT2 inhibitors show no excess severe infection versus DPP-4 inhibitors.
The edition in brief
Once-weekly well-day capillary ketone testing predicted diabetic ketoacidosis or severe ketosis in the following month about as well as twice-weekly testing in 1,410 adults with type 1 diabetes from the EASE-2 and EASE-3 trials (AUC 0.692 vs 0.678 in one model, 0.719 vs 0.711 in another; neither difference significant). Discrimination was modest in both. A network meta-analysis of 30 trials (17,862 adults with type 2 diabetes) found every basal insulin–GLP-1 receptor agonist fixed-ratio combination lowered HbA1c and weight more than basal insulin alone, with mostly low-to-moderate certainty and no robust ranking between products. A meta-analysis of real-world cohorts found no increase in pneumonia or sepsis with SGLT2 inhibitors compared with DPP-4 inhibitors; the lower pooled ratios are very low certainty and should not be read as protection. A JAMA meta-analysis of 85 randomised trials found SGLT2 inhibitors raise haemoglobin by about 0.6 g/dL and haematocrit by about 2.4 percentage points, with a small fall in transferrin saturation. The FDA lists a Class II recall of compounded semaglutide and tirzepatide syringes for lack of sterility assurance.
Fixed-ratio basal insulin–GLP-1 combinations beat basal insulin alone on HbA1c and weight
When basal insulin alone is not enough, a fixed-ratio insulin–GLP-1 combination adds HbA1c lowering without the usual weight gain; pick the product on access and dosing, not ranking.
SGLT2 inhibitors show no excess pneumonia or sepsis compared with DPP-4 inhibitors
Real-world data give no sign that SGLT2 inhibitors raise pneumonia or sepsis risk compared with DPP-4 inhibitors; do not withhold them on that ground.
FDA lists Class II recall of compounded semaglutide and tirzepatide syringes
Ask patients where their GLP-1 injections come from, and steer them to licensed products; this recall concerns sterility of compounded syringes.
SGLT2 inhibitors raise haemoglobin by about 0.6 g/dL
A rise in haemoglobin of about 0.6 g/dL is an expected SGLT2 inhibitor effect; interpret blood counts with that in mind.
Check ketones in an unwell patient on an SGLT2 inhibitor, even when glucose looks normal
In an unwell patient on an SGLT2 inhibitor, check blood ketones whatever the glucose.
Once-weekly well-day ketone testing predicted DKA risk about as well as twice weekly
For people with type 1 diabetes at raised DKA risk, consider a once-weekly well-day ketone check rather than none, alongside usual sick-day testing.
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