The edition · Top Clinical Updates
CGM lowers HbA1c in type 2 diabetes without insulin, and two well-run trials come back negative
A primary care trial extends continuous glucose monitoring beyond insulin users; retatrutide reaches 25% weight loss at 80 weeks; and faecal transplant for IBS and cardiac index-guided surgery both fail to beat their controls.
The edition in brief
In 283 adults with type 2 diabetes not on insulin, managed in 22 US primary care practices, continuous glucose monitoring lowered HbA1c by 0.9 percentage points more than routine care over 26 weeks (8.8% to 7.2% versus 8.7% to 8.0%) and raised time in range by 21 points; the trial was open label and manufacturer funded. In TRIUMPH-1, 2,339 adults with obesity without diabetes lost 23.7% and 25.0% of body weight on retatrutide 9 mg and 12 mg over 80 weeks against 3.9% on placebo, with gains in knee osteoarthritis pain and sleep apnoea severity; gastrointestinal effects were most common. REFIT2 randomised 450 Norwegian adults with moderate to severe IBS to donor or own-stool faecal transplant: 40% and 38% improved, a difference of 1.9 points (−8.1 to 12.0). PELICAN randomised 1,111 high-risk patients having major abdominal surgery to haemodynamic therapy targeting their own resting cardiac index or routine care; the composite of complications within seven days was 44.3% versus 46.9% (RR 0.94, 0.83–1.08). A benchmark of six commercial large language models across 225 Choosing Wisely scenarios found overuse in 5.4% of answers, concentrated in thyroid ultrasound for small incidental nodules and routine ECGs in low-risk adults. The pearl is on judging a negative trial.
Retatrutide: 25% weight loss at 80 weeks, with knee pain and apnoea gains
Retatrutide produced about 25% weight loss in a phase 3 trial, but it remains investigational with no outcome data yet.
Faecal microbiota transplant does not help IBS in a large phase 3 trial
Do not offer faecal microbiota transplant for IBS; a large blinded trial found no benefit over placebo.
Targeting each patient's own cardiac index in major surgery does not cut complications
Targeting a patient's own resting cardiac index during major abdominal surgery did not reduce early complications.
Where AI chatbots push overuse: small thyroid nodules and routine ECGs
AI chatbots mostly follow Choosing Wisely, but their errors cluster on the low-value tests clinicians already over-order.
Reading a negative trial: is it no effect, or no answer?
A negative trial changes practice only when its confidence interval rules out a benefit worth having.
CGM lowers HbA1c in type 2 diabetes managed without insulin
For type 2 diabetes above target without insulin, consider CGM; it lowered HbA1c by 0.9 points in primary care.
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