An oral GLP-1 agonist matched insulin on heart safety with a third of the hypoglycaemia

The edition in brief

In ACHIEVE-4, published 30 September, 2,749 adults with type 2 diabetes and established cardiovascular or chronic kidney disease (38% had CKD) were randomised to the oral non-peptide GLP-1 receptor agonist orforglipron or insulin glargine. Over two years, major cardiovascular events occurred in 4.2% versus 5.0% (HR 0.84, 95% CI 0.59–1.20), meeting non-inferiority; clinically significant hypoglycaemia was 6.8% versus 19.2%, and gastrointestinal events were 62% versus 14%. A meta-analysis of 13 studies (1,275 patients) found fixing the peritoneal dialysis catheter during open insertion sharply reduced catheter displacement (OR 0.08) at the cost of about four extra minutes of operating time, with no difference in infection, omental wrapping or hernia. A KDIGO Controversies Conference report set research priorities for technology to improve guideline-based kidney care, including living guidelines and integrated decision support.