Endocrinology

Younger adults with type 2 diabetes bear the steepest BP-related risk for CVD, kidney disease, and death

In 429,740 Hong Kong adults with type 2 diabetes, systolic BP above 120–129 and diastolic BP above 70–79 mmHg increased CVD, CKD, kidney failure, and mortality risks. Risk gradients were most pronounced at ages 18–44 years and progressively weakened with advancing age. Each 10 mmHg or 1-SD increase in BP conferred roughly 1.2–1.5-fold higher hemorrhagic stroke risk in 18–44-year-olds. Restricted cubic spline analyses showed heterogeneous linear and nonlinear BP–outcome curves across age strata, challenging a single BP target for all adults with diabetes. 1

SGLT2 inhibitors associate with the lowest incident AF risk as second-line therapy in type 2 diabetes

Among 36,744 adults starting metformin plus a second-line oral agent, SGLT2 inhibitor users had the lowest atrial fibrillation incidence over 6.2 years. Compared with SGLT2 inhibitors, AF risk was higher with thiazolidinediones, DPP-4 inhibitors, and sulfonylureas, with subdistribution hazard ratios 1.14–1.22. AF risk did not differ significantly among thiazolidinedione, DPP-4 inhibitor, and sulfonylurea users. Age, hypertension, and renal function modified relative effects, suggesting SGLT2 inhibitors are particularly attractive for AF-prone subgroups when selecting second-line therapy. 2

GLP-1 receptor agonists reduce recurrent limb events and cardiovascular risk after prior major limb events

In 17,288 Taiwanese adults with diabetes and prior major adverse limb events, initiation of GLP-1 receptor agonists was compared with DPP-4 inhibitors. GLP-1 receptor agonists reduced recurrent limb events (SHR 0.90), largely via fewer amputations (SHR 0.86). They also substantially lowered major adverse cardiovascular events, cardiovascular death, all-cause mortality, and progression to long-term dialysis, with hazard ratios around 0.6. These findings support preferential GLP-1 receptor agonist use for secondary limb and cardiovascular prevention in patients with severe peripheral artery disease and prior limb events. 3

In non-ICU inpatients, CGM readings are unreliable for hypoglycemia management

This systematic review of nine studies evaluated CGM accuracy for hypoglycemia in non–critical care hospitalized adults with diabetes. Across 465 paired CGM and reference values below 70 mg/dL, mean absolute relative differences often exceeded 15%. Median absolute relative differences were also high, up to 38.5% in some studies, with heterogeneous pairing methods. These large discrepancies indicate current CGMs are too inaccurate in the hypoglycemic range to guide inpatient insulin titration without confirmatory blood glucose testing. 4