Endocrinology

GLP-1RAs reduce major cardiorenal events in type 1 diabetes without apparent safety signal

In a target trial emulation of 174,678 people with type 1 diabetes, GLP-1RA initiation lowered 5-year MACE compared with nonuse. End-stage kidney disease risk was also reduced, with hazard ratios 0.85 for MACE and 0.81 for ESKD after propensity weighting. Hospitalizations for diabetic ketoacidosis and severe hypoglycemia did not increase among GLP-1RA users. These data suggest GLP-1RAs may offer cardiorenal protection in type 1 diabetes beyond glycemic effects, though residual confounding cannot be excluded. 1

SGLT2 inhibitors halve incident CKD in type 2 diabetes without baseline kidney disease

This systematic review and meta-analysis included seven studies of adults with type 2 diabetes but no chronic kidney disease at baseline. Across randomized trials, SGLT2 inhibitors reduced CKD composite outcomes by 53% versus placebo, with low heterogeneity. Observational cohorts also showed lower CKD incidence with SGLT2 inhibitors compared with other glucose-lowering agents in primary prevention settings. Findings support early SGLT2 inhibitor use to prevent CKD in type 2 diabetes, pending confirmation from additional primary-prevention trials. 2

Control-IQ shows durable real-world benefits and safety in Italian preschool children with type 1 diabetes

This multicenter observational study followed 253 Italian children under 11 years using t:slim X2 with Control-IQ for up to 18 months. In 0.5–5-year-olds, time in range and tight range improved significantly by six months and remained stable through 18 months. Similar improvements occurred in 6–10-year-olds, with no meaningful differences between age groups in glycemic trajectories. Severe hypoglycemia was absent in preschoolers and rare overall, with one severe hypoglycemia and one DKA episode reported. Longer delay between diagnosis and Control-IQ initiation correlated with slightly lower tight-range time, suggesting potential benefit from earlier adoption. 3

Liver stiffness identifies diabetic patients at markedly higher short-term mortality risk

This NHANES-based cohort linked vibration-controlled transient elastography in 4,102 adults to mortality over a mean 24-month follow-up. Advanced fibrosis, defined as liver stiffness ≥9.7 kPa, was strongly associated with all-cause mortality. Diabetes plus MASLD conferred an adjusted hazard ratio for death of 2.77 compared with individuals without both conditions. Diabetes with advanced fibrosis carried an adjusted hazard ratio of 6.41, albeit with wide confidence intervals from limited events. Results support using liver stiffness measurement to refine mortality risk assessment in patients with diabetes beyond FIB-4 alone. 4