Endocrinology

Incretin add-ons yield superior CGM profiles vs glimepiride and glargine in GRADE

This GRADE substudy compared 2-week masked CGM in 1,080 adults on metformin plus glargine, glimepiride, liraglutide, or sitagliptin. Sitagliptin and liraglutide achieved the highest time in range 70–180 mg/dL and the lowest time below 70 mg/dL and glucose coefficient of variation. Glimepiride had the lowest time in range, highest variability, most time below 70 mg/dL, and uniquely showed increased daytime hypoglycemia. Within each HbA1c stratum, mean glucose was similar across treatments, but variability and hypoglycemia exposure were higher with glargine and glimepiride. 1

Tirzepatide lowers broad cardiorenal events vs dulaglutide in T2D with CVD

This post hoc SURPASS-CVOT analysis compared tirzepatide with dulaglutide in 13,165 adults with type 2 diabetes and established cardiovascular disease. Over a median 46.9 months, tirzepatide reduced a 6-component cardiorenal composite, including death, myocardial infarction, stroke, revascularization, heart failure hospitalization, and kidney outcomes (HR 0.84; 95% CI 0.79–0.90). Similar hazard ratios were observed for narrower cardiovascular composites excluding kidney and heart failure components. Gastrointestinal adverse events were more frequent with tirzepatide than dulaglutide, whereas other adverse event rates were comparable. 2

Cereal and fruit fiber intake associates with lower T2D risk and favorable multiomics

This analysis pooled three large U.S. cohorts with 195,222 participants followed up to 34 years, documenting 18,369 incident type 2 diabetes cases. Higher total, cereal, and fruit fiber intakes were each associated with lower diabetes risk, strongest for cereal fiber (HR extreme quintiles 0.77; 95% CI 0.73–0.82). These fiber sources correlated with more favorable insulinemic, lipid, and inflammatory biomarker profiles and a metabolomic signature of lower diabetes risk. Vegetable fiber showed no clear association with diabetes risk or similarly favorable metabolic profiles. 3

Semaglutide lowers MACE and fatty liver index in obese patients at fibrosis risk

This prespecified SELECT analysis evaluated once-weekly semaglutide in obese, nondiabetic patients with atherosclerotic cardiovascular disease at high risk of liver fibrosis. In subgroups defined by elevated Fibrosis-4, semaglutide reduced major adverse cardiovascular events by 21–26% versus placebo, consistent with the overall trial effect. Semaglutide produced a 28% greater reduction in fatty liver index than placebo over 104 weeks (HR 0.72; 95% CI 0.71–0.73). Benefits were observed across several Fibrosis-4 thresholds, suggesting efficacy in patients at risk for substantial liver fibrosis. 4