Internal Medicine

GLP-1 receptor agonists associated with fewer major cardiovascular and kidney events in type 1 diabetes

A national EHR target trial emulation followed 174,678 adults with type 1 diabetes from 2013 to 2024. GLP-1RA initiation was associated with lower 5-year major adverse cardiovascular event risk versus nonuse (4.3% vs 5.0%; risk difference −0.7%; HR 0.85, 95% CI 0.77–0.95). End-stage kidney disease risk was also reduced (5-year risk 1.6% vs 1.9%; risk difference −0.3%; HR 0.81, 95% CI 0.69–0.95). Hospitalizations for diabetic ketoacidosis and severe hypoglycemia did not increase with GLP-1RA use. 1

Nirmatrelvir/ritonavir lowered post-COVID diabetes risk; molnupiravir showed no benefit

This target trial emulation included 88,643 hospitalized adults with first SARS-CoV-2 infection in Hong Kong from March 2022 to October 2023. Among non-diabetic patients, nirmatrelvir/ritonavir was associated with reduced incident post-COVID diabetes versus no antiviral (HR 0.75, 95% CI 0.61–0.92). In patients with pre-existing diabetes, nirmatrelvir/ritonavir lowered diabetes-related rehospitalizations (HR 0.70, 95% CI 0.60–0.81). Molnupiravir was not significantly associated with either incident diabetes or diabetes rehospitalizations. 2

Social determinants substantially shape SGLT2 inhibitor and GLP-1RA prescribing

This systematic review and meta-analysis synthesized 26 retrospective and cross-sectional studies including over 14.6 million patients. Low socioeconomic status was associated with reduced odds of SGLT2i or GLP-1RA use (aOR 0.73, 95% CI 0.61–0.76). Medicaid, Medicare, and Medicare Advantage enrollees, people with lower education, rural residents, and those in high-deprivation neighborhoods had lower utilization. Black patients had reduced use of both drug classes (aOR 0.80, 95% CI 0.79–0.82), while Hispanic and Asian patients had lower GLP-1RA use. 3

Extreme urban heat increased ED visits among older adults in a vulnerable population

This matched case-control study analyzed 55,200 summer ED encounters among adults 65 years and older at two New York City emergency departments. At ED-1, serving predominantly Medicaid-enrolled and racially and ethnically minoritized patients, ED use rose when daily maximum heat index exceeded 66 °F. Risk peaked at 101 °F (cumulative OR 1.24, 95% CI 1.11–1.39) and increased on days 15–18 °F warmer than average. At ED-2, serving predominantly White, privately insured patients, extreme heat associations were not positive and were significantly negative at high anomalies. 4