🔍 10% Visceral Fat loss⤵️ T2D cases by 28% over 10y 5- and 10-yr follow-up of two 18-mo lifestyle RCTs. The story isn’t the weight loss. It’s what stayed lost after the weight came back: 🔹 VAT -27% at 18 mo (MRI) 🔸 5–10 yr later: weight fully regained. VAT still ~15% below baseline (~55–60% of original loss preserved) 🔹 Each 10% VAT loss = 28% lower T2D risk in follow-up (HR 0.72). Association, not proof 🔸 Liver and pancreatic fat fully regained Track waist, not just weight. 🔗 doi.org/10.1161/CIRCULATIONA…

🚨 DiRECT 5-yr data in Diabetic Medicine 👉Primary care low-energy diet: 6.1 kg weight loss, 10% T2D remission at 5 yr (46% → 36% → 10%). 💰Modelled cost dominance over usual care. Lifetime QALY +0.08, cost -£496. 10% reads as failure to some. It isn't. Obesity and T2D are chronic relapsing conditions. Remission ≠ cure. The clinical point worth flagging: 🔹 Patients pursue remission to come off meds. Fair 🔸 Remission isn't licence to drop evidence-based CV prevention 🔹 NICE increasingly puts metformin + SGLT2i as starting point for many adults with T2D 🔸 Statins still matter. CTT: ~22% major vascular event reduction per 1 mmol/L LDL fall 🔹 BP and lipid control need reassessing after remission, not assuming resolved Incretins offer larger weight loss and hard CV data in selected groups (SUSTAIN-6,SELECT, FLOW). DiRECT doesn't. It's a tool. Use it wisely. 🔗 doi.org/10.1111/dme.70306

#ADA2026 #Zenagamtide (Amycretin) Delivers in #T2D 💥 Dual GLP-1 + amylin agonist shows impressive HbA1c & weight reductions with no apparent weight-loss plateau 🧪 Phase 2b (n=226; T2D on metformin ± SGLT2i) 🩸 HbA1c:  ⤵️1.41%(10mg) − 1 .71% (40 mg) vs ⤵️0.14% (pbo) 🎯 HbA1c ≤6.5% achieved:  76% (40 mg) vs 14% (pbo) 📉 Mean weight loss at 36 wks: ⤵️12.9(10mg) − 14.6% (40 mg) vs ⤵️2.1% (pbo) 📊 CGM metrics improved across all doses 🤢 GI AEs were the most common, with rates broadly consistent with GLP-1 and amylin therapies 💡 Notably, the 20 mg group had only 8w at maintenance dose and the 40 mg group only 4w, yet weight loss curves were still trending downward at 36w 👉 One of the strongest combinations of glycaemic and weight efficacy seen to date in T2D❗️ 📌 Poster 1730-P

Retatrutide TRIUMPH-4: 29% weight loss at 12mg. Impressive. ⚠️But here’s what needs discussing: 20.9% experienced dysesthesia (abnormal skin sensations) at that dose vs 0.7% placebo. Before everyone panics: - Generally mild - Rarely led to discontinuation - Overall dropout rates similar across all arms This is novel for incretins. GLP-1s and dual agonists don’t typically cause sensory symptoms—they stick to GI effects. Triple agonism (GLP-1/GIP/glucagon) may affect neural pathways differently. What we don’t know: - Mechanism (why would metabolic receptors affect skin sensation?) - Long-term persistence - Whether slower titration helps The risk-benefit still looks favourable. Most people tolerated it and stayed on treatment. But 1 in 5 experiencing unexplained neurological symptoms at therapeutic doses deserves transparency, not dismissal. For context: This efficacy (29% weight loss) exceeds anything currently available. That’s practice-changing if the safety profile holds. 🎯Bottom line: Unprecedented efficacy with a manageable but unexplained sensory side effect. We need larger, longer trials to understand this fully.

⚠️In #T2D STATIN DELAY = CV RISK 💔 In 7,239 adults w/ diabetes (JAHA 2025): 🕒 1 in 5 delayed statins after initial offer 📈 LDL-C 126 vs 99 mg/dL (while off statin) 💔 CV event rate 10y: 8.5% (delay) vs 6.4% 💥 HR 1.49 for MI/stroke 🧪 LDL exposure mediated risk (HR 1.62) 🗣️ Not just inertia. Nonacceptance matters. 🔗 ahajournals.org/doi/10.1161/…

💔 "Double Trouble" #type1diabetes & visceral adiposity In SFDT1 (n=1,482), half had overweight or obesity But WHtR ≥ 0.5 was a better risk signal than BMI: 📊 High CV risk in: • 13% with WHtR ≥ 0.5 • 4% with WHtR < 0.5 👀 Even men with “normal” BMI were high risk if WHtR was raised ❗ Are we missing “double diabetes” phenotypes? ⏲️ time to look at adjunct therapies❓ 🔗 doi.org/10.1186/s12933-025-0…

🧠 SGLT2 inhibitors in kidney disease: mechanism meets medicine Kasralainy Nephrology Group review 100+ studies across 8 renal domains 📄 📍 Beyond glycaemia: ↓ Glomerular pressure (tubuloglomerular feedback) ↓ Sodium reabsorption (NHE3 inhibition) ↑ Autophagy, ↓ ROS & hypoxia ↑ EPO, ↓ hepcidin → ↑ erythropoiesis Possible immunomodulation 🩺 Applications: ✅ CKD (±diabetes, ±albuminuria) ✅ Renal anaemia ✅ AKI (esp. post-MI, PCI) ⚠️ Dialysis: off-label but emerging 🚫 PKD: avoid outside trials 🔍 Table 3 = practical prescribing guide 📄 doi.org/10.1186/s13098-025-0…

🍽️ Hungry for more than GLP-1 alone? 👉 CagriSema (amylin + semaglutide) aims to REDEFINE weight loss: 📊 −22.7% (Obesity, no T2D) 📊 −15.7% (Obesity + T2D) 68 wks Full results #ADA2025 later this month 🛑 Nausea still a key trade-off Next chapter: combo-first gut-brain therapy? 🔗 novonordisk.com/news-and-med…