Endocrinology

SGLT2 inhibitors outperform GLP-1RAs for kidney protection in metformin-treated type 2 diabetes

In Danish nationwide data emulating a target trial, metformin-treated adults starting SGLT2is were compared with those starting GLP-1RAs. Five-year chronic kidney disease risk was lower with SGLT2is than GLP-1RAs (6.7% vs 8.2%; risk ratio 0.81; risk difference -1.5%). Acute kidney injury burden was also lower with SGLT2is (mean cumulative count ratio 0.88). Albuminuria and mortality were slightly lower with GLP-1RAs, suggesting competing priorities when selecting second-line therapy. Kidney benefits of SGLT2is were most pronounced in individuals without preexisting kidney disease, supporting early use when renal protection is paramount. 1

Blood pressure lowering in type 2 diabetes: mostly linear benefits, limited J-curve

This meta-analysis pooled 89 cohorts including 5.88 million individuals with type 2 diabetes to assess blood pressure–outcome relationships. Apparent J-shaped associations for systolic blood pressure with mortality and cardiovascular events flattened at lower pressures after excluding baseline cardiovascular disease and cancer. Lower systolic blood pressure was associated with reduced cardiovascular events without clear excess all-cause mortality at low levels. Renal outcomes, including renal events, eGFR decline, and albuminuria, rose monotonically with higher blood pressure. Findings support intensive blood pressure control in type 2 diabetes, with limited evidence for harm at lower systolic targets in otherwise stable patients. 2

Early antenatal prediabetes confers high short-term risk of postpartum type 2 diabetes

This New Zealand prospective cohort compared postpartum diabetes risk in women with early antenatal prediabetes versus those developing later gestational diabetes. Among 355 women with booking HbA1c 5.9–6.4% and 490 with later GDM and HbA1c <5.9%, progression to type 2 diabetes was far higher after antenatal prediabetes. Adjusted hazard ratios versus GDM ranged from 4.5 to 16.7 across the 5.9–6.4% HbA1c spectrum, with strong trend by HbA1c band. Booking HbA1c was the strongest predictor of postpartum type 2 diabetes, followed by BMI and Pacific ethnicity. Lipid profiling suggested distinct triglyceride patterns in monogenic and autoimmune diabetes, hinting at the value of targeted etiologic testing in outliers. 3

Behavioral physical-activity counseling lowers 10-year mortality in sedentary type 2 diabetes

In this post hoc analysis of the Italian Diabetes and Exercise Study_2 randomized trial, 300 sedentary adults with type 2 diabetes were followed for 10.3 years. Participants received either standard care or annual one-month behavioral counseling targeting physical activity and sedentary behavior for three years. All-cause deaths were lower with counseling than control (18 vs 35; p = 0.010), mainly from fewer cancer deaths. Age- and sex-adjusted hazard ratio for mortality was 0.50, improving to 0.41 after broader adjustment. Despite observational post-trial follow-up and potential confounding, structured activity counseling appears to confer durable mortality benefit in routine diabetes care. 4