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🫀 New NICE NG28: #T2D is no longer about glucose (1 or 4 Posts) 🔹 T2D → 2x ↑ heart failure risk 🔸 ~40% develop CKD 🔹 CV disease still #1 cause of death Old model → Treat HbA1c New NICE model → Protect heart + kidneys FIRST 💊 SGLT2i now first-line for most ⏱ Delay = preventable organ damage 👉 HbA1c is not the main target anymore 🔗 nice.org.uk/guidance/ng28 🔗tinyurl.com/T2DDeepdive1

🔥My latest @Medscape Medical Mentor podcast is live! 🚨#GLP1 Adverse Effects Practical Tips for Clinicians 🎯Mitigating #gastrointestinal side-effects 🎯#Pancreatitis 🎯Hair loss 🎯Nonarteritic anterior ischemic optic neuropathy #NAION 🎯Interaction with #HRT Link in comments👇🏾

4/4 🫘FIND-CKD 🎯 Bottom Line A promising signal for finerenone beyond diabetes. But positioning in practice depends on: 🔹effect size 🔸safety and outcomes data alongside modern therapy 👀 peer-reviewed publication will give us those answers 🔗bayer.com/media/en-us/fi… (company anouncement)

3/4 🫘 FIND-CKD ❓ What We Don’t Know Yet 🔹 Magnitude of eGFR slope difference 🔸 Hard outcomes: 🫘kidney failure 💔☠️ 🏥💔 🔹 Hyperkalaemia rates 🔸 Subgroup effects (e.g. IgAN vs hypertensive CKD) 🔹 Incremental benefit on top of SGLT2i ⚠️ Important Context Unlike DAPA-CKD and EMPA-KIDNEY, this is a surrogate endpoint result, not a full outcomes dataset. eGFR slope is accepted by regulators. But clinically, the key question is simple: 👉 Will this reduce dialysis, CV events, and death?

1/4 🫘 FIND-CKD: Finerenone Goes Beyond Diabetes Bayer reports positive Phase III results for finerenone in non-diabetic #CKD. This signals a potential expansion beyond diabetic kidney disease. 📊 The Study 🔹 1,584 patients with non-diabetic CKD 🔸 eGFR 25–90, UACR 200–3500 mg/g 🔹 All on maximally tolerated ACEi or ARB 🔸 Finerenone 10–20 mg daily vs placebo 🔹 Primary endpoint: eGFR slope over 32 months 👉 Result: Significant slowing of kidney function decline vs placebo

@parthaskar @kamleshkhunti @DrSdeG @drmohanv @docwas @DrSelvarajah @ChitraEndocrine @DrAmbrishMithal @idrlakshmi @FionaQuigs @ObesitySociety @AbbieSBrooks Will be interesting to see, although of course “bio-similar” semaglutide probably won’t be available in 🇬🇧🇪🇺 until 2031!

Bookmark this one The #NHS cannot afford present costs of #AntiObesity medications India will - likely- show the way & hold a clue For good or bad? The UK health system is heading towards a world of generics and unaffordabilty of most other things @kamleshkhunti @DrSdeG @ShivaniM_KC @NeilFlochMD bbc.co.uk/news/articles/…

Delighted that FIND CKD has meet its primary endpoint. Fantastic news for patients with non-diabetic CKD, including those with GNs, including IgAN Thank you to Bayer, all the investigators, study teams & patients who have made FIND-CKD possible bayer.com/media/en-us/fi…

@Dr_Lama_Amer @AliceYYCheng @WilmotEmma @ATTDconf @DSNforumUK @ABCDiab @LalanthaL @DiabetesUK @IntDiabetesFed @parthaskar @drpratikc Not from this from what we saw but there is data out there… eg pubmed.ncbi.nlm.nih.gov/40990066/

@GoggleDocs @AliceYYCheng @WilmotEmma @ATTDconf @DSNforumUK @ABCDiab @LalanthaL @DiabetesUK @IntDiabetesFed @parthaskar @drpratikc Any coast effective data ?!

❗️Knowledge (of glycaemia) is power❗️ FREEDOM2 trial presented by @WilmotEmma #ATTD2026 @ATTDconf 🔹CGM in those with T2DM on basal Insulin 🔸⬇️Hba1c at 4 and 8 months 🔹Improved sensor metrics/glycaemic profiles 🔸No increased hypoglycaemia 🚫 🔹No change Total Daily Insulin dosing 🔹Interesting patient reported outcomes and dietary/exercise data @AmarPut @drpatrickholmes @kamleshkhunti @TBattelino

❗️Results from SURPASS-EARLY ❗️by @SDelprato @ATTDconf #ATTD2026 Tirzepatide use in early after T2D diagnosis vs conventional care - 2 year results 🔸⬇️Hba1c 🔹⬇️weight 🔸⬇️Cv risk markers (lipid profile/BP) 🔹Effect on beta cell/c-peptide/insulin levels based on OGTT Essentially…. Tirzepatide does what it is expected to do in T2DM 🤷‍♂️😇 @drpatrickholmes @AmarPut @kamleshkhunti @DLBHATTMD @pabeda1 @AskDrShashank

#ATTD2026 Summary of QWINT trials - insulin efsitora once weekly @ATTDconf @TBatellino @kamleshkhunti

A nice reminder of when to consider T1D diagnosis #ATTD2026

Obesity isn’t just a metabolic risk. It’s an infection risk. Evidence suggests ~1 in 10 infection-related deaths worldwide may be attributable to obesity. Obesity increases hospitalisations and mortality across many pathogens and populations. #Obesity #InfectionRisk #PublicHealth sciencedirect.com/science/articl… @TheLancet

The question of cardio/renal risk in T1D has always been the elephant in the room as more molecules show benefit in T2D/obesity populations…. Until now! ❗️Finerenone in T1D and CKD .. the FINE-ONE trial ❗️ 🔸242 participants w/T1D, eGFR 25 to <90 (similar split <60 and >60) mean eGFR 59 🔹median uACR 574.6mg/g, all on ACEi or ARB 🔸32 year mean duration T1D At 6 months 🔹25% ⬇️ uACR with finerenone to placebo 🔸10% hyperkalaemia in finerenone group 🔹eGFR ⬇️ -2ml/min vs placebo (CI -4 to 0) ➡️Finerenone reduces uACR in T1D, Perhaps longer follow up for effect on eGFR to be clearer? Does this relate to harder renal outcome effects? nejm.org/doi/full/10.10… @AmarPut @drpatrickholmes @kamleshkhunti @DLBHATTMD @brendonneuen @P_Rossing @VladoPerkovic @pabeda1

Inflammation as a therapeutic target in obesity-related disease The purinergic P2X7 receptor drives inflammasome activation and meta-inflammation, linking obesity with cardiovascular, kidney, and liver complications oaepublish.com/articles/mtod.… #Obesity #Inflammation #CardioMetabolic

GLP-1 receptor agonists associated with reduced risks of substance use disorders Study shows broad preventive effect across multiple substance types. bmj.com/content/392/bm… @AskDrShashank

Cost-Effectiveness of General Population Versus Targeted Screening Strategies for T1D in Canada Gen pop screening at age 4 cost $404,534 more(than targeted screening) but detected 35 more cases(per 10,000 children) for an ICER of $11,383/case detected diabetesjournals.org/care/article/d…