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September 2023. That’s when I started calling this all out re PAs And amidst all of this? The gall to accuse Gill Leng of bias- and then shut down by a legal court? Is something incredible. Threatening anyone who didn’t agree with their leaders views; Accusations of bias; Personal attacks; Referrals to GMC… Everything has been tried. And here we are. I may not know much about workforce - but I know that anyone in healthcare working outside their training? Will cause harm. Implement the Leng recommendations. Enough obfuscation done. @DHSCgovuk @NHSEngland @NHSE_WTE

gov.uk/government/pub… @PCCS_UK @BritishCardioSo @ESC_Journals @bacpr @AtrialFibUK @ProfKausikRay @cpgale3 @DrRaniKhatib @GoggleDocs

Great to see NICE approval for Teplizumab! Know firsthand the hard work behind the scenes to get to this. A new era in T1D care 🙌🏽 Await the full NICE TA being available soon First drug to delay onset of type 1 diabetes made available on NHS bbc.com/news/articles/…

What does metformin actually add in prediabetes beyond delaying diabetes❓ JAMA, 21-yr DPP/DPPOS follow-up (n=1,173): 🔹 Lifestyle reduced multimorbidity (≥2 long-term conditions): HR 0.79 🔸 Metformin did not: HR 0.91 (NS) 🔹 High-cost dyads: lifestyle HR 0.57. Metformin no signal Layered on: no CV, mortality, cancer or frailty signal for metformin in prediabetes. Lifestyle has hard outcome data in Da Qing (CV events, mortality, +1.44 yr life expectancy). And "lifestyle" here isn't a pamphlet. DPP was 16 individual sessions, 2 yr of monthly follow-up, structured ≥7% weight loss, ≥150 min/wk activity. Not soft. The clinical question shifts: 👉Less "should we start metformin?" 👉More "what structured support gives this person the best chance over the next 20 years?" 🔗 doi.org/10.1001/jama.2…

Great to be @mimslearning Live speaking on Obesity in an enjoyable panel discussion with @drpatrickholmes and going solo talking about multiple risk factor management and cardio-reno-metabolic care in primary and secondary care 🤓

The next chapter from Prof Steven Kahn clearly conceived before #ADA2026 now more timely, published in @DiabetesCareADA diabetesjournals.org/care/article/d… #Diabetes

An Open Letter to the American Diabetes Association: Shame on You c.org/brTFTjVw via @Change

#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

This is shocking 😮. Just happened at the start of #ADA2026 Scientific Sessions.

🚨 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.70…

@cpgale3 What’s going on in East London?

Geographic variation (I would say a ‘hot spot’) of prescribing Wegovy by general practice at sub ICB level in the NHS of England, March 2026 share.google/E4raIviefoND5K…

🔍 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/CIRCUL…

@parthaskar 💔 “Grief is the price we pay for love.” - Colin Murray Parkes. Thinking of you and your family.

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@parthaskar @RCPhysicians @DrLKVaughan @DrAsifQasim @COPDdoc @respirologist @DrSelvarajah @DrSteveTaylor @doctor_katie @ShivaniM_KC @HamidIftikhar33 😳

The attempts of the @RCPhysicians to cling on to the vestiges of what they once supported is quite ...amazing The requirements to be... Certificate in Geriatric Medicine Knowledge-Based Assessment Lead includes being a PA for 7 years. I predict this is a degree anyone can do and be equated to specialist training in near future too. @GeriSoc - are you saying a Consultant of 3 years experience and a PA of 7 years experience are at par? Cos that's....something Link: bgs.org.uk/vacancy-certif…

🚨 TRIUMPH-1: #retatrutide topline data🚨 Phase 3, n=2,339, 80 wk, obesity without diabetes (efficacy estimand): 🔹 12 mg: -28.3% body weight (-31.9 kg) 🔸 9 mg: -25.9% | 4 mg: -19.0% | Placebo: -2.2% 🔹 ≥30% weight loss: 45.3% vs 0.5% 🔸 104-wk extension (BMI ≥35, n=532), 12 mg → MTD: -30.3% Cross-trial context (obesity, no diabetes): 🔹 STEP-1 SEMA 2.4 mg, 68 wk: -14.9% 🔸 SURMOUNT-1 TZP 15 mg, 72 wk: -20.9% 🔹 TRIUMPH-1 RETA 12 mg, 80 wk: -28.3% ⚠️But: 🔸 Topline press release. No peer-reviewed publication yet 🔹 AE discontinuation at 12 mg: 11.3% vs 4.9% placebo 🔸 Dysesthesia 5.1–12.5% vs 0.9%. Efficacy ceiling keeps moving. Enthusiasm needs caution. Still unlicensed in humans outside of research❗️ 🔗 investor.lilly.com/news-releases/…

To be honest there are a lot of unknowns about this. In terms of diabetic retinopathy the postulated theory remain rapid drop in glucose exacerbation the retinopathy. Although they are GLP-1 receptors within the retina. In terms of normal glucose in an obese population without T2D less is known and particularly in non diabetic retinopathy. Other than what you have seen

@GoggleDocs @BevTchangMD Thank you. I have seen the paper. My reading of it is that the risk in people with diabetes is significantly higher. Two further questions: What about people with #obesity and no #diabetes? Is the risk mainly about worsening of the condition or can GLP1 trigger it?

Does #tirzepatide cause or worsen macular degeneration? @GoggleDocs @BevTchangMD 🙏🙏🙏

Age of diagnosis; #T1Diabetes #T2Diabetes & science “Clinicians should be aware that patients progressing to #insulin within 3 years of diagnosis have a high likelihood of #type1diabetes, regardless of initial diagnosis” Via @DiabetologiaJnl Please use, RT as possible Link: pubmed.ncbi.nlm.nih.gov/30969375/

The opportunity this provides and potential is there… if science builds further and regulation/policy/funding allows… hopefully will go the way of tech all those years ago …. Would like to get to a point to say the next 5 years is about cementing and implementing immunotherapy in T1D… not there yet though…

Some weekend reading for those interested in...science For ever more? Treatment of #T1Diabetes has relied on #Insulin And the 'cure' is forever '10 years away' Yet...what hope does science offer...what are the areas of intrigue and interest? A fabulous article via @jclinicalinvest - and the vision of immune tolerance. @ShivaniM_KC @DanielJDrucker @aaronjkowalski @BreakthroughT1D @BT1DUK @DiabetesUK Link: jci.org/articles/view/…