Patrick Holmes

📍Life expectancy ⤵️ by 3-4y for each decade diagnosis of #type2diabetes before 70y 📍driven by ⤴️ CV ☠️ 👉 important to manage all, but the #T2Day cohort especially need our attention @ShivaniM_KC @kamleshkhunti @Dralbalawi1989 thelancet.com/journals/landi…

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

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)

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…

❗️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

A nice reminder of when to consider T1D diagnosis #ATTD2026

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

🚦Our updated @Medscape Primary Care #Hack is live! 🔥Management of #acne in primary care🔥 Co-authored with my wife Catherine Fernando Main change is addition of clascoterone 1% to therapeutic options for #acne PDF link in comments 👇🏾

❗️Trials that changed the game ❗️ Next in our GoggleDocs series - the ACCORD trial 🔹 Intensive BG ⬇️ (HbA1c <6.0%) in high-risk T2D did not significantly reduce MACE 🔸However, intensive strategy was stopped early due 22% ⬆️ in all-cause mortality @drpatrickholmes tells us more @AmarPut @dr_amritlamba @kamleshkhunti @DLBHATTMD

🚨CGM Chart updates! Download now: sign up once to receive your password for ongoing access ▶️Updated monthly to reflect the latest data & tech ▶️Registered users get automatic updates ▶️This release aligns with the latest FIND standards 🔗 diabetesspecialistnurseforumuk.co.uk

📊 New NICE #T2D NG28: Who actually gets these drugs? (4 of 4 posts) 🔹 SGLT2 uptake ~22% 🔸 ~1.7 million eligible Inequality is clear 🔹 Deprived areas → lower prescribing 🔸 Black patients → lower odds 🔹 Women → less likely to receive therapy Yet highest risk sits in these groups NG28 tries to fix this 🔹 Universal SGLT2 first-line 🔸 Early-onset aggressive pathway 🔹 ASCVD → mandated semaglutide But… ⚠️ Guidelines don’t prescribe themselves 👉 HIGHEST NEED ≠ HIGHEST ACCESS 🔗 nice.org.uk/guidance/ng28 🔗 tinyurl.com/NICET2D-Dive-4

🫀 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

💊💉 New NICE #T2D NG28: The prescribing ladder is gone (post 2 of 4) 🔹 Default = metformin + SGLT2i 🔸 ASCVD → add semaglutide upfront 🔹 CKD → eGFR-based pathways 🔸 Early-onset → aggressive combination 🔹 Frailty → minimal therapy But… ⚠️ Start sequentially, not simultaneously 👉 HbA1c no longer drives treatment 👉 Comorbidity does 📊 This is phenotype-led prescribing 🔗 nice.org.uk/guidance/ng28 🔗 tinyurl.com/NICET2D-Dive2

⚖️ New NICE #T2D NG28: Evidence vs affordability (3 of 4 posts) Draft (2025) 🔹 Earlier GLP-1 / tirzepatide 🔸 Faster combination therapy 🔹 More weight-focused care Final (2026) 🔹 Sequential SGLT2 start 🔸 GLP-1 restricted 🔹 “Consider” not “offer” in obesity 🔸 Semaglutide capped at 1mg 📊 Pattern is clear When evidence meets cost… cost wins 👉 BEST EVIDENCE ≠ REAL WORLD CARE 🔗 nice.org.uk/guidance/ng28 🔗 tinyurl.com/NICET2D-Dive3

📊 Do patients actually WANT statins for primary prevention? 📊New @JAMAInternalMed data: 551 participants asked what risk reduction they'd need to justify taking a statin daily At 10% 10-year ASCVD risk: 🔹 Median demand: 7.5 percentage points off their risk 🔸 Statins deliver: ~2.5 percentage points 👉Fewer than 1 in 3 would take statins at actual efficacy 🔗jamanetwork.com/journals/jamai…

@drmahendrapatel @cmmillar @willowhaye @LUFC @Waccoe1919 @TheSquareBall @DM_Zadeh

Leeds Utd v Notts Forest last night — elite performance by #LUFC with 1 🔥 2 🔥 3 🔥 goals sealing the day with five out of 5 wins under the lights! Made up for rubbish weather! The man #Gruev giving a truly master class performance and really coming out of his shell! #LEENOT

❗️Trials that changed the game❗️ The Steno-2 Study 🔹Does multiple risk factor management improve outcomes? @Stenodiabetes investigated! 🤓Hear @drpatrickholmes tell us about another of the key trials in metabolic health care 👇 @AmarPut @dr_amritlamba @P_Rossing @kamleshkhunti @DLBHATTMD @VietHeartPA @IntDiabetesFed @LDC_tweets @mvaduganathan

It couldn’t be any clearer. The agent in the gray jacket removes Alex Pretti’s handgun — and the agent in green empties his magazine into Alex’s back. That’s right. He shot him in the back. Because @CBP and @ICE are a bunch of cowardly pieces of shit.

This is Alex Pretti, a VA ICU nurse, honoring a veteran he cared for at a VA hospital. The son of the deceased veteran just posted this video on Facebook with the following message: “RIP Alex Pretti, he was my Dads ICU nurse, he read my dad’s final salute at the VA after he passed away. Never wanted to share this video but his speech is very on point. Also my Fathers final words to me was continue to fight the good fight. He would be honored in Alex’ sacrifice, and ashamed of this current administration. In my Dads words I encourage you all to continue to ‘fight the good fight’”

❗️Trials that changed the game❗️ Continuing our series with the Diabetes Prevention Programme Study Does lifestyle intervention or metformin impact progression to Type 2 Diabetes for those at risk? @dr_amritlamba tells us more 👀 @drpatrickholmes @AmarPut @kamleshkhunti @DrRonaldMa1

❗️Trials that changed the game❗️ 🔹Episode 3 of our series… and it’s a detailed one… 🔸Another important trial that shapes what we do in T1D…DCCT! Take it away @AmarPut 🙌 #DCCT #diabetes @drpatrickholmes @dr_amritlamba @kamleshkhunti @DLBHATTMD @DrRonaldMa1