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/ar… #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.70306

🔍 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…

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-certifica…

🚨 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-rele…

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/3096…

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/205520

Some early morning #Diabetes education on a Friday…. Why not. “Is that HbA1c correct?” Have a look at the wider picture 🙂 Use, RT as you wish #T1D #T2D

¿Cuándo elegir semaglutida y cuándo tirzepatida? La EASO acaba de actualizar su algoritmo con evidencia hasta noviembre 2025 📊 @EASOobesity Spoiler: depende del objetivo clínico. No es solo pérdida de peso. 🔗 @NatureMedicine nature.com/articles/s41591-0… #ECO2026

Interesting data from #ECO2026 @EASOobesity Building on the need for more data in women’s health esp around menopause but more interesting is the migraine data Expanding the other potential beneficial effects of weight loss and why there are also trials in IIH with incretins

🔥My latest Medscape Primary Care #Hack is live! 💡Continuous Glucose Monitoring #CGM for people living with #T2D Co-authored with @drheatherbell Includes 8 simple steps to interpreting the Ambulatory Glucose Profile report #AGP PDF download link in comments 👇

Don’t miss the signs of #T1Diabetes The 4 Ts And no, they don’t have to be altogether as a presentation Keep this in your mind as a possible diagnosis Even one life saved? Is worth all the “cost” Better safe than sorry #T1Diabetes 💙

Check out our latest @GoggleDocs NICE summary - Semaglutide 2.4mg in ASCVD @DrDerekConnolly @escardio @ATTDconf @EASDelearning @banshisaboo @dramitaol @AskDrShashank @hvanspall @BrJCardiol @ABCDiab @NICEComms

So folks: this means that if you have obesity…. You are 38% less likely to die if you have bariatric surgery - there are no studies for GLP-1ra that show these dramatic results.

🚨NICE TA1152: #semaglutide 2.4 mg recommended as an option for ⤵️💔risk in adults with established CVD and BMI ≥27 kg/m² 🚨 🔹 Eligible: previous MI, ischaemic/haemorrhagic stroke, or symptomatic PAD, with BMI ≥27. No restriction on time since index event. T2D not excluded. 🔸 SELECT (n=17,604): First MACE: HR 0.80 (0.72-0.90) Non-fatal MI: HR 0.72 (0.61-0.85) Coronary revasc: HR 0.77 (0.68-0.87) All-cause death: HR 0.81 (0.71-0.93) Benefit appeared early, before substantial weight loss. 🔹 Preferred ICERs £6,878 to £14,594 per QALY, well below the £20,000 threshold. 🔸 What a TA means for access: statutory funding mandate. ICBs in England must make it available within 90 days when considered the right treatment (Wales: 60 days from final draft). But that doesn't mean immediate primary care prescribing. 🔗 nice.org.uk/guidance/ta1152 #PrimaryCare #Cardiology #GLP1 #NICE

Nigel Farage literally wrote the book on this…