Latest news with #T2D
Medscape
3 days ago
- Health
- Medscape
Popular Diabetes Drug Ups Phimosis Risk in Men With T2D
TOPLINE: Men with type 2 diabetes (T2D) who initiated SGLT2 inhibitors showed nearly double the risk for phimosis after 1 year of treatment than those who initiated GLP-1 receptor agonists (GLP-1 RAs). This elevated risk persisted for over 8 years of follow-up. METHODOLOGY: SGLT2 inhibitors decrease hyperglycaemia by promoting glucose excretion through the kidneys, causing glucosuria, but raise concerns about an approximately threefold elevated risk for genital infections. Researchers in Denmark emulated a target trial to compare the risk for phimosis between male metformin users with T2D who initiated SGLT2 inhibitors (n = 32,543; median age, 62.8 years) and those who initiated GLP-1 RAs (n = 14,730; median age, 63.1 years) from January 2016 to December 2021. The primary outcome was a first-time inpatient or outpatient diagnosis of phimosis, with penile cancer being included as a prespecified secondary outcome. Participants were followed up for a median duration of 4 years, with a maximum follow-up duration being 8 years. TAKEAWAY: The use of SGLT2 inhibitors was associated with a nearly twofold higher risk for phimosis than the use of GLP-1 RAs at 1 year (risk ratio [RR], 1.88; 95% CI, 1.43-2.47). The elevated risk for phimosis with the use of SGLT2 inhibitors vs GLP-1 RAs persisted even after 8 years of follow-up (RR, 1.36; 95% CI, 1.14-1.61). Although the absolute risk for penile cancer was low, the results suggested that men initiating SGLT2 inhibitors had a higher 8-year cumulative risk for penile cancer than those initiating GLP-1 RAs, corresponding to an RR of 6.34 (95% CI, 1.16-34.52). IN PRACTICE: "Increased genital infections due to glucosuria in SGLT2i [SGLT2 inhibitor] users might therefore contribute to the elevated risks of both phimosis and penile cancer. Of note, any such risk must be weighed against the clear beneficial effects of SGLT2i on cardiovascular risk and overall mortality," the authors wrote. SOURCE: This study was led by Christine Ljungberg, Aarhus University and Aarhus University Hospital, Aarhus, Denmark. It was published online on July 30, 2025, in Diabetes Care. LIMITATIONS: Detection bias may have affected the findings as SGLT2 inhibitor users are more likely to develop urogenital symptoms, potentially resulting in more frequent urologic assessments. This study identified few cases of penile cancer, limiting statistical precision for this outcome, and the median follow-up duration of 4 years may have been insufficient for thoroughly assessing the risk for penile cancer. This study lacked information on covariates such as BMI, circumcision status, ethnic diversity, socioeconomic factors, and lifestyle behaviours. DISCLOSURES: This study was supported by Aarhus University. Some authors reported giving presentations and lectures on medical research (with or without compensation), receiving research support, teaching healthcare professionals, and having other ties with various pharmaceutical companies. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
31-07-2025
- Health
- Medscape
GLP-1 Agonists for Type 2 Diabetes Reduce Psoriasis, HS Risk
TOPLINE: Treatment with glucagon like peptide 1 receptor agonist (GLP-1 RA) medications was associated with a lower risk of being diagnosed with hidradenitis suppurativa (HS) or psoriasis, in a study of patients with type 2 diabetes (T2D). METHODOLOGY: Researchers assessed 74,910 patients (mean age, 65 years; 56% women; 45% White and 23% Black individuals) with T2D from the All of Us Database between May 2018 and October 2023. Of all patients, 19.5% received GLP-1 RAs. The primary outcomes of the study were risks for HS and psoriasis, adjusted for effects on control of diabetes and weight loss. TAKEAWAY: Overall, 1601 patients had psoriasis (mean age, 68 years; 56.4% women; 62.4% White and 12.2% Black individuals), and 601 had HS (mean age, 55 years; 77.2% women; 32.9% White and 41.3% Black individuals). Patients treated with GLP-1 RAs showed a significantly lower risk for a future diagnosis of HS (adjusted odds ratio [OR], 0.61; P < .001) than those who were not treated with GLP-1 RAs. GLP-1 RA treatment was also associated with a significant reduction in the risk for a future diagnosis of psoriasis (adjusted OR, 0.41; P < .001). The average time from T2D diagnosis to a diagnosis of HS was 3.98 years and 3.44 years to a diagnosis of HS. IN PRACTICE: 'These findings support a protective effect against HS and psoriasis in patients with T2DM taking GLP-1 RAs independent of weight loss, smoking status, or glycemic control,' the study authors wrote. Based on these findings, they added, 'future research should focus on prospective studies exploring the use of GLP-1 RAs as therapeutic tools to treat HS or psoriasis, prevent disease progression, and evaluate their effect in patients without diabetes.' SOURCE: The study was led by Lauren M. Ching, Georgetown University School of Medicine, Washington, DC, and was published online on July 23, 2025, in JAAD International. LIMITATIONS: Limitations included variance in data harmonization across sites, lack of disease severity information, and selection bias. DISCLOSURES: The study did not receive any funding. One author reported receiving financial aids as an investigator, consultant, and speaker from AbbVie, BMS, Eli Lilly, and various other drug companies. All other authors declared having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
ABC News
29-07-2025
- Business
- ABC News
Bowhill Engineering celebrates $32 million River Torrens to Darlington Project contract win
In the tiny town of Bowhill in South Australia's Murraylands, a $32-million contract is providing a local engineering firm with its biggest opportunity yet. Bowhill Engineering will fabricate the steel tunnel segments for the River Torrens to Darlington (T2D) Project's exit tunnels. The T2D Project is the final stage of the South Australian government's North-South Corridor, a 78-kilometre motorway between Gawler and Old Noarlunga. But while Bowhill Engineering is preparing for big growth, residents are not optimistic the town of Bowhill will grow with it. Bowhill Engineering, a family-run business, has been in the region since the 1970s. It transitioned from Bowhill Motors to Bowhill Engineering in the mid-1990s, and is now the town's main employer. The company is no stranger to big projects, having worked on SA's $354 million Regency Road to Pym Street project, but this contract will require an increase in its operational capacity. The project will push the company to fabricate more than double its average amount of steel per year, with 6,600 tonnes needed for the project. First deliveries are set for March 2026, with work to continue until October 2027. To manage the increase in workload, Bowhill Engineering has ordered more than $6 million worth of new equipment. A computer numerical control machine for precise cutting and three robotic welding systems will soon arrive at a newly built fabrication hall. "It's the biggest contract that we've won by a golden mile," chief executive Jodie Hawkes said. Bowhill Engineering expects the contract win to create 10-15 new positions, and the company is recruiting. But accommodation options for newcomers are limited, according to the local progress association and the council. Bowhill is a popular riverside destination for holiday-makers and tourists, and has experienced major house-price growth over the past five years. But the qualities that make it an attractive place for tourists have created complications for residents looking for growth. Bowhill Progress Association member Shane Mcgrath said the area had become too expensive for families, with holiday shacks becoming million-dollar properties. "Great for holiday makers, but not so good for having people here for helping out in the CFS or local progress [association], or even our sporting club." On top of high property prices, the local council said little land was available for new families to build on. Bowhill relies on bigger neighbouring towns for major services such as Mannum and Murray Bridge, where many of Bowhill Engineering's employees live and commute 30-45 minutes to work. Mid Murray Mayor Simone Bailey said it was unlikely Bowhill would see much development in the future, and the council was looking to nearby towns for future growth in the region instead. "It is quite a primary production area, apart from the holiday homes or the shacks," Ms Bailey said. "It's so close to many other areas that we can all work together for growth." However, Mr Mcgrath said due to a lack of local services, Bowhill would struggle to be maintained without further investment. "A lot of people that live here for all their life, they get to a stage where they have to move out." The nearby towns of Mannum and Murray Bridge are set for an economic boost, as new workers look for places to live nearby. Ms Hawkes believes what is good for the region is good for Bowhill. "The growth that Murray Bridge is looking to have, and being part of the greater Adelaide regional plan, that is a huge bonus for Bowhill," she said. "[It] makes regional living more attractive if you've got the services in your regional centre. "I only see it as a win-win."
Yahoo
23-07-2025
- Health
- Yahoo
Medtronic's MiniMed 780G system gains CE Mark for expanded indications
Medtronic's MiniMed 780G system has received European CE Mark approval to expand the indications for use by people aged two years and above, during pregnancy, and for those with type 2 insulin-requiring diabetes. The approval follows a review of published clinical data encompassing two to six-year-olds, pregnant women, and those with type 2 diabetes (T2D). The LENNY trial highlighted the efficacy and safety of the MiniMed 780G system in children aged two to six years with type 1 diabetes (T1D). Subjects who used the system in auto mode achieved a 0.6% reduction in HbA1C and a 9.9% increase in time in range against manual mode. An improved sleep quality and reduced fear of hypoglycaemia in the auto mode were reported by parents and caregivers. The company noted that the pregnancy poses distinct challenges for glucose management in women with T1D. The MiniMed 780G system's ability to address lower glucose levels offers a potent tool for maintaining tighter control, the company added. Additionally, a European study showed that women using the system during pregnancy achieved an average Pregnancy Time in Range (TIRp) of 66.5%, against traditional insulin therapy. The system has also proved beneficial for individuals with T2D. A pivotal trial reported a 0.7% decrease in HbA1c and an 80% increase in TIR. Real-world data from 26,427 T2D users of the system indicated good glycaemic control, with TIR exceeding international consensus targets. The company is working with the US Food and Drug Administration (FDA) to expand the system's use to a broader population, including individuals with T2D and young children. The SmartGuard algorithm within the system is said to automate insulin delivery based on continuous glucose monitoring (CGM) readings. The system is tailored to be used at an adjustable target glucose of 100mg/dl (5.5mmol/L) and customised on an individual basis. This month, Medtronic obtained CE mark approval for LigaSure RAS, a vessel-sealing instrument for use with the company's Hugo robotic-assisted surgery (RAS) system. "Medtronic's MiniMed 780G system gains CE Mark for expanded indications" was originally created and published by Medical Device Network, a GlobalData owned brand. The information on this site has been included in good faith for general informational purposes only. It is not intended to amount to advice on which you should rely, and we give no representation, warranty or guarantee, whether express or implied as to its accuracy or completeness. You must obtain professional or specialist advice before taking, or refraining from, any action on the basis of the content on our site. Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Medscape
10-07-2025
- Health
- Medscape
Lean Diabetes: A Diagnosis of Exclusion
CHICAGO – 'Lean type 2 diabetes (T2D)' is a diagnosis of exclusion but is also a true entity affecting roughly 10%-20% of people with T2D. That was the message from Kristina Utzschneider, MD, associate professor of medicine at the University of Washington, Seattle, and director of the Diabetes Care Program at the Veterans Affairs Puget Sound, at the American Diabetes Association (ADA) 85th Scientific Sessions in a symposium about 'nuanced' treatment of T2D. 'Type 2 diabetes is a condition characterized by hyperglycemia due to insufficient insulin secretion typically occurring in the context of insulin resistance, after ruling out other potential causes of diabetes. I think that last phrase is key,' she said. 'The first thing is to consider the differential diagnosis, especially if you're seeing a lean patient, which is a little atypical. Could diabetes be due to something else?' Two of the most common alternative diagnoses are autoimmune (type 1 diabetes [T1D]) diabetes or a monogenic form called MODY. The former can be assessed by measuring autoantibodies (GAD, IA-2, or ZnT8), while the latter is characterized by onset younger than 35 years, a strong family history of diabetes, and negative autoantibodies. Other less common alternatives include the result of pancreatic damage, cystic fibrosis-related mitochondrial diabetes, Wolfram syndrome, or lipodystrophy, Utzschneider said. 'In my clinical practice, with most of the lean patients who have come to me because they're not doing well, I test them, and they're type 1,' she told Medscape Medical News . However, she added, a sizable minority of people who actually do have T2D are lean, pointing to the heterogeneity of the condition. 'Lean type 2 diabetes is not necessarily rare. Beta cell dysfunction and insulin resistance are key factors underlying T2D, with more of a beta cell insulin secretory defect in the lean T2D group, but some patients may still have significant insulin resistance that could be targeted.' Very little research has focused on that group, she noted. 'It's tough finding data, as most of the population with type 2 is not lean. In most of the big studies, especially about treatment, the average BMI is 33.' Also in the mix are people of Southeast Asian ethnicity, who typically develop T2D at a lower average BMI than people of other ethnicities. Session moderator Liana K. Billings, MD, director of the Diabetes and Obesity Research Program and the Personalized Medicine in Diabetes Program at NorthShore University HealthSystem, Skokie, Illinois, endorsed the recommendation that for any lean person diagnosed with diabetes, the first step is to check whether they have type 1 or a monogenic type. 'Those tests are becoming more and more available, like the type 1 polygenic risk scores that can be used in helping to understand the genetic risk someone has for type 1 versus type 2 diabetes. It's definitely a growing field where we're trying to make sure that people with lean diabetes get the right diagnosis right out of the gate,' Billings said. 'We're trying to understand how people with lean type 2 may respond differently to medications, or what their prognosis is, and what factors may increase a person's risk of having diabetes at a lean BMI vs a higher BMI,' she added. Lean and Insulin-Resistant According to the World Health Organization, classifications of 'lean,' 'overweight,' and 'obesity' differ in people of Asian background from those of other ethnicities, with cutoffs of < 23, 23-27.4, and ≥ 27.5, respectively, vs < 25, 25-29.9, and ≥ 30 in people of other ethnicities. 'Lean does not necessarily mean someone is insulin sensitive, although typically as BMI increases, insulin sensitivity decreases. A lean individual could potentially be somewhat insulin resistant. And vice versa, somebody who is obese is not necessarily insulin-resistant,' Utzschneider noted. According to data from the US CDC for 2021, approximately 10.2% of people with diagnosed diabetes have a BMI < 25, although that includes people with T1D. However, in contrast, Korean data for 2019-2020 show the proportion of people with diabetes who have a BMI of 18.5-22.9 is about 23.3%. 'Think about this when you're seeing patients in your clinic. If they have Asian ancestry, particularly South Asian ancestry, your threshold for considering [type 2 diabetes] is going to be higher.' Different Treatment by BMI? More Research Needed Very little data are available regarding the effects of T2D treatment in lean people specifically. However, one study evaluated 20 adults with T2D for < 6 years and BMI < 29 not on insulin who were put on a very low-calorie diet aiming for a 5% weight loss, then returned to a regular diet. Their BMIs and visceral and liver fat all declined. Glycemic control and fasting glucose declined as well, and 70% achieved T2D remission. Insulin sensitivity doubled, and beta cell function improved from baseline but did not reach the level of control. 'They're managing the diabetes with the weight loss and lifestyle, but the beta cell defect is still there,' Utzschneider said. As for medications, most studies haven't shown a huge effect of BMI on A1c-lowering effectiveness, with a few exceptions. In the ADOPT study, rosiglitazone was more effective at lowering A1c than metformin among those with obesity. And in a precision medicine modeling study, DPP-4 inhibitors were less effective in people with BMI ≥ 30 or who were very insulin-resistant. In general, Utzschneider said, metformin is still the first-line option, and other glucose-lowering medications are worth trying, but those with lean T2D may require insulin sooner than those with higher BMIs. This can be assessed by measuring C-peptide, which reflects endogenous insulin secretion. It's important to measure both glucose and C-peptide at the same time because if glucose is low, 'the body will shut off insulin secretion, and you won't be able to interpret the results,' she noted. There are no clinical practice guidelines for checking C-peptide in T2D, and no set cutoffs. Utzschneider considers a value of < 0.6 ng/mL to be low, likely requiring insulin, and a value of > 2.7 ng/mL to be high, indicating that the individual is still making insulin but is likely very insulin-resistant, so the treatment should focus on that. Caveats about C-peptide testing include the fact that the C-peptide assay isn't standardized so there's variability from lab to lab, it can be affected by renal clearance and certain medications, and the measure won't be accurate in the setting of glucotoxicity. 'This is an area we need more research and better guidelines on,' she said. Ongoing Research Is Digging Into T2D Heterogeneity Better subclassification of T2D and predictive models are also needed. In one recently published study, researchers from Exeter University, Exeter, England, devised a model for A1c lowering at 1 year, based on nine readily available clinical variables including baseline BMI to recommend the optimal drug class for that patient. 'This is really exciting work,' said Utzschneider, who added that her team is collaborating with the Exeter group on further analyses. She is also participating in a research consortium funded by the National Institute of Diabetes and Digestive and Kidney Diseases called DEFINE-T2D with the goal of improving the classification of T2D by integrating multiple data types from large existing datasets and ultimately leading to improved treatment outcomes. Utzschneider reported receiving research funding from Eli Lilly and Company, Avid, and Amgen and consulting fees from Nevro Corp. Billings reported receiving research support or consultant fees or served on advisory panels for Bayer, Dexcom, Endogenex, Eli Lilly and Company, Novo Nordisk, Sanofi, Pfizer, and Xeris.
