geoffrey modest medical blogs

  A recent study found that GLP-1 receptor agonists were not associated with more acute pancreatitis than sulfonylureas. There was a small increase in GLP-1 related pancreatitis that was offset by decreased alcohol- and triglyceride-related pancreatitis attributable to the GLP-1s: see GLP-1 pancreatitisBMJ2026 in dropbox, or doi:10.1136/ bmjmed-2025-002183 Details : -- 333,687 patients were studied who had type 2 diabetes and antidiabetic therapy was initiated by a GLP-1 receptor agonist (n=132,551) or a sulfonylurea (n= 201,136), between January 2017 and January 2024, from the Veterans Affairs healthcare system databases -- mean age 66, 75% white/21% black -- smoking: never 43%/former 38%/current 20%; alcohol use disorder 6% -- area deprivation index 57 (a composite of socioeconomic disadvantage based on education, income, employment, and other poverty measures, measured at the participants' location, with values ranging from low to high of 0 to 100) -- BMI 34, A1c 8.6%, eGFR 76 -...

  A recent article explored the relationship between difficult-to-control diabetes and endogenous hypercortisolism, finding improved glycemic control with the use of mifepristone   in the CATALYST study (see   dm hypercortisolism mifepristone rx DiabCare2025  in dropbox, or   https://doi.org/10.2337/dc25-1055 ), in the CATALYST study Details : -- 136 individuals who had type II diabetes (T2D) and hemoglobin A1c between 7.5% and 11.5% on multiple medications were then randomized in this prospective, multicenter, double-blind study of  the glucocorticoid receptor antagonist mifepristone (300 to 900 mg daily) vs placebo for 24 weeks, stratified by the presence or absence of an adrenal imaging abnormality     -- specifically, patients had to be on least three glucose lowering medications, or taking insulin and any other glucose lowering medication(s), or taking at least two glucose lowering medications and having at least one microvascular or mac...