geoffrey modest medical blogs

  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...

  a recent study found impressive benefit of GLP1 receptor agonists in patients with Type 1 diabetes (T1D), leading to decreases in cardiovascular and kidney outcomes (see   dm1 GLP1 dec cardiovasc NatureMed2026  in dropbox, or   https://doi.org/10.1038/s41591-026-04274-0 ) Details : -- this study utilized the Optum Labs Data Warehouse, a national dataset including about 300 million patients from >60 health systems -- the study design was a sequential target trial emulation after propensity matched score weighting (a mouthful, described below in the commentary; this technique is a way to effectively  s imulate a randomized controlled trial based on existing data from a large database -- for the study, they found 174,678 individuals with T1D with 6,092,537 person-trials (person-trials includes those patients who  were found to start using a GLP-1  at every time period over  the course of the study ) -- baseline variables, after weighti...