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 -...

  Another recent article just came out on positive benefits for GLP-1 receptor agonists as well as SGLT-2 inhibitors, finding a decreased risk of Alzheimer’s disease and related dementias (see  dm GLP1 SGLT2 less dementia JamaNeuro2025  in dropbox, or  doi:10.1001/jamaneurol.2025.0353 )   Details : -- this was a target trial emulation study using electronic health record data from 2014-2023, from the OneFlorida+ Clinical Research Consortium of patients who were at least 50 years old with type II diabetes and no prior diagnosis of Alzheimer’s disease and related dementias (ADRD)     -- this database integrates longitudinal electronic health records linked with the National Death Index for multiple healthcare partners in Florida, with more than 21 million persons covering approximately 86% of Florida’s population, also extending into Georgia and Alabama -- 33,858 eligible patients were included in the GLP1 versus the other second-line glucose loweri...

  A recent analysis found huge corporate profits by drug companies that make an array of diabetes meds, far exceeding the actual real costs of their manufacture (see  dm meds drug co shenanigans  in dropbox, or  doi:10.1001/jamanetworkopen.2024.3474)   Details : -- these researchers evaluated the “sustainable cost-based prices (CBPs) of insulins, SGLT-2s (sodium-glucose cotransporter-2 inhibitors) and GLP1’s (glucagonlike peptide-1 agonists), and compared them to their current lowest reported prices in 13 countries. -- their methodology of determining the sustainable CBPs:     -- the actual pharmaceutical ingredient (API) cost per unit     -- the costs of formulation and other operating expenses (including packaging and logistical costs)     -- a profit margin with allowance for taxes         -- and the ultimate prices charged should reflect “competitive markets that afford manufacturers sustainabl...