Me reading progress note on a new patient I'm about "...GFR 32, patient has progressed to CKD 3B but no proteinuria, and blood pressure well controlled, no indication for SGLT2i at this time..." Me: 🫠🤬

Structure Therapeutics oral non-peptide GLP1 medication with very good numbers from their ACCESS II trial! Up to 16% body weight loss in the two highest dose arms with low D/C rate(2-4%) impressive results with phase 3 planned to start later this year.

NO business should be allowed to operate with this level of opacity. Full stop. On some level it's not just corrupt but immoral to deny health services to people just by refusing to even engage with them. Or making up lies about their conditions to deny care.

Structure Therapeutics oral non-peptide GLP1 medication with very good numbers from their ACCESS II trial! Up to 16% body weight loss in the two highest dose arms with low D/C rate(2-4%) impressive results with phase 3 planned to start later this year.

This week Eli Lilly quietly presented remarkable 2 year data of a 4 year trial of tirzepatide called SURPASS-EARLY, it's designed to show superiority of tirzepatide + metformin vs other traditional intensive diabetes management in patients with "early" diabetes (<4 years since diagnosis)

Double caturday in our house

Just thinking about the patient in a retatrutide trial whose GFR went from 32 to 98 in the span of 9 months(still ongoing) and whose nephrologist is at a loss for words to explain what's happening to them. No signs of hyperfiltration either. The potential to radically improve QALY is immense

Just thinking about the patient in a retatrutide trial whose GFR went from 32 to 98 in the span of 9 months(still ongoing) and whose nephrologist is at a loss for words to explain what's happening to them. No signs of hyperfiltration either. The potential to radically improve QALY is immense

I literally celebrated with my wife earlier this week when our 1 year old got her MMR vaccine, because now she'll have partial immunity in another week or so. I shouldn't be celebrating this in 2026.

This week Eli Lilly quietly presented remarkable 2 year data of a 4 year trial of tirzepatide called SURPASS-EARLY, it's designed to show superiority of tirzepatide + metformin vs other traditional intensive diabetes management in patients with "early" diabetes (<4 years since diagnosis)

Yet another autoimmune disease helped by GLP1RA, this time Lupus. Including better renal outcomes(significantly less nephritis!) Tracks with anecdotes from my clinic. Have a SLE patient on just Wegovy and 200mg Plaquenil. No more biologics. Best control of their lupus they've ever had.

When over the counter continuous glucose monitors came out I rolled my eyes a little bit because I questioned the utility. But now I found a use case: Reactive hypoglycemia. Diagnosed it this week by having a patient wear one then downloaded the data for analysis! It worked!

Yet another autoimmune disease helped by GLP1RA, this time Lupus. Including better renal outcomes(significantly less nephritis!) Tracks with anecdotes from my clinic. Have a SLE patient on just Wegovy and 200mg Plaquenil. No more biologics. Best control of their lupus they've ever had.

With everything else *waves hands around* going on in the world I figured a nice easy update on some new obesity medicine results is one way to bring some zen and positive vibes into the world! 2 more Amylin drugs and a shockingly tolerable GIP/GLP1 drug from a new player in the space!

With everything else *waves hands around* going on in the world I figured a nice easy update on some new obesity medicine results is one way to bring some zen and positive vibes into the world! 2 more Amylin drugs and a shockingly tolerable GIP/GLP1 drug from a new player in the space!

Something something life imitates art

Sorta odd study but it does involve my favorite ARB and shows it's better at central blood pressure reductions than Nebivolol. So another win for team ARB

It's a 60 degree March day, the sun is out. My mood is lifted as I finally know winter is a few weeks away from ending. Grabbed one of my favorite beers from the cellar for the occasion.

Now more than ever I’m convinced losing Anthony Bourdain meant we lost probably the biggest person on tv who advocated for the wonders of meeting new people and calling anyone online who hated learning new cultures the children they were, ruthlessly to the camera.

The one of the next frontiers for GLP1 meds is neuroscience/addiction disorders. This recently published study looking at various substance use disorders and older GLP1 medications shows a modest benefit across the board www.bmj.com/content/392/...

Boy am I glad our one car is a plug-in hybrid and basically needs gas about once a month or less, especially in warmer weather months.

The one of the next frontiers for GLP1 meds is neuroscience/addiction disorders. This recently published study looking at various substance use disorders and older GLP1 medications shows a modest benefit across the board www.bmj.com/content/392/...

!!!!!!! 👀👀 Trial finished on February 20th...so we should have initial topline phase 3 data for retatrutide and diabetic patients over a 40 week period in late March!!!! Ahhhhhhh!!!!

Another DACRA. Another subpar weight loss result. Just say no to DACRA for weight loss. Petrelintide is a Amylin 3R-Calcitonin agonist. Tolerability was great. Similar to placebo. Weight loss was only 9% and only for the highest dose. No report on other doses.

!!!!!!! 👀👀 Trial finished on February 20th...so we should have initial topline phase 3 data for retatrutide and diabetic patients over a 40 week period in late March!!!! Ahhhhhhh!!!!

Huge announcement by Eli Lilly this morning that undercuts PBMs and their competitor Novo "Zepbound® (tirzepatide) KwikPen® for single-patient use available from Lilly at $449 across all doses through the Lilly Employer Connect platform, with reduced cost-share pricing available to employees"

Is there a word for how it feels when you finally give a patient an actual diagnosis for a disease when for the last 2 years they've had countless tests, seen multiple other doctors with no answers. And then the answer arrives in your Epic inbox. Man. The relief to have an answer to give them

Here's a question for my nephro/primary care folks.... If you have an immunocompromised patient (from biologics, transplant, oncology) would you still prescribe SGLT2i for progressive CKD? There's a risk of GU infections BUT does the benefit outweigh the risk for you? CC: @hswapnil.medsky.social

It’s FINALLY happening and it feels like Christmas morning. Only better. @labcorp.bsky.social @questdiagnostics.bsky.social @ash.hematology.org

Avoid the horrors of the world by finding peace and quiet in the woods, forests and prairies of the world.

No money for health care. No money for cancer research. No money for infrastructure. Always money for war, death and destruction.

Deep cut science post, but related to my last blog post about calcitonin. Another company decides to follow cagrilintide and absolutely hammer the calcitonin receptor and touting it's efficacy in rats. The aversion to food test I think is one of the biggest confounders with this drug development 1/2

Pharmacology win of the month?! Patient with persistently low magnesium despite oral and IV magnesium. Started empagliflozin 9 days ago. Today? Normal magnesium 🎉🎉🎉 Flozination FTW.

Full data published for orforglipron vs oral semaglutide in diabetics. Liver data looks good(which is the big concern with it's weird molecular shape) better A1c reduction is pretty clear. Tolerability slightly "worse" for orforglipron but otherwise another oral pill that just works!

Inspired by Lars I found this very recent publication, treat to target approach for obesity management. I feel like while some subjective measures remain, such as height & waist size, blood pressure this could honestly be a better way to measure GLP1 efficacy in both trials and clinics

If ferritin is 5ng/ml and total iron is so low that lab cannot measure it, is that bad @shematologist.medsky.social 😳👀 Hopefully no push back from insurance for these iron infusion orders 🙈

It's not often in Pharma that you run a head to head trial against your major competition and legit just flat out lose. Cagrisema 23.6% weight loss vs Tirzepatide 25.5% weight loss over 84 weeks. This result is horrid for Novo Nordisk.

I genuinely can't wait for access to improve for GLP1 meds. One of my diabetic patients deliberately stopped their other diabetic medications just so their A1c would elevate because insurance said "their diabetes was well controlled...at A1c of 8.5%" Absolute absurdity 🙃 🙈

Spot the ahem HUGE transcription error that my health insurance company made. They asked for a waist circumference. My PCP put 91cm. Somehow my insurance company turned that into 43 INCHES when I have a BMI of 24 🙃 The same folks who routinely deny care can't even do a simple metric conversion.

To Claire's point, antibiotic resistance is an ever shifting target and what works for one patient may be completely resistant in another. It's one of those things we constantly have to keep track of. We even have resources that collate trending resistance patterns locally it's a big deal.

This was an interesting one to write, dual Amylin-Calcitonin receptor agonists (see: CagriSema) are a hot topic in obesity these days, but they're actually a bit of a mixed bag for diabetes thanks to calcitonin. Read on to find out why!

This was an interesting one to write, dual Amylin-Calcitonin receptor agonists (see: CagriSema) are a hot topic in obesity these days, but they're actually a bit of a mixed bag for diabetes thanks to calcitonin. Read on to find out why!

And that's autoimmune disease #2 (plaque psoriasis) that improves with tirzepatide. The improvement is modest but apparently statistically significant and the trial was short, only 36 weeks so this is rapid improvement! A much longer trial is currently ongoing as well.

The as yet unfulfilled promise of GLP-1 medicines and neurodegenerative disorders @jclinicalinvest www.jci.org/articles/vie... dm5migu4zj3pb.cloudfront.net/manuscripts/...

This is my experience as well. If I ask it for "publications about how GLP1 changes insulin sensitivity" it is actually helpful because it's just collating from Pubmed basically and I can focus a search quickly that way. But it's otherwise....useless. Just a fancier search engine IME

Update from this: CPK down to 301(still high but better!) However, my hemoglobin dropped to 12.8 from my usual 14.5ish and RBC count is 3.9 (low for those who don't know) so I guess iron supplements for a minute as well. Thankfully liver enzymes and renal function were normal for me.

Dr R lives not far from me and she's spot on. Me and my wife got lucky to find a good PCP without super long wait times. Seeing as I'm a PCP myself my patients also say the same thing to me. Shocked I am available(but it's only because my patient panel isn't full yet)

My blue beauty Weber doing yeoman's work in 48 degree February weather with a flat iron steak!

Putting the finishing touches on my next blog post. Why dual Amylin-Calcitonin receptor agonists(DACRAs) like cagrilintide, which is one half of the CagriSema drug being developed by Novo Nordisk, are turning out to be less effective in diabetes than expected. Calcitonin is a liability!

On Valentine's Day my love requested wings. I obliged.