📢 TyG-BMI: a new vital sign in #MASLD? 🔹 NHANES study: TyG-BMI ⤴️ = ⤴️ all-cause ☠️ & 💔☠️ 🔸 U-shaped risk curve—both high & low TyG-BMI = ⤴️ risk 🔹 HbA1c mediated most of the effect 👉 For MASLD, insulin resistance isn’t just present—it’s predictive❗️ 🔗 ggdocs.co/9cu63n @pharmrj.pharmsky.app

🚦Updated @medscape.com Primary Care #Hack 🔥Interpreting iron studies in primary care🔥 🎯 What are iron studies? 🎯 Top tips & pitfalls to avoid 🎯 Managing ⬆️ ferritin 🎯 Iron deficiency: once daily dosing help absorption PDF download link in comments 👇🏾 @goggledocs.bsky.social @pharmrj.pharmsky.app

🚦Latest @medscape.com Primary Care #hack is live! 🔥Paired #hacks covering the diagnosis & management of #HFrEF & #HFpEF in primary care PDF download link in comments 👇🏾 @pharmrj.pharmsky.app @goggledocs.bsky.social @hpillminster.pharmsky.app

📢 Can LFTs track liver fat loss after weight loss in #T2D❓ 🔹 DiRECT sub-study: 74% achieved MASLD remission with ~12kg wt loss 🔸 ⤵️ ALT & GGT= predictors of liver fat ⤵️ (ALT >40 = PPV 100%) 🔹 ALT change most closely linked to liver fat ⤵️ 👉LFTs = simple tool to track remission 🔗 ggdocs.co/9g8ffo

Who’s getting #GLP1 for #obesity 🇺🇸❓ 🔹 <3% of 39M eligible pts got Sema/tirz 🔸 ⚫️⚪️ ⚠️ Px lower in ♂️, ⚫️/Asian/Hispanic pts, high SVI & rural area 🔹 Uptake ⤴️ overall, but disparities persist 🔸 Reflects system-level barriers 👉 #ObesityCare evolving—equity must catch up❗️ 🔗 ggdocs.co/ao046p

🔥Our #CVRMUK paper is now published! 💡"Advancing Cardiovascular, Kidney, and Metabolic Medicine: A Narrative Review of Insights and Innovations for the Future" 🎯This review advocates for an integrated #CKM framework Open access link in comments 👇🏾 @goggledocs.bsky.social @pharmrj.pharmsky.app

📢 Danuglipron dropped—can orforglipron still be the “oral GLP-1 that delivers”? 🔹 Pfizer halts danuglipron after liver signal 🔸 Orforglipron P2=HbA1c ⤵️2.1%, Wt ⤵️14.7%, no liver signal 🔹 P3 2025—will it safely deliver? 👉 Small molecule GLP-1: blockbuster or cautionary tale? 🔗 ggdocs.co/5qu8y3

Hot on heels of CVRMUK congress, @EimearDarcy & I present our updated @medscape.com Primary Care #Hack 🔥#T2D #CVRM checklist🔥 💡A holistic, person-centred approach to supporting our patients living with #T2D PDF download in comments below👇🏾 @goggledocs.bsky.social @pharmrj.pharmsky.app

🎯 CVRMUK London conference tomorrow! I'm covering 💡A history lesson: the evolution of cardio-renal disease 💡The intersection of sleep & #CVRM 💡EASL-EASD-EASO #MASLD guidance 🔥 Our Autumn CVRMUK conference is on 26/11/25 Register 👇🏾 @goggledocs.bsky.social @pharmrj.pharmsky.app

🌍 Our real-world paper shows GLP1s are associated with lower risk of MACE & less costs than DPP4s or insulin in T2DM at higher CV risk 💔 link.springer.com/article/10.1... @pccs.bsky.social @goggledocs.bsky.social @sabouretcardio.bsky.social @astonuniversity.bsky.social @swbhnhs.bsky.social

📢 #GLP1 ⤵️ kidney decline, CV events & mortality in CKD❗️ 🔹 Meta-analysis of 18K pts w/ eGFR <60: ⤵️ eGFR decline ≥50% (OR 0.72) ⤵️ 💔 (OR 0.86) ⤵️ ☠️ (OR 0.77) 🔸 ⤵️⤵️ with human GLP-1 backbone 🥇Evidence across CKD stages—not just macroalbuminuria 👉 GLP-1 now a key 🎯 in CKD + #T2D 🔗 ggdocs.co/tnqomz

Oral semaglutide cost-effective vs. liraglutide—even at 50% ⤵️ price 🔹 🇬🇧 modelled data: ⤴️ QALYs (+0.18) & ⤵️ comp. 🔸 💊 = ⤵️ Rx burden vs. daily 💉 🔹 Results robust across sensitivity analyses ⚠️ funded by NovoNordisk 👉 Challenges low-cost liraglutide, supports 🎯 oral GLP-1 use 🔗 ggdocs.co/9h0bz1

🎯Updated @medscape.com Primary Care #Hack 🔥 #DOAC dosing for stroke prevention in #NVAF & kidney impairment🔥 🚨 #DOACs are not "fire & forget" drugs 💡 Do not use #eGFR; #CrCl should be used for drug dosing PDF download link in comments below 👇🏾 @goggledocs.bsky.social @pharmrj.pharmsky.app

📢 ACR in Obesity (Ob): Are we under Dx albuminuria? 🔹 Ob ⤴️ creatinine excretion = ACR underestimates albuminuria 🔸 Delay Rx in #CKD & #T2D—esp. RASi, SGLT2i, nsMRA 🔹 Bias = in ♂ & ⤴️ muscle 🔸 Review calls➡️♀️♂️ cutoffs or estimated AER (eAER) 🕓 to rethink ACR thresholds in Ob❓ 🔗 ggdocs.co/l1htvt

Albuminuria: The CKM biomarker we’re overlooking❗️ 🥇 risk biomarker 🔹 Even UACR <3.4 mg/mmol = ⤴️ #CVD, #CKD & ☠️ risk 🔸 Signals early endothelial dysfunc. in HTN, #T2D, #HF & #MASLD 🔹 Yet 💧screening rates low 🔸 Newer Rx (SGLT2i, #GLP1 , nsMRA) = 🎯 ⌛detect, disclose & treat❗️ 🔗 ggdocs.co/hot30b

GLP-1 & blood cancer risk: Encouraging signal in cohort study 🔹 #T2D patients on GLP-1 ⤵️ risk vs. insulin for hematological cancers (HR 0.46) 🔸 ⤵️ risk of MDS, MPN, leukaemia, lymphoma & myeloma 🔹 No benefit vs. met 🔸 ⚠️ RWD = unresolved bias 👉 Supports 🎯 trials ⤵️cancer 🔗 ggdocs.co/3yosuj

💡 My latest Medical Mentor podcast is live! 🔥Interpretation & management of hypocalcaemia for PC 🔥 On Spotify, Apple Podcasts & Medscape website (link👇🏾) +see my @medscape.com PC #Hack on hypercalcaemia and hypocalcaemia in PC (link👇🏾) @goggledocs.bsky.social @pharmrj.pharmsky.app

📢 Are you a #UK #HealthcareProfessional managing patients with #KidneyDisease, #HighBloodPressure, #Diabetes or #Lupus? 👩‍⚕️ We want to hear what information/education you deliver about #kidneys, & anything that helped or hindered you. 🔗 app.onlinesurveys.jisc.ac.uk/s/salford/ph... 🙌 Thank you!

#Finerenone: CV & renal protection across all #T2D therapies❗️ 🔹 Pooled analysis: 15,365 pts w/ T2D + CKD or CV 🔸 Consistent benefit on 💔☠️, 🏥💔& kidney outcomes 🔹 ⤴️K+ ⤵️ with SGLT2i use 🔸 Benefit independent of SGLT2i/GLP-1 use 👉 Supports finerenone as a 🎯 in high-risk #T2D❗️ 🔗 ggdocs.co/tx2a5r

📢 #T1D Closed-Loop: MiniMed™ 780G in Real-World France 🔹 TIR ⤴️ 11.8% (2.8h/day) at 6m, HbA1c ⤵️ 0.52% 🔸 Hypoglycemia risk ⤵️, zero severe hypos @ 12m 🔹 Diabetes distress ⤵️ & QoL ⤴️ in adults & teens 🔸 Fear of hypos ⤵️ in adults & children 👉 HCL the new standard in #DiabetesCare❗️ 🔗 ggdocs.co/pwpsiu

📢 Mediterranean Diet: A Recipe for Cancer Prevention? 🇬🇧1 in 10 cancers - Obesity related (ORC) 🔹 n450,111, 15y follow-up in EPIC study 🔸 6% ⤵️ risk ORC withMedDiet adherence (HR 0.94) 🔹 Colorectal, liver, kidney cancer ⤵️ 🔸 Not weight—no mediation via BMI/waist-to-hip ratio 🔗 ggdocs.co/7larkw

MASLD: ‘Elephant in the Room’ of #CKM 🔹 🌍 crisis: 1/3 adults affected, 65% in #T2D 🔸 Liver fibrosis=predictor of ☠️ & #CVD, #CKD,&HCC 🔹 No approved Rx – 🎯 lifestyle, ⤵️weight & multi-specialty care 🔸 Future hope: GLP-1s, PPAR, THR-β agonists 👉 Access the full paper via link 🔗 ggdocs.co/dz0kai

📢 #GLP1 & Safety: 82 Deaths Reported 🇬🇧 🔹 60 deaths linked to #T2D use, 22 to weight loss 🔸 Mounjaro (18), Ozempic/Wegovy (29), Victoza/Saxenda (35) ⚠️Reports ≠ causation, but raises need for better patient education 👉MHRA warns against unregulated online sales & fake pens 🔗 ggdocs.co/oapff4

"Computer says yes" to help pick the best glucose-lowering drug #T2D 🔹 Machine-learning predicts optimal therapy (GLP1, SGLT2i, SU, DPP4i, or TZD) 🔸 Model-concordant Rx = 5.3 mmol/mol ⤵️ HbA1c at 12m 🔹 Better long-term outcomes: 38% ⤵️ glycaemic failure, 29% ⤵️ renal risk, 15% ⤵️ 💔 🔗 ggdocs.co/9p2tgf

📢 Beyond GLP-1: The next wave ... 🔹 GIP/GLP-1 dual agonists (e.g., #Tirzepatide) ⤴️ wt loss vs. GLP-1 🔸 3x agonists (GIP/GLP-1/Glucagon) aim for >25% wt loss 🔹 Emerging 💉💊: Amylin + GLP-1 combos, FGF21 analogs, oral non-peptides 👉 Will the next-gen 💉 ⤴️ wt loss beyond 30%❓ 🔗 ggdocs.co/hefyaj

Can resistance exercise reverse frailty in #T2D ❓ 🔹 Frailty ⤵️ in 36% of intervention group vs. 17% usual care (OR 2.6, p=0.009) 🔸 SPPB ⤴️ by 1+ point in 47.8% vs. 35.3% (p=0.034) 🔹 Early intervention key❗️ 👉 Time to rethink exercise as standard Rx for frailty in #T2D 🔗 ggdocs.co/zvm0cn

📢 Cardiac, Renal & Metabolic (CRM) Overlap: A Public Health Crisis? 🔹 CRM multimorbidity ⤴️ in 20 yrs (1 CRM: 21% → 26%, all 3: 0.7% → 1.5%) 🔸 ⚫️ & low SES = ⤴️ risk but ⤵️treatment❗️ 🔹 Statins underused in 1/3 CRM pts, ACEi/ARB in 40-50%, SGLT2i/GLP1 <5% 👉 MDT + 🎯 therapy= key❗️ 🔗 ggdocs.co/enhs7v

A ☕ a day helps keep the cirrhosis away❓ 🔹 78mg+ daily linked to ⤵️ liver fibrosis risk in #T2D, prediabetes & normoglycemia 🔸 Effect independent of BMI, SES, etc... 🔹 T2D strongest benefit 🔸 No evidence that fancy oat milk lattes offer extra 😉 👉 ☕✅ @pharmrj.pharmsky.app 🔗 ggdocs.co/vcwmxp

#SGLT2is are therapeutic titans but no drug is without harm My #SGLT2i resources to ensure benefits outweigh harms: 🎯 Patientfacing YouTube videos youtube.com/@drkevinfern... 🎯 @medscape.com Primary Care #Hacks www.medscape.co.uk/viewarticle/... @goggledocs.bsky.social @pharmrj.pharmsky.app

GLP-1RAs: Potential in Mental Health? 🔹 Systematic Review 🔸 Cognitive disorders: ⤵️ dementia risk in #T2D 🔹 Substance use: ⤵️ alcohol & nicotine use via dopamine pathways 🔸 Mood & psychotic disorders: No clear benefit, 👉 GLP-1RAs show promise but need RCTs in mental health❗️ 🔗 ggdocs.co/b41wuf

🔥 Updated @medscape.com Primary Care #Hack use of liraglutide semaglutide & tirzepatide for adults living with overweight & obesity 🔥 🎯 Elective peri-operative management consensus 🎯Language matters: obesity & specific conversation techniques PDF download link in comments @goggledocs.bsky.social

Can #GLP1 & #SGLT2i ⤵️ #COPD Exacerbations❓ 🔹 SGLT2i vs DPP4i: ⤵️ 19% risk of moderate/severe exacerbations 🔸 GLP-1RA vs DPP4i: ⤵️ risk by 14% 🔹 SGLT2i vs GLP-1RA: No major difference (HR 0.94) ❓Biological mechanisms 🤔 ⚠️ Observational data 👉 Interesting, but RCTs needed‼️ 🔗 ggdocs.co/v7zkht

#CGM vs. SMBG: Cost-Effectiveness of FreeStyle Libre in 🇨🇦 🔹 More QALYs, lower cost vs. SMBG in #T1D & #T2D 🔸 T1D: +1.25 QALYs, ⤵️ cost (🇨🇦$32,287) 🔹 T2D: +0.48 QALYs, ⤵️ cost (🇨🇦$8091) 🔸 Absenteeism ⤵️ = key driver of 💰 savings 👉 CGM cost effective in 🇨🇦 🔗 ggdocs.co/w8caj3 @pharmrj.pharmsky.app

Real-world tirzepatide use in #T2D in 🇺🇸 🔹 Initiation: 84% start at ≤5 mg, 69.6% ⤴️ dose within 6m 🔸 Dosing at 6m: 56.5% remain <10 mg 🔹 Persistence: 73.3% still on treatment at 6m 🔸 Discontinuation: 26.7% stopped, 29.1% restarted 👉 Persistence high, slower titration the norm 🔗 ggdocs.co/0z0q43

Dexcom ONE in insulin-treated #T1D & #T2D 🔹 HbA1c⤵️ at 6m: T1D (-12 mmol/mol) & T2D (-18) 🔸 TIR⤴️ in T2D (+9%) = 2.2h/day in range 🔹 Diabetes distress ⤵️ (71%→42% in T1D, 51%→31% in T2D) 🔸 🎯 for deprived areas (41% T2D in lowest SES quintile) 👉 Works in deprived area🇬🇧❗️ 🔗 ggdocs.co/tpevdz

My latest @medscape.com Primary Care #Hack is live! Co-authored with #CVRM guru Niraj Lakhani 🔥Lipid management for primary & secondary prevention of #CVD🔥 🎯10 key principles, 10 deeper dives & a flowchart! PDF weblink in comments. @pharmrj.pharmsky.app @goggledocs.bsky.social

📢 #GLP1 in overweight/obesity—who stops & who restarts? 🔹 1-year disc.: #T2D 46.5% ⤵️ vs. no T2D 64.8% ⤴️ 🔸 1-year reinitiation: #T2D 47.3% ⤴️ vs. no T2D 36.3% ⤵️ 🔹 ⤴️Wt loss ⤵️disc. risk 🔸 GI AEs ⤴️ disc. risk (HR 1.38 in T2D, 1.19 no T2D) 👉 💰& 🤢 drive inequities in long-term❗️ 🔗 ggdocs.co/456b83

“#Ozempic babies”: Fact or Fiction? 🔹 No clear evidence from clinical data 🔸 Wt loss ⤴️ fertility in PCOS, but impact on oral contraceptive absorption unclear 🔹 May ⤵️ oral contraception via delayed gastric emptying 🔸💉makers advise contraception & stopping meds 2m pre-conception 🔗 ggdocs.co/otufnr

📢 🏴󠁧󠁢󠁥󠁮󠁧󠁿 Goverment briefing #weightloss 💉 🔹 Now NHS-approved for BMI ≥35 related comorbidity 🔸 Lower BMI thresholds for non ⚪️populations 🔹 NHS rollout phased—90d specialist services, ⤵️ 12y for all 🔸 Concerns: capacity & £15.2B cost 👉 NHS wt loss pathways need urgent expansion! 🔗 ggdocs.co/4aohcm

Ethnicity & Socioeconomic Status (SES) in #T2D Microvascular dis. #SystematicReview 🔹 CKD: 18% prev —no ethnic diff, but ⤵️ SES = ⤴️ risk 🔸 👁️(DR): ⚫️ 28% > SAsian 25% > ⚪️ 19% 🔹 Low SES = ⤴️ DR (25% v 16%) 🔸 Progression risk: ⚫️ ethnicity = ⤴️ ESRD & 👁️ 👉 Need 🎯of high-risk groups❗️ 🔗 ggdocs.co/q0jhsx

This looks interesting 🤨 The dementia screening profile of bloods on ICE (our path ordering system) could be expanding to include bio markers?! One for @goggledocs.bsky.social & @drkevinfernando.bsky.social 🤓

Oral semaglutide in #T2D: Real-world results from 7 countries 🇨🇦🇩🇰🇮🇹🇳🇱🇸🇪🇨🇭🇬🇧 🔹 HbA1c ⤵️ 1.0%, Wt ⤵️ 5.0% at 38w 🔸 Greater benefits in early T2D: HbA1c ⤵️ 1.7%-points if <1 year duration. 👉 Treatment satisfaction ↗️ sig. ❗️Safe, effective across ages, settings. 🔗 ggdocs.co/ussdr9 @pharmrj.pharmsky.app

EASO 🔥 Critiques Lancet’s #Obesity Framework 🇪🇺 🔹“Preclinical obesity” = delayed care 🚨 🔸Ignores T2D evidence (treatment ⤵️ complications) 🔹Flawed metrics: BMI focus ❌, misses root causes 👉 EASO’s fix: ✅ Early intervention ✅ WtHR + biology ✅ Equity > BMI 🔗 ggdocs.co/u5d8il

Dapagliflozin + calorie restriction: A new pillar in #T2D remission? 🇨🇳 🔹 RCT: 44% achieved remission vs. 28% placebo (RR 1.56, 95% CI 1.17-2.09). 🔸 Key stats: –1.3 kg weight difference, ⤵️ insulin resistance 👉 Alternative strategy for early diabetes—long-term sustainability❓ 🔗 ggdocs.co/i51w3p

GLP-1 agonists: A potential game-changer for childhood #obesity ❓ 🔹 In trials, semaglutide reduced BMI by 16.1% in adolescents over 68 weeks vs. 0.6% with placebo. 🔸 Access remains limited, but early results show promise for managing youth. ❗️Long-term studies are needed❗️ 🔗 ggdocs.co/kijcvk

Finerenone in HFpEF/HFmrEF ❗️ 🔹 Early eGFR declines (≥15%) with finerenone are common (23% vs. 13% placebo). 🔸 Unlike placebo, these declines were not associated with worse outcomes. 🔹 Finerenone ⤵️ 💔 & CV ☠️across eGFR changes. ❗️Don’t stop finerenone due to early eGFR dips❗️ 🔗 ggdocs.co/3w7mim

Amycretin: “New kid on the block”❓ 🔹 Phase 1b/2a trial shows amycretin, a dual GLP-1/amylin receptor agonist ⤵️ body weight by up to 22% over 36 weeks. 🔸 Safety profile consistent with incretin therapies, with mild GI side effects. ❗️A promising therapy for #obesity & #T2D. 🔗 ggdocs.co/qjg1lw

Is ASC30 (small molecule #GLP1) the most promising❓ ⚠️ Early P1 trial results ✅ long half-life (60h) 🔹Tolerability "consistent with or better than others" 🔸In-vitro ASC30 👉 2-3x potent to orforglipron 👉 Competition should ⤵️ price of this class 🔗 ggdocs.co/gtcv6u @pharmrj.pharmsky.app

Finerenone: Do we need another treatment for #CKD in #T2D ❓ 🔹 Reduces CKD progression by 23% & CV events by 14% (FIDELITY analysis). 🔸 Complements RASi & SGLT2i therapies, offering comprehensive cardio-renal protection. ❗️A new pillar in T2D & CKD Mx #CombinationTherapy. 🔗 ggdocs.co/nqip3c

IGFBP7: a novel target for #T2D therapy❗️ 🔹 Elevated in T2D islets, IGFBP7 reduces insulin secretion via impaired mitochondrial function. 🔸 Knockdown of IGFBP7⤴️ insulin secretion in human islets by 30%. ❗️Emerging as a potential multi-tissue drug target for T2D etc.. 🔗 ggdocs.co/jk9qlo