{"title":"What is the hidden cost of expensive drugs?","authors":"","doi":"10.1016/s2213-8587(25)00264-5","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00264-5","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"21 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Fleseriu, Elena V Varlamov, Amit Akirov, Fabienne Langlois, Stephan Petersenn, Shlomo Melmed
{"title":"Prolactin-secreting adenomas: pathogenesis, diagnosis, and management","authors":"Maria Fleseriu, Elena V Varlamov, Amit Akirov, Fabienne Langlois, Stephan Petersenn, Shlomo Melmed","doi":"10.1016/s2213-8587(25)00227-x","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00227-x","url":null,"abstract":"Hyperprolactinaemia can result from physiological causes, pharmacological agents, or pathological conditions such as prolactin-secreting pituitary adenomas and other pituitary stalk-compressing masses. Sporadic prolactinomas are the most common functioning pituitary adenomas, with a female predominance during reproductive years. In men, these adenomas are usually larger and more aggressive. Prolactinomas are characterised by positive immunostaining for prolactin, pituitary-specific positive transcription factor 1, and oestrogen receptor α. Dopamine agonists, particularly cabergoline, are typically used as primary therapy. Treatment with up to 2·0 mg per week of cabergoline for at least 6 months normalises prolactin concentrations, achieves adenoma shrinkage of at least 30%, and restores gonadal function in most patients. Transsphenoidal surgery is increasingly used as primary therapy for small prolactinomas given a high chance of remission; transsphenoidal surgery is also indicated for patients with dopamine agonist intolerance or resistance. Radiotherapy is reserved for treatment-refractory prolactinomas. Multidisciplinary management and an individualised approach are key to maximising therapeutic responsiveness and optimising outcomes. In this Review, we assess evidence relating to pathogenesis, diagnosis, and management of prolactinomas, and highlight opportunities for future research.","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"178 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144898085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cardiovascular risk in type 1 versus type 2 diabetes","authors":"Anna Solini","doi":"10.1016/s2213-8587(25)00200-1","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00200-1","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"8 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144898084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vagia Patsoukaki, Lars Lind, Erik Lampa, Sadiq Radhi, Katarina Eeg-Olofsson, Björn Eliasson, Jan W Eriksson
{"title":"Risk differences and underlying factors of cardiovascular events and mortality in patients with type 2 diabetes versus type 1 diabetes: a longitudinal cohort study of Swedish nationwide register data","authors":"Vagia Patsoukaki, Lars Lind, Erik Lampa, Sadiq Radhi, Katarina Eeg-Olofsson, Björn Eliasson, Jan W Eriksson","doi":"10.1016/s2213-8587(25)00165-2","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00165-2","url":null,"abstract":"<h3>Background</h3>Despite improvements in diabetes care and risk factor management, the residual risk for cardiovascular disease and premature death remains substantially elevated in people both with type 1 and type 2 diabetes. This study aimed to compare the risk of cardiovascular disease and mortality, as well as the contibution of underlying risk factors, between type 1 and type 2 diabetes.<h3>Methods</h3>In this nationwide, population-based cohort study, all living people with diabetes aged 18–84 years reported in the Swedish National Diabetes Register (NDR) by Jan 1, 2016, were followed-up over a period of 5 years until Dec 31, 2020. Data from the National Patient Register, including all inpatient and outpatient hospital visits, were used to compare the incidence of major cardiovascular disease events (myocardial infarction, heart failure onset or exacerbation, stroke, and cardiovascular death) and all-cause death, also in different age groups. Baseline data were collected from NDR and other national registers. Cox regression analyses, adjusted for age and sex, as well as for multiple cardiovascular risk factors were performed. In addition, the type 1 diabetes and type 2 diabetes cohorts were compared with matched control groups with no diabetes.<h3>Findings</h3>404 026 adults with type 1 diabetes (38 351 [9·5%]) or type 2 diabetes (365 675 [90·5%]) were included. Individuals with type 2 diabetes had a higher risk than individuals with type 1 diabetes for the composite endpoint of any cardiovascular disease event (HR 1·23, 95% CI 1·07–1·41) at ages younger than 50 years but a lower risk at ages older than 60 years (0·87, 0·82–0·92). A similar pattern was observed for myocardial infarction (0·67, 0·61–0·73) and all-cause mortality (0·89, 0·84–0·95) in ages older than 60 years. However, the risk for stroke was overall lower in type 2 diabetes (0·91, 0·84–0·98, all ages combined), whereas for heart failure it was higher at ages younger than 50 years (1·60, 1·15–2·21). Among people with previous cardiovascular disease, those with type 2 diabetes overall had a lower risk versus type 1 diabetes for all cardiovascular disease (0·76, 0·70–0·81), for myocardial infarction (0·62, 0·56–0·70), cardiovascular mortality (0·68, 0·61–0·75) and all-cause mortality (0·71, 0·66–0·77). In analyses adjusting for multiple cardiovascular risk factors, the whole cohort with type 2 diabetes had a greater risk for incident cardiovascular disease and mortality compared with type 1 diabetes. However, when diabetes duration was excluded from the model, type 1 diabetes was associated with higher risk. Compared with matched controls, both diabetes types were associated with greater risk for the studied outcomes, but this was most marked for type 1 diabetes.<h3>Interpretation</h3>In this study, type 1 diabetes was associated with higher overall risk for cardiovascular disease events and all-cause mortality than type 2 diabetes, particularly at ages older than 60 years for","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"9 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144898087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Rethinking obesity through the lens of genetics, environment and differential life circumstances","authors":"Naveed Sattar","doi":"10.1016/s2213-8587(25)00254-2","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00254-2","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"18 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144901698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yang He MD, Nianrong Mi MMed, Prof Zhifeng Cheng MD, Prof Haibo Xue MD, Jie Han MMed, Prof Haifang Wang MMed, Huihui Wang MD, Jun Wu PhD, Prof Xiaoguang Shi MD, Shuping Zhao MBBS, Prof Binhong Duan MMed, Prof Yikun Zhu PhD, Prof Yanqin Zhou MBBS, Prof Feng Li MBBS, Xin Wang MMed, Hongwei Ling MMed, Su Wang MMed, Prof Qingju Li MMed, Feifei Jiang MMed, Ming Yang MMed, Shaohui Bing MMed, Qing Zheng MSc, Jing Ning BSc, Mengying Guo BSc, Yue Bu BSc, Lei Guan MMed, Yao Li MSc, Liu Yang M Eng, Wanjun Guo MSc, Hai Pan PhD, Prof Xiaoying Li MD
{"title":"Efficacy and safety of cAMP-biased GLP-1 receptor agonist ecnoglutide versus dulaglutide in patients with type 2 diabetes and elevated glucose concentrations on metformin monotherapy (EECOH-2): a 52-week, multicentre, open-label, non-inferiority, randomised, phase 3 trial","authors":"Yang He MD, Nianrong Mi MMed, Prof Zhifeng Cheng MD, Prof Haibo Xue MD, Jie Han MMed, Prof Haifang Wang MMed, Huihui Wang MD, Jun Wu PhD, Prof Xiaoguang Shi MD, Shuping Zhao MBBS, Prof Binhong Duan MMed, Prof Yikun Zhu PhD, Prof Yanqin Zhou MBBS, Prof Feng Li MBBS, Xin Wang MMed, Hongwei Ling MMed, Su Wang MMed, Prof Qingju Li MMed, Feifei Jiang MMed, Ming Yang MMed, Shaohui Bing MMed, Qing Zheng MSc, Jing Ning BSc, Mengying Guo BSc, Yue Bu BSc, Lei Guan MMed, Yao Li MSc, Liu Yang M Eng, Wanjun Guo MSc, Hai Pan PhD, Prof Xiaoying Li MD","doi":"10.1016/s2213-8587(25)00196-2","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00196-2","url":null,"abstract":"Ecnoglutide is a novel biased GLP-1 receptor agonist that preferentially activates the cAMP pathway over β-arrestin recruitment. We aimed to assess both non-inferiority and superiority of ecnoglutide versus dulaglutide, also a GLP-1 receptor agonist, in patients with type 2 diabetes.","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"24 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144898106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ecnoglutide, a biased GLP-1 receptor agonist as a potential new player for type 2 diabetes management?","authors":"André J Scheen","doi":"10.1016/s2213-8587(25)00219-0","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00219-0","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"29 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144898105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Soo Lim, Supawan Buranapin, Xiaolei Bao, María Quiroga, Kyung Hee Park, Jee-Hyun Kang, Anders Rasmussen Rinnov, Arisara Suwanagool
{"title":"Once-weekly semaglutide 2·4 mg in an Asian population with obesity, defined as BMI ≥25 kg/m2, in South Korea and Thailand (STEP 11): a randomised, double-blind, placebo-controlled, phase 3 trial","authors":"Soo Lim, Supawan Buranapin, Xiaolei Bao, María Quiroga, Kyung Hee Park, Jee-Hyun Kang, Anders Rasmussen Rinnov, Arisara Suwanagool","doi":"10.1016/s2213-8587(25)00164-0","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00164-0","url":null,"abstract":"<h3>Background</h3>Consistent with WHO recommendations, obesity is defined as BMI ≥25 kg/m<sup>2</sup> in many Asian populations because of increased health risks at lower BMIs than in other populations. We aimed to investigate the efficacy and safety of once-weekly subcutaneous semaglutide 2·4 mg versus placebo in an Asian population with BMI ≥25 kg/m<sup>2</sup>, together with lifestyle interventions.<h3>Methods</h3>STEP 11 was a 44-week, randomised, double-blind, placebo-controlled, phase 3 trial conducted at 12 clinical sites in South Korea and Thailand. Adults (aged ≥18 years in Thailand and ≥19 years in South Korea) with obesity (BMI ≥25 kg/m<sup>2</sup>) of Asian descent, without diabetes, were randomly assigned 2:1 with a computer-generated sequence and block randomisation to once-weekly subcutaneous semaglutide 2·4 mg or placebo, with a reduced-calorie diet and increased physical activity. Participants, care providers, investigators, and assessors were masked to allocation. Coprimary endpoints, measured in all randomly assigned participants by intention to treat, were percentage bodyweight change and the proportion of participants reaching ≥5% bodyweight reduction. Confirmatory secondary endpoints were the proportion of participants with ≥10% and ≥15% bodyweight reductions and change in waist circumference. Safety was assessed via the assessment of adverse events in all participants who received at least one dose of semaglutide or placebo. This trial was registered at <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> (<span><span>NCT04998136</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>).<h3>Findings</h3>Between Aug 15, 2022, and Nov 20, 2023, 150 participants were randomly assigned (101 to semaglutide 2·4 mg and 49 to placebo). Six (6%) in the semaglutide group and two (4%) in the placebo group discontinued treatment before week 44. 111 (74%) were female and 39 (26%) male, with a mean age of 39 years (SD 11), mean bodyweight of 83·8 kg (18·1), and mean BMI of 31·3 kg/m<sup>2</sup> (5·2). At week 44, mean change in bodyweight was −16·0% (SE 0·7) in the semaglutide 2·4 mg group versus −3·1% (0·9) in the placebo group (p<0·0001), and a greater proportion of participants reached bodyweight reductions of ≥5% (96 [96%] <em>vs</em> 12 [25%]; p<0·0001), ≥10% (78 [78%] <em>vs</em> 5 [10%]; p<0·0001), and ≥15% (53 [53·0%] vs 2 [4·2%]; p<0·0001) in the semaglutide 2·4 mg group. Mean change in waist circumference was −11·9 cm (SE 0·7) with semaglutide versus −3·0 cm (1·0) with placebo (p<0·0001). Adverse events were reported by 90 (89%) of 101 participants in the semaglutide 2·4 mg","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"21 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Growing evidence for semaglutide efficacy in Asian adults with obesity","authors":"Priya Sumithran, Louise A Baur","doi":"10.1016/s2213-8587(25)00201-3","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00201-3","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"72 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}