Shagun Bindlish, MD, FACP, FOMA, DABOM, DACLM, is an internist and diabetologist with advanced expertise in obesity and lifestyle medicine. She serves as medical and scientific chair for the ADA Northern California and is the founder of the Golden State Obesity Society. An educator at Touro University California and University at Sea CME, she has trained providers worldwide in metabolic health. 

Recognized with the Obesity Medicine Association’s Outstanding Contribution Award in 2024, she is also nominated by her peers for the Compassionate Physician of the Year Award by the California Medical Association. Her work focuses on advancing diabetes and obesity care through innovation, education, and advocacy.

Shagun Bindlish, MD, FACP, FOMA, DABOM, DACLM

Each November, as blue lights illuminate buildings and ribbons mark Diabetes Awareness Month, we’re reminded of the millions living with diabetes and of the millions more standing quietly at the edge of diagnosis. For clinicians, it’s time to look beyond the numbers on a glucose meter and confront a more profound truth: 

 is not just a disease of high blood sugar; it reflects a deeper metabolic imbalance.

Behind every elevated HbA1c lies a story of metabolic overload, a body struggling to manage excess energy, inflamed adipose tissue sending distress signals, and β-cells fighting to maintain equilibrium. Obesity and diabetes are not parallel epidemics; they are interwoven threads of the same metabolic fabric. This month

awareness must mean integration, uniting how we think, talk, and care for these interconnected conditions.

The Metabolic Bridge Between Obesity and Type 2 Diabetes

Obesity reshapes metabolism long before a single glucose reading turns abnormal. Adipose tissue, once thought to be inert, is a dynamic endocrine organ. As fat cells expand, they release free fatty acids and pro-inflammatory cytokines such as TNF-α and IL-6, while adiponectin, the guardian of insulin sensitivity, declines. This inflammatory cascade disrupts insulin signaling in the liver and muscle, forcing pancreatic β-cells to secrete more insulin just to maintain normalcy.

Over time, the relentless demand leads to β-cell exhaustion. The pancreas cannot keep up; glucose rises. What we call “type 2 diabetes” is often the final act of years of unseen metabolic struggle.

The lesson is clear: Obesity and Diabetes are not separate diseases but biological partners along a shared continuum.

Why Some with Obesity Develop Diabetes, and Others Don’t

Not everyone with obesity develops diabetes, and understanding why is key to prevention. Two individuals with identical BMIs may walk entirely different metabolic paths. The difference lies in where fat is stored and how it behaves.

Visceral and ectopic fat nestled in the liver, pancreas, and muscle acts as a metabolic saboteur, promoting insulin resistance. In contrast, subcutaneous fat can serve as a safer storage reservoir. Those able to expand subcutaneous depots without spilling fat into vital organs remain metabolically healthier, even at higher weights.

The second determinant is β-cell resilience. Genetics, early nutrition, ethnicity, and even prenatal exposures influence β-cell endurance. For instance, South Asian and Hispanic individuals develop diabetes at lower BMI thresholds because their β-cell reserve is smaller. Add to those modern stressors, poor sleep, inactivity, processed diets, and the balance tips faster.

Identifying risk early allows us to intervene before β-cells exhaustion.

 BMI and waist circumference remain simple yet powerful markers of visceral adiposity.

 Fasting glucose, HbA1c, fasting insulin, and, when needed, an oral glucose tolerance test reveal early dysglycemia.

 Family history, gestational diabetes, PCOS, sleep apnea, ethnicity, and medication history refine assessment.

 Regular HbA1c, waist measurement, and even continuous glucose monitoring in high-risk individuals can expose subtle metabolic shifts.

A 5 – 10% weight loss can reduce diabetes risk by half. Mediterranean-style nutrition, daily movement combining aerobic and strength training, and adequate sleep can also reduce diabetes risk. Yet sustaining it requires behavioral scaffolding: goal setting, self-monitoring, and community support.

2. Pharmacotherapy: The Metabolic Revolution

A new generation of therapies is redefining possibilities. GLP-1 receptor agonists, such as semaglutide and dual GIP/GLP-1 agents like tirzepatide deliver unprecedented improvements in both weight and glycemia. When viewed not as shortcuts but as metabolic restoratives, these medications empower patients and clinicians alike. For many, they are the bridge from chronic struggle to sustainable success.

3. Metabolic Surgery: Durable Transformation

For patients with severe obesity (BMI ≥ 40 kg/m² or ≥ 35 kg/m² with comorbidities), bariatric or metabolic surgery offers a durable impact, often achieving diabetes remission through hormonal and metabolic reset. The key lies in lifelong follow-up: nutritional, psychological, and medical.

Together, these pillars form a continuum of lifestyle first, pharmacotherapy next, and surgery when indicated.

Integrating Care: Healing the Whole Metabolism

Too often, diabetes clinics focus on glucose while obesity programs focus on weight. This division misses the point. Both conditions spring from the same root cause: disordered energy balance and impaired insulin action. An integrated metabolic care uniting endocrinology, obesity medicine, nutrition, psychology, and exercise physiology delivers the best outcomes.

Technology now enhances this integration: continuous glucose monitors, smart scales, and AI-based coaching can personalize interventions in real time. But integration is not just logistical, it’s philosophical. By treating obesity and diabetes together, we move from symptom control to root-cause medicine.

 promise greater synergy across glucose and weight regulation.

 will soon allow personalized interventions based on insulin resistance or β-cell profile.

 are transforming lifestyle monitoring and early prevention.

 recognizes that metabolic disease begins decades before diagnosis.

Obesity Medicine Association (OMA) Clinical Practice Guidelines

: Comprehensive frameworks for evidence-based care.

: An interactive roadmap integrating pharmacotherapy, behavior, and surgery.

: Education on communication, bias reduction, and metabolic comorbidities.

This Diabetes Awareness Month, let’s redefine awareness itself. It’s no longer enough to chase glucose targets. We must confront the metabolic roots that feed the epidemic. Every conversation about diabetes must include obesity; every discussion about weight must include metabolic health.

Articles

Diabetes Awareness Month highlights the interconnectedness of obesity and type 2 diabetes, emphasizing the need for integrated care. Obesity and diabetes are not separate diseases but part of a shared metabolic continuum. The distribution and behavior of fat, along with β-cell resilience, determine diabetes risk. Early risk assessment and intervention are crucial. Management involves lifestyle changes, pharmacotherapy, and metabolic surgery. Integrated care, combining endocrinology, obesity medicine, and technology, addresses the root causes of metabolic disorders, moving beyond symptom control to holistic treatment.

Shagun Bindlish, MD, emphasizes the urgent need to integrate diabetes and obesity care, addressing their shared metabolic roots for better health outcomes.

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Beyond Blood Sugar: Reframing Diabetes Awareness Through the Lens of Obesity

Michelle O'Donoghue, MD, is the McGillycuddy-Logue Endowed Chair in Cardiology at Brigham and Women's Hospital and associate professor at Harvard Medical School

Very Low LDL-C Improves Risk of MACE in Patients With ASCVD, With Michelle O’Donoghue, MD

 has shown a monotonic relationship with lower incidence of future major adverse cardiovascular events, including recurrent stroke, in patients with 

atherosclerotic cardiovascular disease (ASCVD)

, according to an analysis of the FOURIER trial. These data also support that an LDL-C of <40 mg/dL may be a reasonable target for cardiovascular outcome improvement.

ASCVD is a well-known contributor to the pathogenesis of first and recurrent ischemic stroke. Although existing guidelines have long endorsed lowering LDL-C for the prevention of major adverse cardiovascular events in patients with ASCVD, limited data exist regarding patients who have already experienced an ischemic stroke. To that end, O’Donoghue and colleagues conducted this analysis.

 spoke with Michelle O’Donoghue, MD, the McGillycuddy-Logue Endowed Chair in Cardiology at Brigham and Women’s Hospital and associate professor at Harvard Medical School, to discuss the impacts these data may have on LDL-C-lowering therapies going forward.

“There really didn’t seem to be a floor or a basement in terms of lowering LDL further translating into even lower risk,” O’Donoghue told 

. “Perhaps even more importantly, there did not appear to be any safety signals – for patients who achieved very, very low LDL cholesterol concentrations, we did not see an increased risk of hemorrhagic stroke or any other adverse events of concern. I think that provides important reassurances that pushing LDL cholesterol even further down is safe.”

FOURIER was a double-blind, randomized, placebo-controlled, multicenter study investigating the impacts of evolocumab combined with statin therapy in patients with cardiovascular disease. Patients aged ≥40 to ≤85 years with a history of clinically evident cardiovascular disease at high risk for a recurrent event, as well as fasting LDL-C ≥70 mg/dL or non-HDL-C ≥100 mg/dL and fasting triglycerides ≤400 mg/dL were eligible for inclusion. Investigators excluded patients with NYHA class III or IV 

, uncontrolled or recurrent ventricular tachycardia, untreated hyper- or hypothyroidism, homozygous familial hypercholesterolemia, or LDL or plasma apheresis.

A total of 27,564 patients were enrolled in FOURIER and were randomly assigned to either evolocumab 140 mg every 2 weeks or 420 mg once a month, or matching placebo, both of which were administered subcutaneously with a prefilled 1.0 mL pen. The primary endpoint was a composite of time to cardiovascular death, myocardial infarction (MI), hospitalization for unstable angina, stroke, or coronary revascularization.

Ultimately, investigators observed a significant reduction in the primary endpoint with evolocumab compared with placebo (1344 patients [9.8%] vs 1563 patients [11.3%]; HR, 0.85; 95% CI, 0.79-0.92; 

 <.001), with a consistent effectacross all subgroups. Additionally, the least-squares mean percentage reduction in LDL cholesterol levels was 59% with evolocumab, from a median baseline of 92 mg/dL to 30 mg/dL.

Based on these data, O’Donoghue and colleagues selected 5291 patients from the FOURIER study group. The team used modified Poisson regression models to examine the relationship between achieved LDL-C and the incidence of the composite primary endpoint in the original trial.

O’Donoghue and colleagues followed patients for a total of 14,418 patient years, with a maximum follow-up of 8.6 years. Median achieved LDL-C with evolocumab was 31.5 mg/dL (IQR 21.5-47 mg/dL). Additionally, investigators found that patients with lower achieved LDL-C exhibited substantially lower annualized incidence rates of the primary composite endpoint. When modeled categorically, the lowest incidence rates of the primary endpoint were observed in patients with achieved LDL-C <40 mg/dL.

O’Donoghue and colleagues highlighted these results as endorsing the longstanding suggestion to lower LDL-C targets in patients with prior ischemic stroke. Additionally, they suggest that these data indicate the safety of even lower LDL-C goals than are present in current guidelines.

“I think providing further supporting evidence that we should be even more aggressive than we are right now for lowering LDL-C will translate into greater benefits for patients,” O’Donoghue said. “Mainly, I think it would just further increase the absolute benefit, because people are at higher risk when they’re close to the time of their event. And so, we expect that the number needed to treat would probably be even smaller for that very high-risk group.”

Editor's Note: O'Donoghue reports disclosures with Amgen, Novartis, AstraZeneca, Janssen, Novo Nordisk, Verve, and others.

Monguillon V, Kelly P, O’Donoghue ML, et al. Efficacy and safety of very low achieved LDL-cholesterol in patients with prior ischemic stroke. Circulation. Published online November 3, 2025. 

Amgen Pharmaceuticals. Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER). ClinicalTrials.gov Identifier: NCT01764633. Updated May 28, 2024. Accessed November 26, 2025. 

https://clinicaltrials.gov/study/NCT01764633

Sabatine MS, Giugliano RP, Keech AC, et al. EVOLOCUMAB and clinical outcomes in patients with cardiovascular disease. New England Journal of Medicine. 2017;376(18):1713-1722. 

Videos

O’Donoghue discusses the results of this analysis of the FOURIER trial, highlighting that no limit was found for lowered LDL-C improving MACE risk.

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Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

Atherosclerotic Cardiovascular Disease

Dyslipidemia

Abigail Brooks is an assistant managing editor for 

She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

New research is shedding light on state- and local-level geographic disparities in the availability of gastroenterologist care, highlighting limited access to care in rural areas and areas with low household incomes relative to urban areas.

Study findings point to substantial disparities in the availability of specialist care, particularly in the Midwest and Southwest regions and rural and impoverished areas, all of which had fewer gastroenterologists than patients with inflammatory bowel disease (IBD) needing care.

“To the best of our knowledge, this is the first nationwide study to comprehensively assess the density of GI specialists at a granular, local level across the US,” Jonathon Casey Chapman, MD, a gastroenterologist at Gastroenterology Associates in Baton Rouge, Louisiana, and colleagues wrote.

 “In addition, this study is the first to evaluate the local-level density of patients with IBD, providing novel insights into geographic disparities in both specialist availability and patient distribution.”

The evolving management of IBD continues to bring both opportunities and challenges, particularly as it pertains to patient access, individualized care, and navigating an expanding therapeutic pipeline. Despite advances in treatment options, most recently with the US Food and Drug Administration (FDA) approvals of a single-injection, once-monthly maintenance regimen of Omvoh (mirikizumab-mrkz) for subcutaneous use in adults with moderately to severely active ulcerative colitis (UC) and upadacitinib (Rinvoq) for the treatment of adults with moderately to severely active UC and Crohn's disease after they have received ≥ 1 approved systemic therapy, barriers such as insurance restrictions, cost, and access to specialist care continue to create hurdles for patients.

The descriptive retrospective analysis assessed the availability of GI specialists using multiple data sources to depict GI specialist density at both state and local levels using the first 3 digits of US postal codes (ZIP codes) as geographical markers. For each first 3-digit ZIP code tabulation area (ZCTA) and state in the US, investigators calculated the density of patients with IBD per 100,000 population, gastroenterologists per 100,000 population, and gastroenterologists per 100 patients with IBD. They used 2022 claims data to identify patients with IBD, the 2022 National Provider Identifier registry for provider details, and the 2020 US Census for area-level variables.

Overall, 520,020 patients with IBD were included in the study. At the national level, the density of patients with IBD per 100,000 population was 156.9. At the state level, the density of patients with IBD per 100,000 population varied, with Maine (337.1) and Rhode Island (251.4) having the highest density and New Mexico (58.2) and Hawaii (63.6) having the lowest density. At the local level, 65.7% of the 3-digit ZCTAs had a density of 100 to <250 patients with IBD per 100,000 general population, whereas 24.6% had a density of patients lower than 100.

A total of 21,611 GI specialists were identified from the 2022 NPI registry. At the national level, there were 6.5 GI specialists available per 100,000 population. Kansas (2.0) and Wyoming (3.1) had the lowest GI specialist density per 100,000 population, while New Jersey (11.2) and Rhode Island (10.8) had the highest GI specialist density. Investigators pointed to similarly considerable disparity in the geographic availability of GI specialists at the local level.

The GI specialist density per 100 patients with IBD at the national level for gastroenterologists was 4.2. At the state level, Kansas (1.4) and Maine (1.9) had the lowest density for gastroenterologists per 100 patients with IBD. While Michigan was among the top 10 states with the highest number of patients with IBD (n=23,969), it had a low density of gastroenterologists (per 100 patients with IBD) of 2.2.

Further analysis revealed one-fifth of ZIP codes had a gastroenterologist density (per 100 patients with IBD) of <1, and more than one-third had a density of 1 to <5. Across the US, 130 3-digit ZCTAs had 0 gastroenterologists/100 patients. Investigators noted 62% of these ZIP codes were in rural areas and 25% had household income <150% of the poverty line.

Additionally, they pointed out ZIP codes with ≥5 gastroenterologists/100,000 population tended to have lower poverty rates and were more urban than those with 1 to <5 gastroenterologists/100,000 population.

“This study shows that despite the burden of IBD in the US, the geographic distribution of gastroenterologists varies widely. Rural areas and areas with low household incomes have fewer gastroenterologists than urban areas, indicating disparities in the availability of GI specialists,” investigators concluded.

“The results may help inform healthcare policies that impact resource allocation for underserved patients with IBD throughout the US.”

Upadhyay N, Vadhariya A, Gorritz M, et al. Geographic Distribution of Gastroenterologists and Patients With Inflammatory Bowel Disease in the United States. 

Livingston R. FDA Approves Single-Dose Formulation of Mirikizumab-mrkz for Ulcerative Colitis. HCPLive. October 27, 2025. Accessed November 28, 2025. 

https://www.hcplive.com/view/fda-approves-single-dose-formulation-of-mirikizumab-mrkz-for-ulcerative-colitis

Brooks A. FDA Approves Updated Indication for Upadacitinib (Rinvoq) in IBD. HCPLive. October 13, 2025. Accessed November 28, 2025. 

https://www.hcplive.com/view/fda-approves-updated-indication-for-upadacitinib-rinvoq-in-ibd

New research highlights significant geographic disparities in gastroenterologist availability, particularly in rural and low-income areas compared to urban regions. The study, the first of its kind, assessed the density of GI specialists and patients with inflammatory bowel disease (IBD) across the US. Findings reveal that rural and impoverished areas, especially in the Midwest and Southwest, have fewer specialists relative to patient needs. Despite advancements in IBD treatment, barriers such as insurance, cost, and specialist access persist, underscoring the need for informed healthcare policies to address these disparities.

State- and local-level disparities in the availability of gastroenterologist care disproportionately affect patients with IBD and populations living in rural and high-poverty areas.

Gastroenterology

Gastroenterology condition center page is a comprehensive resource for clinical news and insights on digestive and GI conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for 

, IBS and IBD, Crohn's disease, and more.

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On the HCPLive inflammatory bowel disease page, resources on the topics of medical news and expert insight into IBD can be found. Content includes articles, interviews, videos, podcasts, and breaking news on IBD and more.

Geographic Disparities in GI Specialist Availability Suggest Limited Access to Care

Victoria Johnson joined the MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and now HCPLive. You can reach her at vjohnson@mjhlifesciences.com

Almost all patients with oral corticosteroid (OCS)-dependent severe, uncontrolled asthma achieved a maintenance OCS dose of 5 mg per day or less and more than half completely discontinued OCS while maintaining asthma control after 52 weeks of open-label 

Tezepelumab was originally approved by the United States (US) Food and Drug Administration (FDA) in 2021 as the first biologic therapy for treating asthma and was later approved for self-administration in 2023.

 These new data are from the multicenter, single-arm, phase 3 WAYFINDER trial (NCT05274815) and were published in 

“Improvements in asthma therapies in recent years, including the advent of personalised, potentially disease-modifying biologic therapies, have resulted in the evolution of treatment goals from short-term control of symptoms and exacerbations to long-term disease remission. Although there is not yet a consensus on how to define asthma remission, the widely agreed components are the absence of systemic corticosteroid use and asthma exacerbations together with very mild or no asthma symptoms,” study investigator David J. Jackson, MBBS, MSc, PhD, Professor, Guy's Severe Asthma Centre, School of Immunology & Microbial Sciences, Guy's Hospital, King's College London, and colleagues wrote.

 “Therefore, tezepelumab shows promise in helping enable patients with severe asthma to achieve clinical remission.”

WAYFINDER was conducted between May 17, 2022, and Sept 9, 2024 and enrolled adults with severe, uncontrolled asthma receiving a maintenance OCS dose of 5–40 mg per day (or equivalent) of prednisone or prednisolone from 68 clinical centers across 11 countries (Argentina, Belgium, Bulgaria, France, Germany, Latvia, Mexico, Poland, Spain, UK, and US). In the trial, 298 participants (69.1% female; n = 206) received tezepelumab 210 mg subcutaneously once every 4 weeks for up to 52 weeks. The co-primary endpoints were the proportion of participants who reduced their prescribed maintenance OCS dose to 5 mg per day (contingent on participants demonstrating preserved adrenal function) or less without loss of asthma control and the proportion of participants who discontinued OCS without loss of asthma control and were assessed at weeks 28 and 52.

Participants in WAYFINDER had a mean baseline maintenance OCS dose of 10.8 mg per day (SD, 6.5). Jackson and colleagues found that the proportion of participants who had a maintenance OCS dose of 5 mg per day or less without loss of asthma control was 88.9% (n = 265; 95% CI, 84.8–92.3) at week 28 and 89.9% (n = 268; 95% CI, 85.9–93.1) at week 52.

Furthermore, 32.2% of participants (n = 96; 95% CI, 26.9–37.8) were able to discontinue OCS without loss of asthma control by week 28, increasing to 50.3% (n = 150; 95% CI, 44.5–56.2) by week 52. OCS reduction and discontinuation outcomes were consistent across prespecified subgroups defined by baseline blood eosinophil count, fractional exhaled nitric oxide, and allergy status. Serious adverse events occurred in 9.4% of participants (n = 28), most commonly asthma (13 cases) and pneumonia (3 cases), and 1.3% (n = 4) experienced adverse events that led to tezepelumab discontinuation. Two deaths occurred during the study, though neither was considered related to tezepelumab treatment.

In a related editorial, Paola Rogliani, MD, and Luigino Calzetta, PhD, both from University of Rome “Tor Vergata” in Italy, compared the positive findings of WAYFINDER to the previously negative findings of the similar SOURCE trial of tezepelumab.

The SOURCE and WAYFINDER trials of tezepelumab differed notably in design, patient populations, and outcomes. SOURCE was a rigorous, randomized, double-blind, placebo-controlled study that failed to meet its primary endpoint overall, showing meaningful OCS reduction only in patients with baseline eosinophils ≥150/μL. In contrast, WAYFINDER was a larger, open-label, non-randomized trial that enrolled OCS-dependent patients across a wider eosinophil range with striking reductions in OCS use, though its lack of a control group and higher-risk baseline profile limit direct comparison. Differences in baseline eosinophil counts and starting OCS doses further complicate interpretation, and adjusted analyses suggest that WAYFINDER’s apparent benefits may be partially explained by placebo effects seen in SOURCE.

“In conclusion, although WAYFINDER4 provides suggestive evidence that tezepelumab might reduce OCS dependence in severe asthma, methodological limitations, baseline imbalances, and the influence of the placebo effect indicate that these findings are not definitive; well-designed randomized, placebo-controlled trials or high-quality pooled analyses are needed to confirm the OCS-sparing effect of tezepelumab,” Rogliani and Calzetta wrote.

Jackson DJ, Lugogo NL, Gurnell M, et al. Oral corticosteroid reduction and discontinuation in adults with corticosteroid-dependent, severe, uncontrolled asthma treated with tezepelumab (WAYFINDER): a multicentre, single-arm, phase 3b trial. 

. Published online November 26, 2025. doi: 10.1016/S2213-2600(25)00359-5

Iapoce C. FDA Approves Tezepelumab Self-Administration for Severe Asthma. Article. HCPLive. February 2, 2023. https://www.hcplive.com/view/fda-approves-tezepelumab-self-administration-severe-asthma

Rogliani P, Luigino Calzetta. Efficacy of tezepelumab in reducing oral corticosteroid use in severe asthma. 

. Published online November 1, 2025. doi: 10.1016/s2213-2600(25)00395-9

Wechsler ME, Menzies-Gow A, Brightling CE, et al. Evaluation of the oral corticosteroid-sparing effect of tezepelumab in adults with oral corticosteroid-dependent asthma (SOURCE): a randomised, placebo-controlled, phase 3 study. 

 Published online March 2022. doi: 10.1016/s2213-2600(21)00537-3

Tezepelumab has shown promise in reducing oral corticosteroid (OCS) dependence in patients with severe, uncontrolled asthma. In the WAYFINDER trial, nearly all participants achieved a maintenance OCS dose of 5 mg or less, with over half discontinuing OCS entirely while maintaining asthma control. Despite these positive outcomes, the trial's open-label design and lack of a control group limit the conclusiveness of the findings. Comparisons with the SOURCE trial highlight differences in trial design and patient populations, suggesting the need for further randomized, placebo-controlled studies to confirm tezepelumab's OCS-sparing effects.

However, a related editorial from University of Rome was quick to point out possibly sizable placebo effects in the trial.

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Tezepelumab Drastically Reduces OCS Use for Asthma in Open-Label Trial

Alex Hillenbrand is an assistant editor for 

. She earned her BA in English from Lafayette College in 2023 and went on to write for pop culture, entertainment, and sports media outlets before joining MJH Life Sciences in 2025. In her free time, Alex enjoys cooking, going on walks, and meeting new people. Contact her at mjhlifesciences.com.

Semaglutide, a glucagon-like peptide-1 receptor agonist, is linked with significant cardiorenal improvements and a favorable safety profile in adults with 

, with or without type 2 diabetes mellitus (T2DM).

Findings from a meta-analysis of 5 randomized controlled trials showed semaglutide significantly reduced the risk of major cardiovascular adverse events (MACE), kidney-related complications, and cardiovascular mortality, additionally pointing to the need to address gaps in the literature and enhance generalizability.

“Our findings advocate for semaglutide's role as a valuable therapeutic option for patients with CKD due to its demonstrated cardiovascular and renal benefits,”

wrote study investigator, Mahir Tesfaye from Addis Ababa University in Ethiopia, and colleagues.

 “The observed reduction in cardiovascular medication usage also means that semaglutide may decrease the need for intensive pharmacological interventions. This might improve patient quality of life, adherence, and healthcare costs.”

Standard treatment strategies for CKD include medication management of associated risk factors, such as hyperglycemia, dyslipidemia, and blood pressure. Recent cardiovascular outcome trials have highlighted renoprotective benefits and glucose-lowering effects in glucagon-like peptide-1 receptor agonists, but have been limited in sample size.

To address this gap in research, investigators conducted a systematic review of MEDLINE, Embase, and Cochrane CENTRAL databases to find studies comparing semaglutide with placebo or standard care in adults 18 ≥ years of age with CKD, regardless of comorbidity of type 2 diabetes mellitus status.

Primary outcomes included major kidney-related adverse events, MACE, cardiovascular mortality, nonfatal myocardial infarction (MI), and nonfatal stroke.

All-cause mortality, serious adverse events, hospitalization due to unstable angina or heart failure, and the use of cardiovascular medications were the secondary outcomes.

Investigators leveraged data from 12,785 participants with comorbid T2DM and CKD from 5 randomized controlled trials. The patient population had a mean age of 64-67 years, was predominantly male, with elevated body weight (~90–109 kg) and body mass index (~32–37 kg/m²), consistent blood pressure (systolic blood pressure ~135–138 mmHg; diastolic blood pressure ~76–78 mmHg) and glycemic control (Hemoglobin A1c ~5.6–8.7%).1

An outlier study, Apperloo, had a younger cohort, with a mean age of 55 years, and was the only trial with a completely non-diabetic CKD population, while the remaining studies enrolled 100% patients with T2DM.

Analysis of the pooled trial data revealed a significantly reduced risk of cardiovascular mortality compared with placebo, with a 26% relative risk reduction (Relative Risk [RR], 0.74; 95% Confidence Interval [CI], 0.62–0.88; I² = 36%).

Investigators observed a 22% reduced incidence of MACE (RR, 0.78; 95% CI, 0.70–0.87; I² = 0%), highlighting consistent cardiovascular benefit. While there was a trend toward reduction in nonfatal myocardial infarction and nonfatal stroke, these outcomes were not statistically significant (MI: RR, 0.86; 95% CI, 0.66–1.12; I² = 24%; stroke: RR, 0.86; 95% CI, 0.53–1.40; I² = 64%).

Kidney outcomes were similarly improved, with a 20% decrease in major kidney adverse events among patients receiving semaglutide (RR, 0.79; 95% CI, 0.71–0.87; I² = 0%).

For secondary outcomes, semaglutide showed a non-significant trend toward reduced all-cause mortality (RR, 0.80; 95% CI, 0.68–0.93; I² = 44%), and was associated with fewer serious adverse events (RR, 0.86; 95% CI, 0.74–0.99; I² = 87%). Sensitivity analysis further strengthened the effect on serious adverse events (RR, 0.92; 95% CI, 0.87–0.98; I² = 14%).

Investigators noted no significant differences in hospitalizations for unstable angina (RR, 1.01; 95% CI, 0.55–1.84; I² = 27%) or heart failure (RR, 1.03; 95% CI, 0.76–1.40; I² = 0%). The need for cardiovascular medications was modestly reduced, corresponding to a 14% relative risk reduction, with low heterogeneity.

“These findings are collectively supportive of its use as a therapeutic strategy for CKD management, with or without diabetes,” investigators concluded.

 “Long-term studies, however, are needed to confirm its role in reducing rates of hospitalization and mortality in broader populations of patients.”

Abdullah A, Sagreeka FNU, Aniket GA, et al. Safety and Efficacy of Semaglutide in Patients With Chronic Kidney Disease, With or Without Type 2 Diabetes: A Systematic Review and Meta‐Analysis. 

‌Alicic RZ, Cox EJ, Neumiller JJ, Tuttle KR. Incretin drugs in diabetic kidney disease: biological mechanisms and clinical evidence. 

https://doi.org/10.1038/s41581-020-00367-2

Caruso I, Giorgino F. SGLT2 inhibitors as cardio-renal protective agents. 

. Published online November 2021:154937. doi:

https://doi.org/10.1016/j.metabol.2021.154937

Semaglutide, a glucagon-like peptide-1 receptor agonist, demonstrates significant cardiorenal benefits and a favorable safety profile in adults with chronic kidney disease (CKD), with or without type 2 diabetes mellitus (T2DM). A meta-analysis of five randomized controlled trials revealed semaglutide's efficacy in reducing major cardiovascular adverse events (MACE), kidney-related complications, and cardiovascular mortality. The analysis also highlighted a reduction in cardiovascular medication usage, potentially improving patient quality of life and healthcare costs. Long-term studies are needed to confirm its broader impact on hospitalization and mortality rates.

Meta-analysis shows semaglutide lowers cardiovascular and kidney risks while supporting safety in adults with chronic kidney disease.


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Chronic Kidney Disease

Semaglutide Provides Cardiorenal Benefits in CKD With or Without Diabetes

Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

This global analysis highlights the incidence of psoriasis around the world by 2025, noting various distinctions in region, age groups, and sex.

Plaque Psoriasis

The HCPLive plaque psoriasis page is a resource for medical news and expert insights on psoriasis. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for psoriatic disease, and more.

Dermatology

The HCPLive dermatology page is a resource for medical news and expert insights on skin disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for dermatologic conditions, and more.

Psoriasis Incidence Projected to Increase by 2025 Across Various Groups

Vinay Mehta, MD: Board-certified allergist/immunologist with Allergy & Asthma Associates of Southern California

Board-certified allergist shares how clinicians can better recognize and prevent atopic dermatitis in patients with skin of color, addressing pigmentation.

Atopic Dermatitis

Atopic Dermatitis condition center page, audiences can find a variety of coverage mediums for medical news and updates, including articles, video interviews, podcasts, and breaking news on dermatitis research, treatment, and drug development.

How to Recognize and Treat Atopic Dermatitis in Patients with Skin of Color

Brandon Yan, MD, is a resident physician at the University of California.

Yan discusses the reversion of 50-year trends in mortality and the steps needed to reduce these rates back to pre-pandemic levels.

Heart Failure

The HCPLive heart failure page is a resource for medical news and expert insights on HF. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for heart disease, reduced and preserved ejection fraction, and more.

Cardiomyopathy

Stroke

On the HCPLive stroke page, resources on the topics of medical news and expert insight into CVA can be found. Content includes articles, interviews, videos, podcasts, and breaking news on stroke medicine, and more.

Hypertension

The HCPLive hypertension page is a resource for medical news and expert insights on high blood pressure. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for hypertension, and more.

Addressing Post-Pandemic Cardiovascular Mortality Rate Increases, With Brandon Yan, MD

This research, presented at the SDPA Fall Conference, highlights a consensus report proposing the first formal set of dermoscopy proficiency expectations for PAs.

Conference

 conference coverage page features articles, videos, and expert-led live coverage from major medical meetings throughout the year.

Expert Consensus Provides Recommendations on Dermoscopy Standards for PAs 

Marcus Shaker, MD, a professor of pediatrics and medicine at the Dartmouth Geisel School of Medicine

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A quick guide for clinicians on epinephrine dosing, optimal observation periods, and the role of tryptase and other labs in anaphylaxis care.


Allergy

Allergy condition center page is a comprehensive resource for clinical news and insights on allergic and inflammatory diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for food and seasonal allergies, as well as allergic asthma and related conditions.

Anaphylaxis

The HCPLive anaphylaxis page is a comprehensive resource for clinical news and insights on acute allergic reactions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for preventing anaphylaxis, and more.

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Semaglutide Provides Cardiorenal Benefits in CKD With or Without Diabetes