This Week in Diabetes & Endocrinology: Weight Loss Agents and Renal Outcomes

This week's research highlights offer a nuanced look at weight management strategies and renal safety profiles. From the Journal of medical economics, a trial simulation modeling study evaluated tirzepatide versus semaglutide in individuals with obesity or overweight without type 2 diabetes ^[1].

The authors describe results indicating that tirzepatide at maximum-tolerated-dose was less costly by $41,688 per patient and gained 0.506 QALYs compared to semaglutide. Clinicians should interpret these cost-effectiveness findings as modeled predictions rather than direct observed clinical trial outcomes. Meanwhile, a systematic review and network meta-analysis of 63,909 adults found that all obesity medications produced greater weight loss than placebo ^[2].

Tirzepatide and semaglutide were identified as the most effective, exceeding 10% total body weight loss. The authors suggest that clinicians should individualize treatment based on efficacy, complication profile, and safety. Elsewhere this week, an observational cohort study analyzed 63,215 patients with baseline neuropsychiatric conditions across a large US federated data platform ^[3].

Higher attained semaglutide dose was associated with significantly lower incidence of several neuropsychiatric outcomes versus metformin, SGLT2 inhibitors, and DPP-4 inhibitors. These associations require confirmation in prospective studies, and the findings should be considered hypothesis-generating only. We also saw research in BMJ open diabetes research & care regarding sex differences in insulin therapy outcomes ^[4].

This systematic review and meta-analysis evaluated sex differences across 24 studies involving adults with Type 1 and Type 2 diabetes. Findings indicate mixed results, including higher time-in-range in Type 1 diabetes and higher weight-adjusted insulin doses in women with Type 2 diabetes. Evidence certainty ranges from very low to moderate, requiring cautious interpretation regarding clinical application. Finally, a meta-analysis of dapagliflozin for renal outcomes in type 2 diabetes and CKD was published in Frontiers in Medicine ^[5].

This systematic review and meta-analysis of 10 studies synthesized evidence on dapagliflozin for renal outcomes. It found a reduced risk for some renal composite endpoints but a more significant decline in eGFR and CrCI levels. The findings are based on pooled observational data and require cautious interpretation.