This Week in Endocrinology — Oct 21, 2026
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The week's practice-changing Endocrinology research, summarized for clinicians.
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Continuous Glucose Monitoring in Non-Insulin-Treated Type 2 Diabetes.
In adults with type 2 diabetes not using insulin in primary care, continuous glucose monitoring lowered glycated hemoglobin about 0.9 points more than routine care without added hypoglycemia.
New England Journal of Medicine · 2026 · PubMed
This week’s papers
- 01
Continuous Glucose Monitoring in Non-Insulin-Treated Type 2 Diabetes.
In adults with type 2 diabetes not using insulin in primary care, continuous glucose monitoring lowered glycated hemoglobin about 0.9 points more than routine care without added hypoglycemia.
Oser TK et al. · New England Journal of Medicine · 2026
From the briefingThe headline comes from the New England Journal of Medicine, where Oser and colleagues randomized 283 adults with type 2 diabetes not using insulin, across 22 primary care practices in the United States, to continuous glucose monitoring or routine care for 26 weeks [1]. Starting from an average glycated hemoglobin near 8.8 percent, the monitoring group finished about 0.9 percentage points lower than the routine-care group, and spent roughly 21 more percentage points of the day in the 70 to 180 range. Time in hypoglycemia was also slightly lower, and no severe hypoglycemia was reported. This is a single trial, it was funded by Dexcom, and the abstract does not tell us how much structured education or clinician feedback accompanied the sensors, but it is randomized evidence in exactly the primary care population where coverage and guideline language on monitoring have been most hesitant.
If you only have time for one paper this week, make it the CONNECT trial of continuous glucose monitoring in non-insulin-treated type 2 diabetes in the New England Journal of Medicine [1]. It provides randomized primary care evidence on a question that has largely rested on observational data, and it reopens the debate over who should have access to sensors.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 02
Efficacy and safety of HRS-7535, a novel oral small-molecule glucagon-like peptide-1 receptor agonist, in participants with type 2 diabetes mellitus inadequately controlled by metformin and sodium-glucose co-transporter 2 inhibitors: a multicentre, randomised, double-blind, placebo-controlled, parallel-group Phase II trial.
The oral small-molecule GLP-1 agonist HRS-7535 lowered HbA1c by up to 1.8 points over 16 weeks on metformin plus SGLT2 inhibitor, with mainly mild gastrointestinal effects.
Xu M et al. · Diabetologia · 2026
From the briefingOn the pharmacologic side, Diabetologia reports a phase two trial from Xu and colleagues of HRS-7535, an oral small-molecule GLP-1 receptor agonist, added to metformin plus an SGLT2 inhibitor in 155 Chinese adults [2]. Over 16 weeks the higher 60 milligram dose lowered glycated hemoglobin by about 1.8 points against roughly 0.4 with placebo, and about two thirds of participants on that dose reached a target below 7 percent. Weight loss was modest at around 2.4 percent, gastrointestinal effects were the most common adverse events, and there was no severe hypoglycemia. It is short, small, and industry-funded, so it signals a promising class of non-peptide oral agents rather than anything ready for practice.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 03
A Recipe for Better Diabetes Management: The DASH4D Dietary Pattern.
A modified DASH diet lowered blood pressure and improved glycemic control in type 2 diabetes with hypertension, prompting authors to argue it should be a recommended dietary pattern.
Selvin E et al. · Diabetes Care · 2026
From the briefingDiet gets its own argument in Diabetes Care, where Selvin and colleagues make the case that the American Diabetes Association standards, which recommend individualized nutrition therapy without endorsing a specific pattern, leave clinicians without a starting point [3]. They summarize the DASH for Diabetes trial, in which a modified DASH eating plan lowered blood pressure and improved glycemic control in adults with type 2 diabetes and hypertension, and they conclude that it should be a recommended diet. This is a perspective piece, not new data, but it sharpens a real tension in current guidance.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 04
Evolving phenotype of newly diagnosed type 2 diabetes: a 15-year population-based comparison.
Over fifteen years in Israel, newly diagnosed type 2 diabetes patients became older and more comorbid but better controlled, with SGLT2 inhibitors and GLP-1 agonists displacing sulfonylureas.
Kirshner D et al. · Diabetologia · 2026
From the briefingThe context for all of this is shifting, as a large Israeli comparison in Diabetologia from Kirshner and Hauzer shows [4]. Comparing about 80,000 people diagnosed with type 2 diabetes in 2005 to 2008 against about 100,000 diagnosed in 2020 to 2023, the median age at diagnosis rose to nearly 67 years, the share of patients aged 85 or older nearly doubled, and comorbidity burden climbed. Yet patients now arrive with lower glycated hemoglobin and much lower LDL cholesterol, largely because statins were already on board. Early use of SGLT2 inhibitors and GLP-1 receptor agonists went from essentially zero to between 11 and 15 percent, while sulfonylurea use fell more than fourfold. The authors read this as a move from glucose-centric to cardiorenal and weight-driven care, and note that very elderly patients remain underrepresented in the trials that guide it. Being retrospective and from a single health system, it describes trends rather than proving their causes.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 05
Prediabetes subtype-based stratification reveals distinct long-term risks for type 2 diabetes.
Over 20 years in Korean adults, meeting all three prediabetes criteria raised diabetes risk about fifteen-fold, and low insulin secretion or sensitivity further sharpened risk stratification.
Choe HJ et al. · Diabetologia · 2026
From the briefingIn Diabetologia, Choe and colleagues followed more than 7,000 Korean adults for up to 20 years with oral glucose tolerance tests every two years [5]. Each prediabetes definition, whether impaired fasting glucose, impaired glucose tolerance, or an elevated glycated hemoglobin, carried roughly a five-fold higher risk of diabetes compared with normoglycemia. Risk climbed steeply with the number of criteria met: people meeting all three had about fifteen times the risk, spent only around 1.7 years in prediabetes, and rarely reverted to normal. Low insulin secretion or low insulin sensitivity added further risk, and even normoglycemic people with poor secretion or sensitivity were more likely to progress. The physiologic indices require glucose tolerance testing that is uncommon in routine practice, so the immediate relevance is to how prevention trials and programs might target their highest-risk participants.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 06
Predictors of Type 2 Diabetes Remission and Relapse After Metabolic-Bariatric Surgery or Medical-Lifestyle Therapy in the ARMMS-T2D Study.
Over a median 11 years, 58 percent of surgical patients achieved diabetes remission versus 3 percent with medical therapy, with shorter diabetes duration predicting remission and fewer relapses.
Simonson DC et al. · Diabetes Care · 2026
From the briefingAt the other end of the disease course, Diabetes Care reports long-term follow-up from the ARMMS-T2D consortium led by Simonson [6]. Across a median of 11 years, 58 percent of participants randomized to metabolic-bariatric surgery achieved remission, compared with 3 percent of those receiving medical-lifestyle therapy. Shorter diabetes duration, no insulin use, and greater weight loss at one year predicted remission, while longer duration and more medication classes predicted relapse after remission. Read alongside the Korean data, the common thread is that time and beta-cell reserve matter: the earlier in the disease, the more modifiable it appears. The ARMMS analysis is limited to 262 patients, so the predictors inform conversations rather than define eligibility.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 07
Real-world, digital-first delivery of GLP-1 receptor agonist therapy in women.
Among 8,127 United Kingdom women using digitally delivered, mostly tirzepatide therapy, mean six-month weight loss was about 15 percent with high retention, though without a comparator group.
Deanfield J et al. · Nature Medicine · 2026
From the briefingIn Nature Medicine, Deanfield and colleagues describe 8,127 women in the United Kingdom who started GLP-1-based therapy, almost all tirzepatide, through a digital program with mandatory blood monitoring, weekly video follow-up, and clinician-guided titration [7]. Average weight loss at six months was about 16 kilograms, or around 15 percent of body weight; more than four in five women lost at least 10 percent, and about one in five lost at least 20 percent. Most participants with diabetes-range glycated hemoglobin at baseline normalized, lipids improved, retention was above 90 percent, and no serious treatment-related adverse events were reported. The authors themselves flag the limits: no comparator group, a self-paying population, and only six months of follow-up, so this supports feasibility of the care model rather than its superiority to conventional clinics.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 08
The development of obesity pharmacotherapy: from early challenges and setbacks to recognition by WHO.
A historical review traces obesity drugs from safety withdrawals and stigma to GLP-1-based therapies now included in WHO guidelines and the Essential Medicines List for a narrow population.
Halpern B et al. · The Lancet Diabetes & Endocrinology · 2026
From the briefingFraming that shift, The Lancet Diabetes and Endocrinology carries a historical review by Halpern and colleagues tracing obesity drugs from early withdrawals over safety and weak efficacy to the arrival of GLP-1 receptor agonists and multiagonists [8]. They note that WHO has now issued global guidance and added GLP-1 receptor agonists to the Essential Medicines List, though for a narrowly defined population, and argue that stigma and regulatory caution slowed translation. Taken together, the two papers show efficacy is no longer the main barrier; access, delivery, and equity are.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 09
Diagnostic Utility of Diurnal Salivary Cortisol Profiles in Neoplastic and Non-Neoplastic Hypercortisolism.
In a retrospective single-centre cohort, the salivary cortisol nadir distinguished non-neoplastic hypercortisolism from ACTH-dependent Cushing's syndrome with about 90 percent sensitivity and 87 percent specificity.
Bonnet-Serrano F et al. · European Journal of Endocrinology · 2026
From the briefingIn the European Journal of Endocrinology, Bonnet-Serrano and colleagues reviewed more than 400 inpatients in Paris who had full 24-hour serum and salivary cortisol cycles [9]. The lowest cortisol value across the day discriminated Cushing's syndrome from non-Cushing's patients slightly better than a single midnight value, with near-perfect accuracy in both serum and saliva. More usefully, the salivary nadir separated non-neoplastic hypercortisolism from ACTH-dependent Cushing's with about 90 percent sensitivity and 87 percent specificity at a cut-off of 5.3 nanomoles per liter. This is retrospective, single-centre work using a radioimmunoassay, so the threshold needs validation with other assays before it travels, but it addresses one of the hardest differential diagnoses in the field with an ambulatory test.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 10
Precision Thyroid Oncology Using Genetic-Based Therapies: A Narrative Review.
Targeted RET, NTRK, and BRAF/MEK therapies have transformed some advanced thyroid cancers, especially RET-mutant medullary cancer, but benefit and access vary widely by tumor type and country.
Marotta V et al. · Thyroid · 2026
From the briefingIn Thyroid, Marotta, Xing, and Vitale review approved genetic-based therapies for advanced thyroid cancer [10]. They identify selpercatinib, which outperformed multikinase inhibitors head to head, as the best first-line option in RET-mutant medullary cancer, describe encouraging results with BRAF and MEK combinations in BRAF V600E anaplastic cancer, and note that RET and NTRK inhibitors help only a small fraction of patients with radioiodine-refractory differentiated cancer because those alterations are rare. Their central point is that access is uneven, shaped heavily by country-specific approvals.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
The full briefing
This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.
Welcome to This Week in Endocrinology. This week we're covering 10 notable papers spanning the changing toolkit for type 2 diabetes, risk prediction from prediabetes through remission, the scaling of obesity pharmacotherapy, and refinements in adrenal and thyroid practice. Let's dive in.
We start with type 2 diabetes management, where several papers ask whether tools once reserved for more advanced disease belong earlier in the course. The headline comes from the New England Journal of Medicine, where Oser and colleagues randomized 283 adults with type 2 diabetes not using insulin, across 22 primary care practices in the United States, to continuous glucose monitoring or routine care for 26 weeks [1]. Starting from an average glycated hemoglobin near 8.8 percent, the monitoring group finished about 0.9 percentage points lower than the routine-care group, and spent roughly 21 more percentage points of the day in the 70 to 180 range. Time in hypoglycemia was also slightly lower, and no severe hypoglycemia was reported. This is a single trial, it was funded by Dexcom, and the abstract does not tell us how much structured education or clinician feedback accompanied the sensors, but it is randomized evidence in exactly the primary care population where coverage and guideline language on monitoring have been most hesitant. On the pharmacologic side, Diabetologia reports a phase two trial from Xu and colleagues of HRS-7535, an oral small-molecule GLP-1 receptor agonist, added to metformin plus an SGLT2 inhibitor in 155 Chinese adults [2]. Over 16 weeks the higher 60 milligram dose lowered glycated hemoglobin by about 1.8 points against roughly 0.4 with placebo, and about two thirds of participants on that dose reached a target below 7 percent. Weight loss was modest at around 2.4 percent, gastrointestinal effects were the most common adverse events, and there was no severe hypoglycemia. It is short, small, and industry-funded, so it signals a promising class of non-peptide oral agents rather than anything ready for practice. Diet gets its own argument in Diabetes Care, where Selvin and colleagues make the case that the American Diabetes Association standards, which recommend individualized nutrition therapy without endorsing a specific pattern, leave clinicians without a starting point [3]. They summarize the DASH for Diabetes trial, in which a modified DASH eating plan lowered blood pressure and improved glycemic control in adults with type 2 diabetes and hypertension, and they conclude that it should be a recommended diet. This is a perspective piece, not new data, but it sharpens a real tension in current guidance.
The context for all of this is shifting, as a large Israeli comparison in Diabetologia from Kirshner and Hauzer shows [4]. Comparing about 80,000 people diagnosed with type 2 diabetes in 2005 to 2008 against about 100,000 diagnosed in 2020 to 2023, the median age at diagnosis rose to nearly 67 years, the share of patients aged 85 or older nearly doubled, and comorbidity burden climbed. Yet patients now arrive with lower glycated hemoglobin and much lower LDL cholesterol, largely because statins were already on board. Early use of SGLT2 inhibitors and GLP-1 receptor agonists went from essentially zero to between 11 and 15 percent, while sulfonylurea use fell more than fourfold. The authors read this as a move from glucose-centric to cardiorenal and weight-driven care, and note that very elderly patients remain underrepresented in the trials that guide it. Being retrospective and from a single health system, it describes trends rather than proving their causes.
Our second theme is predicting who progresses, and who stays in remission. In Diabetologia, Choe and colleagues followed more than 7,000 Korean adults for up to 20 years with oral glucose tolerance tests every two years [5]. Each prediabetes definition, whether impaired fasting glucose, impaired glucose tolerance, or an elevated glycated hemoglobin, carried roughly a five-fold higher risk of diabetes compared with normoglycemia. Risk climbed steeply with the number of criteria met: people meeting all three had about fifteen times the risk, spent only around 1.7 years in prediabetes, and rarely reverted to normal. Low insulin secretion or low insulin sensitivity added further risk, and even normoglycemic people with poor secretion or sensitivity were more likely to progress. The physiologic indices require glucose tolerance testing that is uncommon in routine practice, so the immediate relevance is to how prevention trials and programs might target their highest-risk participants. At the other end of the disease course, Diabetes Care reports long-term follow-up from the ARMMS-T2D consortium led by Simonson [6]. Across a median of 11 years, 58 percent of participants randomized to metabolic-bariatric surgery achieved remission, compared with 3 percent of those receiving medical-lifestyle therapy. Shorter diabetes duration, no insulin use, and greater weight loss at one year predicted remission, while longer duration and more medication classes predicted relapse after remission. Read alongside the Korean data, the common thread is that time and beta-cell reserve matter: the earlier in the disease, the more modifiable it appears. The ARMMS analysis is limited to 262 patients, so the predictors inform conversations rather than define eligibility.
Our third theme is obesity pharmacotherapy moving from trials into real-world delivery. In Nature Medicine, Deanfield and colleagues describe 8,127 women in the United Kingdom who started GLP-1-based therapy, almost all tirzepatide, through a digital program with mandatory blood monitoring, weekly video follow-up, and clinician-guided titration [7]. Average weight loss at six months was about 16 kilograms, or around 15 percent of body weight; more than four in five women lost at least 10 percent, and about one in five lost at least 20 percent. Most participants with diabetes-range glycated hemoglobin at baseline normalized, lipids improved, retention was above 90 percent, and no serious treatment-related adverse events were reported. The authors themselves flag the limits: no comparator group, a self-paying population, and only six months of follow-up, so this supports feasibility of the care model rather than its superiority to conventional clinics. Framing that shift, The Lancet Diabetes and Endocrinology carries a historical review by Halpern and colleagues tracing obesity drugs from early withdrawals over safety and weak efficacy to the arrival of GLP-1 receptor agonists and multiagonists [8]. They note that WHO has now issued global guidance and added GLP-1 receptor agonists to the Essential Medicines List, though for a narrowly defined population, and argue that stigma and regulatory caution slowed translation. Taken together, the two papers show efficacy is no longer the main barrier; access, delivery, and equity are.
Finally, two papers refine adrenal and thyroid practice. In the European Journal of Endocrinology, Bonnet-Serrano and colleagues reviewed more than 400 inpatients in Paris who had full 24-hour serum and salivary cortisol cycles [9]. The lowest cortisol value across the day discriminated Cushing's syndrome from non-Cushing's patients slightly better than a single midnight value, with near-perfect accuracy in both serum and saliva. More usefully, the salivary nadir separated non-neoplastic hypercortisolism from ACTH-dependent Cushing's with about 90 percent sensitivity and 87 percent specificity at a cut-off of 5.3 nanomoles per liter. This is retrospective, single-centre work using a radioimmunoassay, so the threshold needs validation with other assays before it travels, but it addresses one of the hardest differential diagnoses in the field with an ambulatory test. In Thyroid, Marotta, Xing, and Vitale review approved genetic-based therapies for advanced thyroid cancer [10]. They identify selpercatinib, which outperformed multikinase inhibitors head to head, as the best first-line option in RET-mutant medullary cancer, describe encouraging results with BRAF and MEK combinations in BRAF V600E anaplastic cancer, and note that RET and NTRK inhibitors help only a small fraction of patients with radioiodine-refractory differentiated cancer because those alterations are rare. Their central point is that access is uneven, shaped heavily by country-specific approvals.
If you only have time for one paper this week, make it the CONNECT trial of continuous glucose monitoring in non-insulin-treated type 2 diabetes in the New England Journal of Medicine [1]. It provides randomized primary care evidence on a question that has largely rested on observational data, and it reopens the debate over who should have access to sensors.
Here is what this week's evidence adds up to in Endocrinology. First, a single randomized trial now shows that continuous glucose monitoring meaningfully lowers glycated hemoglobin in non-insulin-treated type 2 diabetes in primary care, without added hypoglycemia; durability and cost-effectiveness remain open. Second, both prediabetes and remission data point to disease duration and beta-cell function as central to prognosis, with risk rising sharply when multiple glycemic criteria are met, though physiologic risk tools are not yet practical for routine use. Third, obesity pharmacotherapy delivered digitally can achieve trial-like weight loss at six months in a self-selected population, but controlled and longer-term evidence is still missing. Fourth, the person newly diagnosed with type 2 diabetes is older and more comorbid than fifteen years ago, a group the trial evidence base underrepresents. And fifth, the salivary cortisol nadir looks promising for separating non-neoplastic hypercortisolism from Cushing's, pending external validation.
That's your roundup for This Week in Endocrinology. The full transcript and references are available on the episode page. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.
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