📢 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

Real-World Comparisons Between Glucagon-Like Peptide-1 Receptor Agonists and Other Glucose-Lowering Agents in Type 2 Diabetes: Retrospective Analyses of Cardiovascular and Economic Outcomes in England...

Introduction Clinical trials have demonstrated that glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce the risk of major adverse cardiovascular events (MACE) in adults with type 2 diabetes (T...

link.springer.com

📢 #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

GLP-1 agonists: 82 deaths linked to adverse reactions, UK data show

Data submitted to the UK drugs regulator show a total of 82 deaths related to glucagon-like peptide-1 receptor agonists, the class of drugs used for weight loss and type 2 diabetes. Data from the yel...

ggdocs.co

"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

A five-drug class model using routinely available clinical features to optimise prescribing in type 2 diabetes: a prediction model development and validation study

We have developed a five-drug class model that uses routine clinical data to identify optimal glucose-lowering therapies for people with type 2 diabetes. Individuals on model-predicted optimal therapy...

ggdocs.co

📢 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

Caffeine intake associated with a lower risk of liver fibrosis in different glucose status

To investigate the prevalence of liver fibrosis, and the association between caffeine intake and fibrosis in populations with different glucose metabo…

ggdocs.co

#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

An analysis on the role of glucagon-like peptide-1 receptor agonists in cognitive and mental health disorders - Nature Mental Health

De Giorgi and colleagues present a comprehensive analysis of pre-clinical and clinical studies examining the role of glucagon-like peptide-1 receptor agonists in mental disorders.

ggdocs.co