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Diabetes & Endocrinology
5th Nov, 2025
The Lancet
Despite advances in targeted therapies, treatment with glucocorticoids remains a mainstay in the management of various immune-mediated diseases. High cumulative doses of exogenous glucocorticoids lead to a spectrum of side-effects, in particular increased fracture risk. Fragility fractures might result in immobility, frequent admission to hospitals, and loss of quality of life. Glucocorticoid excess impairs bone microarchitecture and bone strength and can cause multiple vertebral fractures. Fracture risk at other skeletal sites is also enhanced and triggered by an increased risk for falls.
Despite improvements over the past two decades, underdiagnosis and suboptimal glycaemic management of diabetes remain major challenges globally, particularly in low-income and middle-income countries. These findings highlight the urgent need for enhanced strategies and capacity building to improve the detection, treatment, and management of diabetes worldwide. Targeted interventions to bolster health-care systems' capacity to effectively diagnose and manage diabetes could lead to better health outcomes and reduce the burden of this growing disease.
Participants receiving monlunabant showed statistically significant and clinically meaningful weight loss compared with those receiving placebo for all tested doses. Only slightly greater weight loss was observed at higher doses, whereas adverse events appeared dose dependent. Further investigation is needed to assess the safety and efficacy of lower doses of monlunabant, to evaluate its potential as a medication for obesity.
Brandi ML, Pieterman CRC, English KA, et al. Multiple endocrine neoplasia type 1 (MEN1): recommendations and guidelines for best practice. Lancet Diabetes Endocrinol 2025; 13: 699–721—In this Review, the spelling of Camilla Schalin-Jäntti's name was incorrect in the appendix. This correction has been made to the online version as of Sept 18, 2025.
Type 1 diabetes is a lifelong condition requiring a multitude of tasks and constant adaptation to evolving physiological and lifestyle needs. Following a type 1 diabetes diagnosis, and throughout their life, people living with type 1 diabetes are empowered through regular care and structured education. Existing diabetes education programmes provide knowledge on carbohydrate counting, sick day rules, and exercise but they do not explore and address the varying and complex needs that emerge with ageing.
Education is a central pillar of type 1 diabetes care. Health-care professionals must educate people with type 1 diabetes and their carers to make numerous diabetes-related decisions per day pertaining to high-level medical concepts, including the effects of nutrition, exercise, and hormones on insulin needs. Self-management of type 1 diabetes affects glycaemia, which in turn influences acute and chronic type 1 diabetes-related complication risks and quality of life. As approaches to type 1 diabetes diagnosis and therapy rapidly evolve, the interprofessional teams caring for people with type 1 diabetes across the lifespan must absorb new information and incorporate it into practice.
As screening and early treatment for type 1 diabetes become more widespread, the European action for the Diagnosis of Early Non-clinical Type 1 diabetes For disease Interception (EDENT1FI) consortium highlights the need for clearer, more consistent terminology. In this context, the group proposes a set of preferred terms to support communication around early-stage type 1 diabetes, including the use of ‘early-stage’ or ‘presymptomatic’ type 1 diabetes for stages 1 and 2, and ‘symptomatic type 1 diabetes’ for stage 3.
For decades, type 2 diabetes has been managed as a monolithic condition, defined by hyperglycaemia and treated via uniform, stepwise algorithms. Although operationally convenient, this practice increasingly fails to account for the biological heterogeneity of type 2 diabetes. Just as oncology evolved from treating cancer as a single disease to recognising distinct malignancies with targeted therapies, a similar transformation is now underway in the field of type 2 diabetes.1 A syndromic framework grounded in molecular pathophysiology could ultimately reorient diabetes care towards precise, stratified risk prediction, personalised prevention, and targeted therapy.
In The Lancet Diabetes & Endocrinology, the STEP-UP T2D and STEP-UP trial groups present new findings on the efficacy and safety of higher-dose semaglutide (7·2 mg once weekly) in individuals with obesity, both with and without type 2 diabetes.1,2 These trials build upon the foundational evidence supporting semaglutide 2·4 mg as an effective bodyweight management drug for people with diseases mediated by obesity. The clinical trials of semaglutide, and its main incretin-based alternative tirzepatide, have consistently shown very substantial and well sustained bodyweight loss and major therapeutic benefits across a range of secondary conditions—notably type 2 diabetes, prediabetes, hypertension, sleep apnoea, and heart failure.
Diabetes, a public health challenge affecting millions of people worldwide, is associated with severe complications such as heart disease, kidney failure, retinopathy, neuropathy, and premature mortality.1,2 Diabetes profoundly affects quality of life. According to the Global Burden of Diseases, Injuries, and Risk Factor Study (GBD), 561 million people worldwide were living with diabetes in 2023.3,4 This number is projected to rise to 1·3 billion by 2050,4 which illustrates the enormous challenges faced by health-care systems and societies globally.
The endocannabinoid system—comprising cannabinoid receptors (CB1 and CB2), lipid-derived ligands, and metabolic enzymes—plays a major role in regulating energy homoeostasis.1 CB1 receptors are abundant in the brain, where they influence emotionality, cognition, and social behaviour, but are also found in peripheral metabolic organs such as adipose tissue, liver, and pancreas. In these organs, CB1 activation promotes lipogenesis, reduces insulin sensitivity, and impairs leptin action, contributing to obesity-related metabolic dysfunction.
Cardiovascular disease is one of the leading causes of death globally. Tragically, as many as 80% of heart disease and stroke cases could be avoided through prevention. For people with diabetes, the risk of developing cardiovascular disease is increased, and cardiovascular disease is also one of the leading causes of death and morbidity in this population. On Sept 29, World Heart Day draws attention to this concerning reality. This year's theme, “Don't Miss a Beat”, emphasises prevention and collective action—promoting a heart-healthy lifestyle, and calling on individuals, governments, and communities to help reduce the risk of heart disease.
Psychiatry
Lithium is a classic, primary treatment for bipolar disorder that has paradoxically been used less over time, especially in North America, which goes against the accumulating evidence for its efficacy. Bipolar disorder is increasingly conceptualised as a chronic, potentially progressive condition worsened and accelerated by each mood episode, which might resemble multiple sclerosis or rheumatoid arthritis as a condition that requires disease-modifying treatments to change illness trajectory. In this Personal View, we argue that lithium acts like a disease-modifying drug in bipolar disorder.
Meta-analyses and mega-analyses of structural MRI and diffusion MRI studies in thousands of people with schizophrenia have shown reduced brain volumes and structural connectivity relative to healthy control participants. Some of these structural differences probably present pre-morbidly. Severity of schizophrenia symptoms and cognitive impairment consistently correlate. Convergent findings with different analytical methods show that the results are not artefactual. Post-mortem studies add validity and point to a pathophysiology of reduced neuronal size and dendritic arborisation, which is multifactorial.
The bidirectional association between hyperemesis gravidarum and depression suggests shared underlying biological mechanisms and highlights the long-term mental health burden associated with hyperemesis gravidarum. This finding emphasises the importance of systematic psychiatric screening during and after pregnancy, as well as the assessment of lifetime depression history in reproductive care. Improved collaboration between psychiatry, gynaecology, and primary care is essential to enhance patient outcomes.
Medical News
15th Jan, 2026
phys.org
Surgery
Journal of the American Medical Association
Medical Journal
Wiley
What's New: Drugs
FDA
Nature Medicine's Advance Online Publication (AOP) table of contents.
