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Summary: The ONWARDS 3 randomized clinical trial studied the efficacy of once-weekly insulin icodec in comparison to once-daily insulin degludec for glucose control in insulin-naive type 2 diabetes patients. The double-masked, double-dummy trial was conducted from March 2021 to June 2022 across 92 sites in 11 countries, enrolling 588 adults with type 2 diabetes. The participants were randomly divided into two groups: 294 receiving once-weekly icodec and daily placebo, and 294 receiving daily degludec and weekly placebo.

The primary endpoint was the change in Hemoglobin A1c (HbA1c) from baseline to week 26. Insulin icodec showed a noninferior HbA1c change from the baseline (-1.6 percentage points) compared to insulin degludec (-1.4 percentage points) and demonstrated confirmed statistical superiority. However, the trial showed a higher rate of combined level 2 (clinically significant) or level 3 (severe) hypoglycemic events in the insulin icodec group than in the insulin degludec group, despite the overall low rates in both groups. There was no significant difference in weight changes between the two groups.

The study concluded that once-weekly insulin icodec demonstrated superior HbA1c reduction compared to once-daily degludec after 26 weeks of treatment in insulin-naive type 2 diabetes patients. The convenience of once-weekly administration should be considered against the slightly higher absolute risk of hypoglycemia. The study’s limitations include its short duration (26 weeks) and a lack of data on sustained effects, patient-reported outcomes, and continuous glucose monitoring.

Article: Once-Weekly Insulin Icodec vs Once-Daily Insulin Degludec in Adults With Insulin-Naive Type 2 Diabetes: The ONWARDS 3 Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)

See also: Visual Abstract

Related Study: Weekly Icodec versus Daily Glargine U100 in Type 2 Diabetes without Previous Insulin – New England Journal of Medicine (link to abstract – $ for full-text)

Open-label RCT | Weekly insulin Icodec proves noninferior to daily Glargine in type 2 diabetes

3 Jul, 2023 | 14:23h | UTC

Weekly Icodec versus Daily Glargine U100 in Type 2 Diabetes without Previous Insulin – New England Journal of Medicine (link to abstract – $ for full-text)

SR | Gonadotropin‐releasing hormone analogues for endometriosis

3 Jul, 2023 | 14:14h | UTC

Gonadotropin‐releasing hormone analogues for endometriosis – Cochrane Library

Summary: Gonadotrophin-releasing hormone analogues for pain associated with endometriosis – Cochrane Library

SR | Oral contraceptives containing drospirenone for premenstrual syndrome

3 Jul, 2023 | 14:13h | UTC

Oral contraceptives containing drospirenone for premenstrual syndrome – Cochrane Library

Summary: Birth control pills with drospirenone for treating premenstrual syndrome – Cochrane Library

USPSTF Recommendations | Screen for anxiety disorders in adults, including pregnant and postpartum women

30 Jun, 2023 | 15:03h | UTC

Screening for Anxiety Disorders in Adults: US Preventive Services Task Force Recommendation Statement – JAMA

Editorial: Are There Reasons to Fear Anxiety Screening? – JAMA

Evidence Report: Anxiety Screening: Evidence Report and Systematic Review for the US Preventive Services Task Force – JAMA

Patient Page: Screening for Anxiety Disorders in Adults – JAMA

Author Interview: USPSTF Recommendations: Screening for Depression and Suicide Risk in Adults, and Screening for Anxiety Disorders in Adults – JAMA

Commentary: U.S. Preventive Services Task Force Recommends Screening Adults for Anxiety Disorders – Psychiatric News Alert

From NAFLD to MASLD | New consensus changes fatty liver disease terminology to avoid stigmatization

30 Jun, 2023 | 15:01h | UTC

A multi-society Delphi consensus statement on new fatty liver disease nomenclature – Hepatology

Commentary on Twitter

Big news in the field of Hepatology

In 1980, Jurgen Ludwig and his colleagues at Mayo Clinic, identified a severe type of fatty liver disease in people who did not drink signficant amounts of alcohol. The disease was more common in women, most patients were obese and suffered… pic.twitter.com/aAq2vneIov

— TheLiverDoc (@theliverdr) June 25, 2023

Consensus Statement 2023 Update | Timing of elective surgery and risk assessment after SARS-CoV-2 infection

30 Jun, 2023 | 15:00h | UTC

Timing of elective surgery and risk assessment after SARS-CoV-2 infection: 2023 update – Anaesthesia

Commentary on Twitter

?"In most circumstances, surgery should proceed unless risk assessment indicates that the risk of proceeding exceeds the risk of delay."@Assoc_Anaes @RCoANews @UkFssa @RCSnews @elboghdadly @doctimcook @justin_kua @NigelMercer @rmoonesinghe

?https://t.co/gfjymze0oi pic.twitter.com/D8bEfAHBD7

— ??????????? (@Anaes_Journal) June 20, 2023

M-A | Metoclopramide effective in acute migraine relief, comparable to most active drugs, superior to placebo

30 Jun, 2023 | 14:51h | UTC

The efficacy and safety of metoclopramide in relieving acute migraine attacks compared with other anti-migraine drugs: a systematic review and network meta-analysis of randomized controlled trials – BMC Neurology

Post hoc analysis | Low-dose aspirin linked to increased risk of anemia in older adults

29 Jun, 2023 | 14:06h | UTC

Summary: In a post hoc analysis of the ASPREE randomized controlled trial, the impact of daily low-dose aspirin on anemia, hemoglobin, and serum ferritin concentrations in elderly individuals was investigated. The study included 19,114 community-dwelling individuals aged 70 years and older (or ≥65 years for Black and Hispanic individuals) from Australia and the United States.

Findings reveal an increased incidence of anemia in the aspirin group compared to the placebo group (51.2 events versus 42.9 events per 1000 person-years, respectively). This correlates to a 20% increase in risk (hazard ratio, 1.20 [95% CI, 1.12 to 1.29]). Hemoglobin concentrations displayed a more pronounced decline in the aspirin group by 0.6 g/L per 5 years. Additionally, among participants with ferritin measures, the aspirin group exhibited a greater prevalence of ferritin levels less than 45 µg/L at year 3 and overall decline in ferritin by 11.5%. The study found similar results even in the absence of major bleeding.

This research underscores the risk of anemia and decline in ferritin in otherwise healthy older adults taking low-dose aspirin, highlighting the need for periodic monitoring of hemoglobin levels. However, the study lacked data on the causes of anemia, indicating the need for further research.

Article: Effect of Low-Dose Aspirin Versus Placebo on Incidence of Anemia in the Elderly: A Secondary Analysis of the Aspirin in Reducing Events in the Elderly Trial – Annals of Internal Medicine (link to abstract – $ for full-text)

News Release: Low-dose aspirin may increase anaemia risk in healthy older adults: study – Monash University

Commentaries:

Aspirin Use Ups Risk of Anemia in Elderly Patients: ASPREE – TCTMD

Low-dose aspirin associated with 20% increase in risk of anemia among older adults – ACP Internist

Original Study: Effect of Aspirin on All-Cause Mortality in the Healthy Elderly – New England Journal of Medicine