The question of who truly benefits from GLP-1 receptor agonists is still vexed, even with their widespread adoption. New data from EASD suggests the current BMI cutoffs for these drugs might be missing a significant portion of high-risk patients, specifically those classified merely as overweight. This week's edition unpacks that discrepancy and its implications for cardiovascular risk management.
1. **GLP-1s and BMI**, GLP-1 receptor agonists are approved for weight loss at a BMI of 30 or above, or 27 and above with a weight-related condition. Patients with a BMI between 25-26.9, classed as overweight, currently have no access to these drugs, regardless of their actual cardiovascular risk. That exclusion is being challenged.
2. **CT Scans for Osteoporosis**, Cranial CT scans, performed for other indications, can predict major osteoporotic fractures using Hounsfield unit measurements. This offers a low-cost, opportunistic screening route for a silent disease.
3. **Gut Microbiome and T2D**, A study of over 200,000 individuals identified 789 gut bacterial species linked to type 2 diabetes. This same microbial signature is detectable in people before their blood sugar levels rise, suggesting an early biomarker.
This week's evidence points to a growing recognition that traditional diagnostic and eligibility criteria, often based on single markers like BMI or blood glucose, are becoming insufficient. We are seeing a shift towards a more holistic, risk-based approach, leveraging existing data or novel biomarkers to identify patients earlier and more accurately. The established lines are blurring.
Clinicians should scrutinise current eligibility criteria for high-impact drugs, remembering that risk often extends beyond simple cutoffs.
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