BACKGROUND:Diabetic peripheral neuropathy (DPN) affects approximately 50% of individuals with diabetes and is a risk factor for amputations. Unfortunately, foot exams and screening tools are inconsistent and miss early-stage nerve damage. A smartphone-based application that delivers controlled vibrations, records patient responses, and computes a vibration perception threshold (SVPT) may present an accessible, precise monitoring avenue. This study assesses the clinical relevance and precision of SVPTs for measuring large-fiber sensory deficits in patients with diabetes. METHODS:We measured SVPTs in 71 patients with pre-diabetes or diabetes and compared their efficacy with tuning fork exams. We analyzed the correlation between SVPT and Rydel-Seiffer tuning fork (RSTF) scores, along with their relationship with clinical DPN markers such as hemoglobin A1c (HbA1c), age, and disease duration using multivariable linear regression. RESULTS:The SVPTs moderately correlated with RSTF scores (Rs = -0.43, p = 0.0019). Among adults aged 50 to 69 years, SVPTs correlated significantly with clinical markers [F(4, 29) = 4.76, p = 0.00447, Multiple R2 = 0.396, Adjusted R2 = 0.313, ϵ = 0.167]. The interaction between age and HbA1c was positively associated with SVPTs (β = 0.118, p = 0.001), while SVPTs were negatively associated with diabetes duration (β = -0.098, p = 0.003). CONCLUSIONS:We present a clinically relevant, patient-operated smartphone application for large-fiber sensory monitoring, tested on patients with varying DPN risk. This novel platform has the potential to provide a precise, reliable, and accessible avenue for identifying individuals at risk of developing DPN complications, prior to overt clinical manifestation.

A panel of experts in the use of continuous glucose monitoring (CGM) data in the treatment of diabetes met in Burlingame, California on October 27, 2025 to discuss the utility of the glycemia risk index (GRI) for clinical care research and population health management. The GRI composite metric is a single number (on a 0-100 percentile scale-lower is better) based on an expert-determined weighting of the seven individual components in the existing ambulatory glucose profile (AGP). The GRI describes the quality of glycemia based on glucose values collected in a 14-day CGM tracing, thus providing additional insights into CGM profiles beyond the AGP. During the meeting, the mathematical derivation of the GRI metric was presented along with its use for adult and pediatric individuals with diabetes and cancer who require medications that can adversely affect the glucose concentration. Examples where the GRI provided useful insights into the quality of CGM tracings were also discussed by the expert panel. In addition, a new smartphone application, the GRI Calculator, was presented. This app calculates the GRI of a CGM tracing and provides visualization of sequential CGM tracings for a specific individual. The GRI provides a reference measurement for the accuracy of artificial intelligence (AI) models assigning levels of glycemic quality to CGM tracings intended to match the assessments of clinicians. The GRI is now part of the data visualization panel for the Integration of Connected Diabetes Device Data into the Electronic Health Record (iCoDE-2) project, which standardizes both CGM and insulin dosing data. Further exploration of the potential value of the GRI for non-insulin users needs to be undertaken. The panel unanimously recommended that CGM manufacturers and developers of data visualization software for CGMs add the GRI to their data platforms for insulin users.

Prediabetes is common worldwide and offers a critical opportunity for interventions to prevent type 2 diabetes. Vitamin D has biologically plausible effects on beta cell function, insulin sensitivity, and the immune system, and observational studies consistently associate higher 25-hydroxyvitamin D (25[OH]D) levels with a lower risk of developing diabetes. Three randomized, double-blind, placebo-controlled trials designed specifically for adults with prediabetes tested moderate-to-high doses of vitamin D3 (Tromsø, D2d) or an active analog (DPVD). Each study showed a modest reduction in progression to type 2 diabetes. An individual participant data meta-analysis of these trials (n = 4190) demonstrated a 15% relative risk reduction, with greater benefit among those with low baseline 25(OH)D levels or a body mass index less than 30 kg/m2. Vitamin D supplementation also increased the likelihood of regression to normal glucose regulation. These findings are further supported by multiple aggregate-data meta-analyses showing a consistent benefit of vitamin D supplementation in adults with prediabetes. Compared with intensive lifestyle interventions, metformin, and incretin-based therapies, vitamin D is inexpensive, safe, accessible, and easy to implement, with an estimated number needed to treat of ∼30. The 2024 Endocrine Society Guideline now recommends vitamin D supplementation for adults with prediabetes at doses above the recommended dietary allowance without requiring routine 25(OH)D testing. Achieving and maintaining a blood 25(OH)D level above 40 ng/mL may confer additional benefit, but the hypothesis needs to be tested in clinical trials.

This narrative review provides a historical perspective on how observational research on type 2 diabetes has been developed and consolidated over the last 50 years and how well-designed cohort studies will provide us with knowledge for research and practice in the future and aid guideline development. We have included data from a large number of cohorts from every continent that have been used to study the development and/or progression of type 2 diabetes, including cohorts that are general population-based, disease-based, intervention-based and registry-based. We have structured the results from the past 50 years based on the following themes: diagnosis and screening, complications, risk factors and pathophysiology. We also discuss the strengths and weaknesses of observational research when compared with other research designs. Finally, we discuss the emerging and future directions for type 2 diabetes research using cohorts, which include novel developments, such as artificial intelligence, precision health and the exposome. We conclude that cohort research has significantly advanced our understanding of type 2 diabetes and aided guideline development, and complements experimental work, such as human randomised controlled trials and animal studies. Both approaches are essential and complementary in our pursuit to provide a more comprehensive understanding of the development and progression of type 2 diabetes, and to change dogma, practice and policies for better outcomes.

This consensus report evaluates the potential role of continuous glucose monitoring (CGM) in screening for stage 2 type 1 diabetes (T1D). CGM offers a minimally invasive alternative to venous blood testing for detecting dysglycemia, facilitating early identification of at-risk individuals for confirmatory blood testing. A panel of experts reviewed current evidence and addressed key questions regarding CGM’s diagnostic accuracy and screening protocols. They concluded that while CGM cannot yet replace blood-based diagnostics, it holds promise as a screening tool that could lead to earlier, more effective intervention. Metrics such as time above range >140 mg/dL could indicate progression risk, and artificial intelligence (AI)-based modeling may enhance predictive capabilities. Further research is needed to establish CGM-based diagnostic criteria and refine screening strategies to improve T1D detection and intervention.

Introduction and Objective: Our goal was to identify the value of continuous glucose monitor (CGM) screening to identify individuals with stage 2 type 1 diabetes (T1D). If these individuals are identified, then useful treatments, such as teplizumab, may help delay the onset of stage 3 (symptomatic) T1D. Methods: We used a group consensus process consisting of an in-person meeting of authors and panelists on October 15, 2024, and a virtual meeting with additional panelists. Following conversations at these meetings, the authors drafted the article and sent the first and second draft out for review, comments, and endorsement by the remaining in-person and virtual panelists. Results: The committee developed sixteen conclusions about CGM screening for stage 2 T1D, in three different categories: current status of screening for stage 2 T1D, current status of CGM screening for stage 2 T1D, and future status of CGM screening for stage 2 T1D (see table). Conclusion: CGM offers promise as a tool to identify people with stage 2 T1D. These individuals could then undergo traditional venous blood glucose testing to screen for stage 2 T1D, to confirm the diagnosis so that an immune protective drug may be prescribed. Eventually, instead of serving as an adjunctive tool, CGM testing may be designated to replace plasma glucose testing and HbA1c testing to identify individuals with stage 2 T1D who may benefit from immunotherapy. A. Ayers: Consultant; Liom Health AG. C. Ho: None. J.K. Mader: Advisory Panel; Abbott. Speaker's Bureau; Abbott. Advisory Panel; Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company. Stock/Shareholder; elyte Diagnostics. Advisory Panel; embecta. Speaker's Bureau; embecta, Menarini. Advisory Panel; Medtronic. Speaker's Bureau; Dexcom, Inc. Advisory Panel; Dexcom, Inc., Novo Nordisk A/S. Speaker's Bureau; Novo Nordisk A/S. Advisory Panel; Roche Diabetes Care. Speaker's Bureau; Roche Diabetes Care. Advisory Panel; Sanofi. Speaker's Bureau; Sanofi. Advisory Panel; Biomea Fusion, PharmaSens, Tingo Medical. Stock/Shareholder; decide Clinical Software. J.C. Wong: Research Support; Abbott, Dexcom, Inc., Tandem Diabetes Care, Inc. G. Freckmann: Advisory Panel; Abbott, Boydsense, Dexcom, Inc., Lilly Diabetes, Vertex Pharmaceuticals Incorporated. Speaker's Bureau; Abbott, Menarini, Roche Diabetes Care, Sinocare Inc. Research Support; Ascensia Diabetes Care, Bionime, i-Sens. Consultant; i-Sens, Perfood. Advisory Panel; PharmaSens. Consultant; Roche Diabetes Care, Sinocare Inc, Ypsomed AG. J.F. Garcia-Tirado: None. I.B. Hirsch: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc, MannKind Corporation. Consultant; Abbott, Roche Diabetes Care, Hagar. S.B. Johnson: None. D. Kerr: None. S.H. Kim: Other Relationship; Novo Nordisk. Consultant; TeCure. R. Lal: Consultant; Abbott, Biolinq, Capillary Biomedical, Inc, Gluroo, PhysioLogic Devices, Portal Insulin, Sanofi, Tidepool. Advisory Panel; Provention Bio, Inc, Provention Bio, Inc, Microbion, Microbion, Lilly Diabetes. Research Support; Insulet Corporation, Medtronic, Tandem Diabetes Care, Inc, Sinocare Inc. E. Montaser: None. H.K. O'Donnell: Advisory Panel; Sanofi. Other Relationship; Sanofi. V.N. Shah: Consultant; Dexcom, Inc. Advisory Panel; Sanofi, Novo Nordisk. Consultant; Lilly Diabetes. Advisory Panel; embecta. Consultant; Insulet Corporation. Advisory Panel; Tandem Diabetes Care, Inc, Ascensia Diabetes Care. Research Support; Enable Bioscience. Consultant; Genomelink and Lumosfit. D.C. Klonoff: Consultant; Synchneuro, Thirdwayv, Tingo, Afon, embecta, Glucotrack, Lifecare, Novo Nordisk, Samsung. Abbott Diabetes Care Sanofi

INTRODUCTION:Metabolic dysfunction-associated steatotic liver disease (MASLD) is an important public health threat, potentially leading to chronic liver disease and liver cancer. Current guidelines recommend using the Fibrosis-4 score for initial identification of subjects at risk of future complications. We formulate a novel population screening strategy based on the Steatosis-Associated Fibrosis Estimator (SAFE) score, recently developed for MASLD risk stratification in primary care. METHODS:We interrogated the National Health and Nutrition Examination Survey data, 2017-20, in which a sample of subjects representative of US civilian population underwent vibration-controlled transient elastography (VCTE). The current guideline and a new, SAFE-based proposal were applied to these data to project the number of subjects to be diagnosed with liver fibrosis gauged by liver stiffness measurement (LSM), including significant (LSM ≥8 kPa) and advanced (LSM ≥12 kPa) fibrosis, as well as the number of VCTEs to be performed. RESULTS:In the survey data, 2,691 subjects, projecting to 75.8 million US adults, were found to have MASLD, of whom 11% had LSM 8-12 kPa and 6% LSM ≥12 kPa. When the current guideline was applied, 18.1 million VCTEs would be needed to diagnose 3.5 million subjects with LSM ≥8 kPa and 1.7 million subjects with LSM ≥12 kPa. In comparison, a new approach based on the SAFE score would detect 4.9 million with LSM ≥8 kPa and 2.5 million subjects with LSM ≥12 kPa (37% and 45% improvement over the current guideline, respectively), while requiring 5.0 million fewer VCTEs (28% reduction). DISCUSSION:The proposed population risk stratification approach using the SAFE score is simpler and substantially more effective, yielding more subjects with liver fibrosis while requiring less resources compared with the currently recommended algorithm.

OBJECTIVE:Conduct a preliminary randomized trial that compared a 6-week type 2 diabetes (T2D) prevention programme to an educational video control for adults with pre-diabetes. METHODS:Adults (N = 62) with pre-diabetes were randomized to the group-delivered Project Health T2D or an educational video control, completing measures at pre-test, post-test and 3-month follow-up. RESULTS:Participants randomized to the intervention versus control condition showed significantly greater reductions in body fat (d = 0.76, p = 0.002; d = 1.07, p < 0.001), weight (d = 0.59, p = 0.030; 0.65, p = 0.017) and body mass index (BMI = kg/m2; d = 0.60, p = 0.030; 0.67, p = 0.014), significantly greater increases in lean mass (d = 0.80, p = 0.003; 0.93, p = 0.001) at post-test and 3-month follow-up, respectively, and marginally greater reductions in glycated haemoglobin (HbA1c) (d = 0.54, p = 0.056), but not fasting plasma glucose at 3-month follow-up (d = 0.25, p = 0.364). Project Health T2D also produced a marginally greater 75% reduction in future onset of type 2 diabetes compared with educational controls, reducing incidence over the total 5-month observation period from 15% to 4% (odds ratio = 4.52, p = 0.096). CONCLUSIONS:Project Health T2D produced encouraging reductions in body fat, weight and T2D incidence, and increases in lean mass, and is less intensive than other lifestyle modification T2D prevention programme, suggesting that it might be useful to evaluate in a fully powered efficacy trial with a longer follow-up.

Prediabetes is an intermediate state of glucose homeostasis whereby plasma glucose concentrations are above normal but below the threshold of diagnosis for diabetes. Over the last several decades, criteria for prediabetes have changed as the cut points for normal glucose concentration and diagnosis of diabetes have shifted. Global consensus does not exist for prediabetes criteria; as a result, the clinical course and risk for type 2 diabetes vary. At present, we can identify individuals with prediabetes based on three glycemic tests (hemoglobin A1c, fasting plasma glucose, and 2-h plasma glucose during an oral glucose tolerance test). The majority of individuals diagnosed with prediabetes meet only one of these criteria. Meeting one, two, or all glycemic criteria changes risk for type 2 diabetes, but this information is not widely known and does not currently guide intervention strategies for individuals with prediabetes. This review summarizes current epidemiology, prognosis, and intervention strategies for individuals diagnosed with prediabetes and suggests a call for more precise risk stratification of individuals with prediabetes as elevated (one prediabetes criterion), high risk (two prediabetes criteria), and very high risk (three prediabetes criteria). In addition, the roles of oral glucose tolerance testing and continuous glucose monitoring in the diagnostic criteria for prediabetes need reassessment. Finally, we must reframe our goals for prediabetes and prioritize intensive interventions for those at high and very high risk for type 2 diabetes. image

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Abstract Disclosure: L. Needleman: None. S.H. Kim: None. A.L. Kossler: None. C. Dosiou: None. Background: In a previous longitudinal observation study, we showed that patients with prediabetes increased HbA1c by a mean of 0.7% and 30% progressed to type 2 diabetes after treatment with teprotumumab for 3 months, or after 4 infusions [1]. However, temporal effects of hyperglycemia and the impact of lower doses of teprotumumab on hyperglycemia are unknown. Clinical case: An 86-year-old woman was diagnosed with Graves’ disease after evaluation for palpitations showed undetectable TSH, free T4 2.31 ng/dL (ref. 0.8-1.8 ng/dL), total T3 252 ng/dL (ref. 76-181 ng/dL), and elevated TSI (5.0, ref. <1.3). Thyroxine levels normalized four weeks after starting methimazole. Nine weeks after the initial presentation she developed diplopia and bilateral proptosis. She was diagnosed with active moderate-to-severe thyroid eye disease (CAS 4/7) and was started on teprotumumab 10 mg/kg intravenously every three weeks. The dose was not increased to 20 mg/kg due to concern for adverse effects given the patient’s age and underlying hearing impairment. At baseline, she had prediabetes based on a HbA1c of 6.0%. Additional risk factors for type 2 diabetes included older age and Asian race [1]. Continuous glucose monitoring (CGM, Dexcom G7) before starting teprotumumab showed 71% time in tight range (TITR, 70-140 mg/dL) with average fasting glucose of 115 mg/dL. Prior to starting teprotumumab, she received counseling for lifestyle modification including carbohydrate moderation. Ten days following her first teprotumumab dose, her TITR reduced to 66%. After three doses of teprotumumab, her proptosis improved by 2 mm, CAS decreased to 1/7, and diplopia resolved. However, the TITR was 59% and average fasting glucose increased to 128 mg/dL. HbA1c also increased to 7.4% and the patient was started on metformin. Conclusion: In this case, teprotumumab increased glucose as early as after the first infusion. Glucose tolerance continued to worsen with subsequent doses, with development of type 2 diabetes, even with reduced dosage of teprotumumab. This case demonstrates that monitoring for teprotumumab-related hyperglycemia can be optimized with use of CGM and that lower doses of teprotumumab do not eliminate the risk of worsening glucose tolerance. Whether hyperglycemia would have been more severe with full dose teprotumumab remains uncertain. Reference: [1] Amarikwa L, Mohamed A, Kim SH, Kossler AL, Dosiou C. Teprotumumab-Related Hyperglycemia. J Clin Endocrinol Metab. 2023 Mar 10;108(4):858-864. Presentation: 6/3/2024

The objective of this study was to determine the relationship between water and sugar-sweetened beverage (SSB) intake, health behaviors, and self-perceived health status using data from the 2019 Korea Youth Risk Behavior Web-based Survey (KYRBS). The subjects included in this analysis were 57,302 Korean adolescents from the 7th to 12th grades. The intake patterns of water and SSBs were categorized into four groups: Group I, adequate water intake (≥4 cups/day) and low frequency of SSB intake (≤1–2 times/week); Group II, adequate water intake and high frequency of SSB intake; Group III, inadequate water intake (<4 cups/day) and low frequency of SSB intake; Group IV, inadequate water intake and high frequency of SSB intake (≥3 times/week). Complex sample analyses were used for considering strata, clusters, and weights for samples. Significant differences were observed in the distribution of sociodemographic characteristics between the water and SSB intake groups. As grade levels increased or if students were female, there was a significant increase in the proportion of students characterized by low water intake and high consumption of SSB. Adolescents with healthier beverage habits, characterized by adequate water intake and low frequency of SSB consumption (Group I), generally abstained from smoking and alcohol, were more physically active, and maintained a desirable diet, reporting a better perceived health status. In contrast, those with higher SSB consumption and inadequate water intake (Group IV) were more likely to perceive their health as poor, with higher rates of smoking and alcohol use, lower physical activity levels, and poorer dietary habits compared to Group I. In conclusion, adolescents with desirable beverage consumption habits differed by sex and grade and they reported positive health behaviors and better overall health status. This suggests that there is a need for more active education and intervention in schools and families, as well as increased efforts by adolescents to promote healthy beverage habits.

PURPOSE:Assess incidence, severity, and glucose excursion outcomes in thyroid eye disease (TED) patients receiving the insulin-like growth factor-1 receptor inhibitor teprotumumab from 3 clinical trials. DESIGN:Analysis of pooled glycemic data over time. PARTICIPANTS:Eighty-four teprotumumab- and 86 placebo-treated active TED patients from the phase 2 and phase 3 (OPTIC) controlled clinical trials and 51 teprotumumab-treated patients from the OPTIC extension (OPTIC-X) trial. METHODS:Eight intravenous infusions were given over 21 weeks. Phase 2 serum glucose was measured at weeks 1, 4, 15, and 21, with fasting measurements at weeks 1 and 4. Serum glucose was measured at each study visit in OPTIC and OPTIC-X, with fasting measurements at weeks 1 and 4 (in patients without diabetes) or all visits (in patients with diabetes). In all studies, hemoglobin A1c (HbA1c) was measured at baseline, 12, and 24 weeks plus weeks 36 and 48 in OPTIC-X. MAIN OUTCOME MEASURES:Serum glucose and HbA1c. RESULTS:In the phase 2 and 3 studies, 9 hyperglycemic episodes occurred in 8 teprotumumab patients; mean HbA1c level increased 0.22% from baseline to week 24 (to 5.8%; range, 5.0%-7.9%) versus 0.04% in patients receiving the placebo (to 5.6%; range, 4.6%-8.1%). At study end, 78% (59/76) of teprotumumab patients and 87% (67/77) of patients receiving placebo had normoglycemic findings. Normoglycemia was maintained in 84% (57/68) of patients receiving teprotumumab and 93% (64/69) of patients receiving placebo. Among baseline prediabetic patients, 43% (3/7) remained prediabetic in both groups, and 29% (2/7) of teprotumumab patients and 14% (1/7) of patients receiving placebo had diabetic findings at week 24. OPTIC-X patients trended toward increased fasting glucose and HbA1c whether initially treated or retreated with teprotumumab. Fasting glucose commonly rose after 2 or 3 infusions and stabilized thereafter. Most hyperglycemic incidents occurred in patients with baseline prediabetes/diabetes but were controlled with medication. No evidence was found for progression or increased incidence of hyperglycemia with subsequent doses. CONCLUSIONS:Serious glycemic excursions are uncommon in patients with normoglycemia before teprotumumab therapy. Patients with controlled diabetes or impaired glucose tolerance can be treated safely if baseline screening, regular monitoring of glycemic control, and timely treatment of hyperglycemia are practiced. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

This report represents the conclusions of 15 experts in nephrology and endocrinology, based on their knowledge of key studies and evidence in the field, on the role of continuous glucose monitors (CGMs) in patients with diabetes and chronic kidney disease (CKD), including those receiving dialysis. The experts discussed issues related to CGM accuracy, indications, education, clinical outcomes, quality of life, research gaps, and barriers to dissemination. Three main goals of management for patients with CKD and diabetes were identified: (1) greater use of CGMs for better glycemic monitoring and management, (2) further research evaluating the accuracy, feasibility, outcomes, and potential value of CGMs in patients with end-stage kidney disease (ESKD) on hemodialysis, and (3) equitable access to CGM technology for patients with CKD. The experts also developed 15 conclusions regarding the use of CGMs in this population related to CGMs’ unique delivery of both real-time information that can guide monitoring and management of glycemia and continuous and predictive data in this population, which is at higher risk for hypoglycemia and hyperglycemia. The group noted three major clinical gaps: (1) CGMs are not routinely prescribed for patients with diabetes and CKD; (2) CGMs are not approved by the United States Food and Drug Administration (FDA) for patients with diabetes who are on dialysis; and (3) CGMs are not routinely available to all of those who need them because of structural barriers in the health care system. These gaps can be improved with greater stakeholder collaboration, education, and awareness brought to the use of CGM technology in CKD.

Aromatase inhibitors (AIs) are a cornerstone adjuvant treatment of many hormone receptor-positive breast cancers, and nearly half of women taking aromatase inhibitors suffer from AI-induced arthralgia (AIA), also known as AI-associated musculoskeletal syndrome (AIMSS), for which there are limited evidence-based treatments. Pharmacologic management and complementary methods including supplements, exercise, physical therapy, yoga, acupuncture, and massage have all shown mixed results. Comprehensive diet and lifestyle strategies are understudied in AIA/AIMSS despite their disease-modifying effects across many chronic conditions. Here we report a case of a woman with stage 2 estrogen and progesterone receptor-positive invasive ductal carcinoma on adjuvant anastrozole whose AI-induced arthralgia was durably controlled through a Mediterranean plant-forward diet and daily physical activity guided by continuous glucose monitoring. We posit that diet and a lifestyle inclusive of daily physical activity constitute a low-cost, low-risk, and potentially high-reward strategy for controlling common AI-induced musculoskeletal symptoms and that more investigation in this arena, including well-designed randomized trials, is warranted.

Introduction and Objective: Glucagon-like peptide 1 receptor agonists (GLP-1 RA) have been associated with both increased (Bezin 2023) and decreased risk (Wang 2023) of certain cancers in patients with type 2 diabetes (T2DM). We investigated the risk of developing 13 obesity-associated malignancies in patients with T2DM who received GLP-1RA compared with other anti-hyperglycemic agents except insulin. Methods: We conducted a real-world retrospective cohort study on 130 million US adults using deidentified electronic health records from Eversana Life Sciences. The study included patients with new diagnosis of T2DM and no history of malignancy who were prescribed GLP-1RA (n=30,196) within 12 months of T2DM diagnosis and propensity matched to patients on other anti-hyperglycemic agents (n=30,196) between 2010 to 2023. Outcome was incidence of 13 obesity-associated malignancies. Time-varying Cox proportional hazard model was used to compare time to event rates. Results: In patients with T2DM (56 years, 53% female, 53% White), there was a total of 1219 malignancies after a mean follow up of 2.9 years. Most common cancers were breast (388), prostate (328), and colorectal (148). GLP-1RA users had higher risk for prostate cancer (HR 1.28, 95% CI 1.03, 1.6) compared with those on other anti-hyperglycemic agents. However, E-value was small (1.2), indicating unmeasured confounders affecting outcomes. There was no increased rate of other or overall malignancies (HR 1.04, 95% CI 0.93, 1.17). Conclusion: Despite a noted increased risk for prostate cancer with GLP-1RA use, non-visible confounders limit the results. Other cancers showed no significant association with GLP-1RA use. Disclosure F.A. Ishola: None. C. Pike: None. S.H. Kim: Consultant; ALIGOS Therapeutics. Advisory Panel; GI Dynamics. Research Support; Fractyl Health, Inc. Consultant; Nutrisense.

AIM:To assess whether adults with diabetes on oral hypoglycaemic agents undergoing general endotracheal anaesthesia during nine common surgical procedures who are glucagon-like peptide-1 receptor agonist (GLP1-RA) users, compared with non-users, are at increased risk of six peri- and post-procedure complications. MATERIALS AND METHODS:A retrospective observational cohort analysis of over 130 million deidentified US adults with diabetes (defined as being on oral hypoglycaemic agents) from a nationally representative electronic health dataset between 1 January 2015 and 1 April 2023 was analysed. Cohorts were matched by high-dimensionality propensity scoring. We compared the odds of six peri- and postoperative complications in GLP1-RA users and non-users. A sensitivity analysis compared these odds in GLP1-RA users to non-users with diabetes and obesity. We measured the odds of (a) a composite outcome of postoperative decelerated gastric emptying, including antiemetic use, ileus within 7 days post-procedure, gastroparesis diagnosis, gastric emptying study; (b) postoperative aspiration or pneumonitis; (c) severe respiratory failure; (d) postoperative hypoglycaemia; (e) inpatient mortality; and (f) 30-day mortality. RESULTS:Among 13 361 adults with diabetes, 16.5% were treated with a GLP1-RA. In the high-dimensionality propensity score-matched cohort, GLP1-RA users had a lower risk of peri- and postoperative complications for decelerated gastric emptying and antiemetic use compared with non-users. The risk of ileus within 7 days, aspiration/pneumonitis, hypoglycaemia and 30-day mortality were not different. A sensitivity analysis showed similar findings in patients with diabetes and obesity. CONCLUSION:No increased risk of peri- and postoperative complications in GLP1-RA users undergoing surgery with general endotracheal anaesthesia was identified.