Browse the evidence

Network meta-analyses (NMA) provide superior clinical utility for diabetes management compared to standard pairwise meta-analyses by simultaneously comparing multiple treatments using both direct and indirect evidence.

When choosing between multiple diabetes medications (like SGLT-2 inhibitors, GLP-1 RAs, or finerenone), rely on Network Meta-Analyses (NMA) rather than single-trial results. NMAs allow you to compare all options simultaneously against standard care, revealing which drugs best reduce specific risks like heart failure or kidney disease for your patient's specific profile.

SGLT-2 inhibitors and GLP-1 receptor agonists significantly reduce major adverse cardiovascular events (MACE) and end-stage kidney disease (ESKD) in Type 2 Diabetes patients, with SGLT-2i showing specific superiority for kidney outcomes.

For Type 2 Diabetes patients with heart or kidney risks, prioritize SGLT-2 inhibitors or GLP-1 RAs. These drugs do more than lower blood sugar; they significantly reduce the risk of heart attacks, heart failure hospitalizations, and kidney failure. SGLT-2 inhibitors are particularly strong for protecting the kidneys.

Semaglutide improves cardiovascular outcomes, including reducing the risk of major adverse cardiovascular events (MACE), in patients with type 2 diabetes.

If you have type 2 diabetes and heart disease, kidney disease, or heart failure, ask your doctor about adding a GLP-1 RA like semaglutide. It can significantly lower your risk of heart attack, stroke, and heart failure, even if your blood sugar is already well-controlled.

Genetically modeled GLP-1 and GIP receptor agonism reduces fatty food liking and increases vegetarian food liking.

Genetic evidence suggests that activating GLP-1 and GIP receptors shifts food preferences away from fatty foods and towards vegetarian options. This change in food preference may contribute to the observed reduction in binge drinking.

Tirzepatide treatment (10 mg or 15 mg once weekly for 72 weeks) significantly improves self-reported health-related quality of life (HRQoL) in adults with obesity or overweight and type 2 diabetes, specifically in physical functioning, bodily pain, general health, vitality, and social functioning.

If you have type 2 diabetes and are overweight or obese, treatment with tirzepatide (Mounjaro/Zepbound) can significantly improve your daily quality of life. This includes feeling less pain, having more energy, and being more socially active. The improvements are seen in both physical and mental well-being, and they are greater for those who lose more weight. Talk to your doctor about whether this once-weekly injection is right for you, especially if you are struggling with physical limitations due to your weight.

Glucagon regulates glucose and amino acid homeostasis and counters hypoglycemia.

Glucagon is a natural hormone that helps keep your blood sugar and amino acid levels stable. It acts as a counter-regulatory mechanism to prevent hypoglycemia, making it essential for metabolic balance.

Lifestyle interventions (caloric restriction and exercise) are the foundation of MASLD treatment but often fail to achieve sufficient or sustained weight loss, necessitating pharmaceutical intervention.

Start with lifestyle changes: eat less and move more. This is the foundation of treating fatty liver. However, be realistic: it is very hard to maintain these changes long-term, and many people struggle to lose enough weight. If lifestyle changes are not enough, talk to your doctor about adding medications like GLP-1RAs or SGLT2-is, which can help you achieve the weight loss needed to improve your liver health.

GLP-1 receptor agonists (GLP-1RAs) such as liraglutide and semaglutide significantly reduce major adverse cardiovascular events (MACE) in patients with type 2 diabetes at high cardiovascular risk.

If you have Type 2 Diabetes and are at high risk for heart problems, ask your doctor about GLP-1 RAs like liraglutide or semaglutide. These drugs not only help control blood sugar but have been proven in major studies to significantly lower your risk of heart attack, stroke, and cardiovascular death. The benefits extend beyond glucose control to direct heart protection.

Obesity is a chronic disease driven by dysfunctional adipose tissue and dysregulated energy homeostasis, requiring medical treatment rather than solely lifestyle changes.

Obesity is a medical condition, not a moral failing. If you have obesity, you need medical treatment, not just willpower. Seek a doctor who understands this and offers evidence-based therapies.

Naltrexone/bupropion combination therapy produces moderate weight loss (up to 6.1% vs placebo) and improves metabolic markers, but carries risks of seizures and psychiatric side effects.

This medication can help you lose weight by affecting brain chemicals that control hunger. It is taken twice daily and must be started at a low dose to avoid side effects like nausea, constipation, or headaches. It is not suitable for people with a history of seizures, eating disorders, or heart problems. You must stop the medication if you do not lose at least 5% of your body weight after 12 weeks.

Current clinical guidelines recommend continuing GLP-1 receptor agonists for most patients undergoing elective surgery, shifting away from routine preoperative cessation.

Do not stop your GLP-1 medication before surgery unless your surgeon or anesthesiologist explicitly tells you to. Most modern guidelines now say you should keep taking it, and you should discuss your specific risk factors with them.

Metformin is the first-line pharmacological treatment for T2DM and prediabetes, offering significant reduction in microvascular complications and diabetes-related deaths through mechanisms including inhibition of hepatic gluconeogenesis and increased insulin sensitivity.

Metformin is the standard first-line drug for T2DM and prediabetes. It reduces complications and deaths. If you experience stomach upset, ask your doctor about slow-release versions or slow titration to manage side effects.

SGLT2 receptor inhibitors (SGLT2R-i) provide significant cardiovascular and renal benefits, including reduced cardiovascular mortality and heart failure hospitalization, in addition to glycaemic control, by preventing glucose reabsorption in the kidneys.

SGLT2 inhibitors (like empagliflozin or dapagliflozin) are powerful drugs for T2DM patients with heart or kidney risks. They significantly reduce heart failure hospitalizations and mortality. Maintain good hygiene to minimize the risk of genital infections.

Interval training (IT) and moderate intensity continuous training (MICT) produce equivalent changes in whole-body fat mass and lean mass when compared directly.

You do not need to train at high intensities to lose fat or build muscle. Moderate intensity continuous training (MICT) is just as effective as interval training (IT) for changing body composition. Choose the intensity you can sustain consistently, as the physiological outcome regarding fat and lean mass is essentially the same.

Obesity acts as an independent risk factor and driver for cardiovascular diseases through mechanisms including insulin resistance, endothelial dysfunction, systemic inflammation, and neurohormonal activation, leading to hypertension, heart failure, coronary artery disease, and stroke.

High body weight is a major biological driver of heart disease, not just a cosmetic issue. Addressing it requires medical and public health strategies, not just willpower, because it triggers harmful biological changes like inflammation and high blood pressure.

GLP-1 receptor agonists (e.g., semaglutide) and dual agonists (e.g., tirzepatide) are effective pharmacotherapies for obesity, achieving 10-20% mean body weight reduction, but their use is limited by stigma, regulatory barriers, and lack of insurance coverage.

If you have obesity, ask your doctor about GLP-1 receptor agonists (like semaglutide) or dual agonists (like tirzepatide). These are proven to help with significant weight loss. If insurance doesn't cover them, advocate for policy changes or look for patient assistance programs.

GLP-1 receptor agonists (GLP-1RAs) induce weight loss primarily through central nervous system (CNS) mechanisms, specifically by acting on GLP-1 receptors in the dorsal vagal complex (NTS and area postrema) and hypothalamic nuclei, rather than through peripheral signaling alone.

GLP-1 medications like semaglutide work by signaling to your brain to reduce hunger and food intake, not just by slowing digestion. Understanding this brain-gut connection helps explain why these drugs are effective for weight loss and why side effects like nausea occur via specific brain pathways.

For patients with Class II obesity (BMI 35-39.9 kg/m2), tirzepatide is significantly superior to other medications and endoscopic procedures, but its weight loss efficacy is inferior to major surgeries like Roux-en-Y gastric bypass (RYGB) and One-Anastomosis Gastric Bypass (OAGB).

If you have Class II obesity (BMI 35-39.9), surgery (like gastric bypass) will likely help you lose more weight than medication. However, if you are not ready for or cannot undergo surgery, newer medications like tirzepatide are still significantly more effective than other non-surgical options, though they will not achieve the same level of weight loss as surgery.

Higher BMI is associated with increased all-cause mortality in a J-shaped curve, with the lowest mortality risk occurring at a BMI of 20-25 kg/m2 for never-smokers without chronic disease, and increased risk for BMI > 25 kg/m2.

Maintain a BMI between 20 and 25 kg/m2 to minimize your risk of death. If you are a smoker or have a chronic disease, your optimal BMI might be slightly higher, but for the general healthy population, staying in this range is the safest bet for longevity.

Once-weekly subcutaneous semaglutide at 2.4 mg significantly improves heart failure symptoms, exercise capacity, and quality of life in patients with heart failure with preserved ejection fraction (HFpEF) and obesity, independent of weight loss mechanisms.

For patients with HFpEF and obesity, once-weekly semaglutide (2.4 mg) significantly improves heart failure symptoms, exercise capacity, and quality of life. This treatment addresses a major unmet need in this population, offering benefits beyond weight loss alone. Patients should discuss this option with their healthcare provider, considering the potential for gastrointestinal side effects and the significant clinical improvements observed.

Intensive glycemic control (targeting HbA1c ≤ 7%) significantly reduces cardiovascular events and microvascular complications in patients with Type 1 Diabetes.

If you have Type 1 Diabetes, keeping your blood sugar as close to normal as possible (targeting an A1c around 7%) is proven to significantly lower your risk of heart disease and kidney/eye damage over the long term.

Statins significantly reduce cardiovascular events, all-cause mortality, and stroke in patients with Type 2 Diabetes, regardless of baseline cholesterol levels.

If you have Type 2 Diabetes, taking a statin (like atorvastatin) is a highly effective way to prevent heart attacks, strokes, and early death, even if your cholesterol numbers aren't extremely high.

Lower grip strength is significantly associated with higher risks of all-cause mortality, cardiovascular disease mortality, respiratory disease mortality, and mortality from specific cancers (colorectal, lung, breast), independent of traditional risk factors.

Measure your grip strength regularly using a dynamometer. If your score is low (below sex-specific thresholds, e.g., <26 kg for men, <16 kg for women), it is a strong signal to review your overall health, including cardiovascular and metabolic markers, even if you feel healthy. Focus on building strength through resistance training, as higher grip strength is linked to lower mortality risk.

The association between lower grip strength and adverse health outcomes is stronger in younger age groups compared to older age groups.

If you are under 55 and have low grip strength, do not dismiss it as 'just being weak.' The risk associated with low strength is actually higher for you than for older adults. Prioritize strength training and medical check-ups.