Monthly endocrinology and diabetes bulletin — October 10, 2026

This issue covers what was published, presented, or approved between September 28 and October 10, 2026. It was dominated by the EASD meeting in Milan (September 28 to October 2), with simultaneous publications in NEJM, The Lancet, The Lancet Diabetes & Endocrinology, and The Lancet Regional Health – Americas on drugs and lifestyle interventions in diabetes and obesity; there is also a Korean approval of a domestically developed GLP-1 and an FDA thyroid approval. Ten items.

Type 1 and type 2 diabetes

1. Survodutide (glucagon/GLP-1 dual agonist): up to 13.1% weight loss in obesity with type 2 diabetes (SYNCHRONIZE-2)

[Clinical trial] [International / Germany]
Published in NEJM on October 1 and presented that day at EASD: phase 3, double-blind, placebo-controlled trial (NCT06066528) of 755 adults with obesity or overweight and type 2 diabetes (baseline HbA1c 7.4%), randomized to weekly survodutide 3.6 or 6.0 mg for 76 weeks. Under the efficacy estimand (assumes full adherence), weight loss was up to 13.1% vs 3.1% with placebo; up to 79.3% lost ≥5% (vs 32.7%). Under the treatment-regimen estimand, weight loss was 8.2% (3.6 mg) and 9.8% (6.0 mg) vs 3.9% with placebo. HbA1c fell by up to 1.21 points (placebo 0.03) and up to 29.5% reached HbA1c <5.7% (placebo 4.0%). According to the company release, discontinuation for GI events was 18% vs 1.2%, mostly during dose escalation.
Why it matters: the most quoted figure (13.1%) is the efficacy estimand; under the treatment-regimen estimand, weight loss with the high dose is 9.8%. GI discontinuation is high. Funded by Boehringer Ingelheim; no active comparator and not available in the region.
https://doi.org/10.1056/NEJMoa2607219
https://www.ajmc.com/view/dual-agonist-survodutide-delivers-up-to-13-1-weight-loss-in-t2d
https://www.biopharminternational.com/view/survodutide-weight-loss-synchronize-obesity-type-2-diabetes

2. Oral orforglipron noninferior to glargine for cardiovascular events (ACHIEVE-4)

[Clinical trial] [International / United States]
Published in The Lancet on September 30 and presented at EASD: phase 3, randomized, open-label, event-driven noninferiority trial (margin 1.8) of 2,749 adults with type 2 diabetes, BMI ≥25, and increased cardiovascular risk (established cardiovascular or kidney disease), comparing once-daily orforglipron with titrated insulin glargine. Four-point MACE: 4.2% vs 5.0%, HR 0.84 (95% CI 0.59-1.20), noninferiority met; three-point MACE: HR 0.77 (95% CI 0.52-1.13), superiority not shown. At 52 weeks, an additional −0.50 points in HbA1c and −8.9% in weight vs glargine. Deaths 1.4% vs 3.2% (not controlled for multiplicity). According to Pharmacy Times coverage, discontinuation for adverse events was about 15.4% vs 5.4%.
Why it matters: this is a safety trial, not a benefit trial; the 1.8 margin is wide, the design open-label, and the insulin comparator favors the drug on weight. The mortality signal is exploratory. Funded by Lilly; orforglipron (Foundayo) is already approved in the US for obesity.
https://doi.org/10.1016/S0140-6736(26)01865-9
https://www.pharmacytimes.com/view/orforglipron-shows-cv-safety-vs-insulin-glargine-in-achieve-4
https://investor.lilly.com/node/54996

3. Eloralintide + tirzepatide: up to 23.3% weight loss in type 2 diabetes (phase 2b)

[Congress] [United States / Argentina]
Presented at EASD (company release dated September 30; lead author Liana K. Billings): 48-week, randomized, double-blind, placebo-controlled phase 2b trial (NCT06603571) of 367 adults with obesity or overweight and type 2 diabetes (baseline weight 105.4 kg; HbA1c 8.1%), enrolled in the US and Argentina. The combination of the amylin agonist eloralintide with tirzepatide produced 13.2% to 23.3% weight loss (efficacy estimand) depending on dose, vs 14.8% with tirzepatide 15 mg and 3.0% with placebo; HbA1c −2.2 to −2.9 points (tirzepatide −2.4). Discontinuation for adverse events: 10.8% to 27.0% with the combination, 2.9% with tirzepatide, and 16.7% with placebo.
Why it matters: the primary endpoint was vs placebo only; the comparison with tirzepatide is secondary, and discontinuation for adverse events was higher with the combination than with tirzepatide alone. Company data, not yet peer reviewed; the company plans to start phase 3 by the end of 2026.
https://investor.lilly.com/node/54991
https://www.hcplive.com/view/easd-2026-eloratzp-bests-tirzepatide-on-weight-loss-a1c-in-type-2-diabetes

4. Responding to smart-pen alerts is associated with more time in range in type 1 diabetes

[Congress] [United States / International]
Presented at EASD (MiniMed release dated October 5): in a six-month randomized trial of 143 people with type 1 diabetes and HbA1c >8% comparing MiniMed's Smart MDI system (pen connected to CGM) with multiple daily injections plus CGM, Smart MDI met its noninferiority primary endpoint. In an analysis by responder status, those who responded more often to missed-dose and high-glucose alerts had 8.1 percentage points more time in range and 0.6 points lower HbA1c than less frequent responders. According to the release, a real-world analysis showed a 9.4-point difference in time in range.
Why it matters: the responder analysis is not a randomized comparison, so it conflates adherence with the effect of the technology (the release itself urges caution in extrapolating); the practical message (teach patients to act on alerts) is reasonable for those already using smart pens with CGM, who are few in the Dominican Republic. Presented by the manufacturer.
https://news.minimed.com/2026-10-05-Responding-more-frequently-to-MiniMed-Smart-MDI-alerts-linked-to-better-glucose-outcomes-for-people-with-diabetes

5. Remission of early-onset type 2 diabetes with a low-energy diet and supervised exercise (RESET for Remission)

[Clinical trial] [Canada / England]
Presented at EASD and published simultaneously in The Lancet Regional Health – Americas: randomized, open-label, blinded-endpoint trial at three sites (Leicester, Montreal, and Edmonton) in 96 adults with early-onset type 2 diabetes (50 intervention, 46 usual care). The intervention (800-900 kcal/day for 12 weeks with twice-weekly supervised aerobic and resistance exercise, then maintenance to week 24) achieved remission (HbA1c <6.5% off medication for at least 12 weeks) in 54% (27/50) vs 4% (2/46) with usual care.
Why it matters: the effect is large and the intervention does not depend on expensive drugs, making it transferable to our setting; but the trial is small, lasted 24 weeks, and the durability of remission is unknown.
https://medicaldialogues.in/diabetes-endocrinology/news/low-energy-diet-plus-supervised-exercise-tied-to-early-onset-type-2-diabetes-remission-lancet-180698

Obesity and metabolism

6. Retatrutide in obesity with type 2 diabetes: full TRIUMPH-2 publication

[Clinical trial] [International / United States]
Presented at EASD and published online in The Lancet on September 29, the TRIUMPH-2 trial (NCT05929079): phase 3, double-blind, 80 weeks, 1,152 adults with BMI ≥27 and type 2 diabetes (baseline BMI 38.2; HbA1c 7.71%) at 92 sites in 8 countries. Under the treatment-regimen estimand, weight loss was 11.9%, 16.8%, and 18.8% with 4, 9, and 12 mg vs 5.1% with placebo (20.8% with 12 mg under the efficacy estimand). HbA1c −1.4 to −1.6 points. With 12 mg vs placebo: nausea 28% vs 8%, diarrhea 34% vs 13%, hypotension 6% vs <1%, and dysesthesia 7% vs 1%; discontinuation for adverse events or death 4-12% vs 5%.
Why it matters: peer review confirms the results previously announced by the company, but the 18.8% (treatment-regimen) figure should be cited rather than 20.8%. Dysesthesia and hypotension are signals to watch. Funded by Lilly; FDA submission planned for Q1 2027.
https://investor.lilly.com/node/54981
https://www.pharmacytimes.com/view/retatrutide-cuts-weight-up-to-18-8-in-adults-with-t2d-obesity

7. Korea approves efpeglenatide, its first domestically developed GLP-1 for obesity

[Regulatory MFDS] [South Korea]
Korea's Ministry of Food and Drug Safety (MFDS) announced on October 7 the approval of efpeglenatide (weekly autoinjector, Hanmi Pharmaceutical; 2, 4, 6, 8, and 10 mg) for chronic weight management in adults with obesity or overweight without diabetes, as an adjunct to diet and exercise. According to Korean pharmaceutical press, the basis is a phase 3 trial in 448 Korean adults: mean weight loss of 9.75% at 40 weeks (interim result) and about 80% of participants losing ≥5%. The application was filed in December 2025 and review took less than a year. (Sources in Korean.)
Why it matters: efficacy is modest compared with semaglutide or tirzepatide, the data are interim and exclusively Korean, and press reports do not detail the placebo arm; its relevance for the region is as one more competitor that could pressure prices.
https://dailypharm.com/user/news/343190
https://news.mtn.co.kr/news-detail/2026100717235113087

8. Petrelintide, a weekly amylin analog: up to 10.7% weight loss at 42 weeks with mild GI effects (ZUPREME-1)

[Publication] [Poland / Romania / United States]
The Lancet Diabetes & Endocrinology published online on September 29 (presented at EASD) the phase 2 ZUPREME-1 trial: 5:1 randomized, double-blind, placebo-controlled, 493 adults with overweight or obesity without type 2 diabetes (485 received at least one dose) at 32 sites, five maintenance doses (1.0 to 9.0 mg) plus lifestyle counseling. At week 28 (primary endpoint), weight loss was 7.9% to 9.8% vs 1.7% with placebo; at week 42 (exploratory), 8.7% to 10.7%. Nausea 20% vs 6% (80% mild); only 1% discontinued for GI events.
Why it matters: the advantage is tolerability, not magnitude, which falls short of incretin agonists; its likely place is in combination or for patients who do not tolerate GLP-1s. Phase 2; a Zealand Pharma drug developed with Roche.
https://www.pharmacytimes.com/view/petrelintide-yields-up-to-10-7-weight-loss-with-mild-gi-effects
https://www.emjreviews.com/?p=525552

Thyroid, adrenal, and pituitary

9. FDA approves tiratricol (Emcitate), the first US-approved treatment for MCT8 deficiency

[Regulatory FDA] [United States / Sweden]
On September 28 the FDA approved tiratricol (Egetis Therapeutics), a thyroid hormone analog given as tablets for oral suspension (once daily or in two to three divided doses), for peripheral thyrotoxicosis in MCT8 transporter deficiency (Allan-Herndon-Dudley syndrome), in adults and children. According to the label, approval rested on a study with a 30-day randomized, double-blind withdrawal period (NCT05579327; 20 enrolled, 15 randomized), in which T3 rose on placebo and remained stable on tiratricol, and on a 12-month single-arm open-label study (46 patients) showing reductions in total T3, heart rate (−8.9 bpm), and systolic blood pressure (−4.1 mmHg). Warning: the drug cross-reacts with T3 immunoassays, producing falsely elevated values; it is not recommended for primary hypothyroidism.
Why it matters: this is an ultra-rare X-linked disease, but the T3 assay interference is practical information for any laboratory; treatment corrects peripheral thyrotoxicosis, not neurological damage.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/220963s000lbl.pdf
https://www.placera.se/pressmeddelanden/egetis-therapeutics-egetis-therapeutics-announces-u-s-fda-approval-of-emcitate-tiratricol-for-patients-with-mct8-deficiency-20260928

Bone and reproductive endocrinology

No items in this issue. The ASBMR annual meeting is being held in Boston, October 9-12, and its results will appear in the next issue.

Cross-cutting

10. CGM and artificial intelligence at EASD 2026: tight range and voice-based screening

[Congress] [International]
Two EASD abstracts (September 28 to October 2) stand out: an analysis of nearly 100,000 people with normal glucose or prediabetes using CGM found that time in tight range (70-140 mg/dL) predicts HbA1c better than standard time in range (70-180 mg/dL) and flags abnormalities in people with normal HbA1c; and an AI model analyzing 20 seconds of voice identified about 8 in 10 people with diabetes-range HbA1c but wrongly flagged nearly half of those below the threshold (evaluation in 801 UK participants).
Why it matters: tight range is an association finding that still needs to show clinical utility in people without diabetes; with that false-positive rate, the voice tool is not ready for population screening. Congress abstracts without full publication.
https://diatribe.org/diabetes-research/top-diabetes-news-easd-2026
https://www.news-medical.net/news/20260929/Short-voice-recordings-could-screen-patients-for-type-2-diabetes.aspx

Upcoming meetings and dates

ASBMR 2026, annual meeting of the American Society for Bone and Mineral Research, Boston, October 9-12 (ongoing). ATA 2026, annual meeting of the American Thyroid Association, Philadelphia, November 4-7. World Diabetes Day, November 14.

Monthly endocrinology and diabetes bulletin — October 10, 2026
10 verified items from September 28 to October 10: NEJM, The Lancet, The Lancet Diabetes & Endocrinology, Lancet Regional Health – Americas, FDA, and Korea's MFDS, plus EASD 2026.
Three worth your time:
• Survodutide in obesity with type 2 diabetes (SYNCHRONIZE-2, NEJM, n=755): up to −13.1% weight (efficacy estimand; −9.8% under the treatment-regimen estimand) and −1.21 points HbA1c at 76 weeks; 18% stopped for GI events.
• Oral orforglipron was noninferior to glargine for cardiovascular events (ACHIEVE-4, Lancet, n=2,749): HR 0.84 (0.59-1.20); open-label with a wide margin.
• A low-energy diet plus supervised exercise achieved 54% vs 4% remission in early-onset type 2 diabetes (RESET, n=96); small and only 24 weeks.
Full bulletin, with a critical appraisal of each study and links to sources:
https://boletinesmedicos.com/en/endocrinologia/2026-10-10.html
#Endocrinology #Diabetes #Obesity #EASD2026

Endocrinology, Oct 2026: survodutide up to −13.1% weight in T2D (NEJM, n=755) and oral orforglipron noninferior to glargine for CV events, HR 0.84 (Lancet). Critical appraisal:
https://boletinesmedicos.com/en/endocrinologia/2026-10-10.html