Diabetes Core Update – February 2026

Podcast: Diabetes Core Update
Episode Date: January 28, 2026
Hosts: Dr. Neil Skolnik and Dr. John J. Russell
Theme: In this episode, Neil and John review the latest clinically relevant studies from ADA journals and related literature. This month's focus includes new insights on semaglutide’s cardiovascular benefits, its effects on kidney health, research into water versus artificially sweetened beverages in T2DM, and a historical and scientific look at carbohydrate-restricted diets and their impact on cardiovascular and body composition outcomes.

1. Semaglutide & Cardiovascular Outcomes by Adiposity (SELECT Trial)

Source: The Lancet
Segment Start: 00:02

Key Discussion Points

• Overview: SELECT trial analyzed semaglutide (2.4mg weekly) versus placebo in 17,000+ patients with overweight/obesity and established ASCVD, focusing on cardiovascular event (MACE) rates in relation to adiposity measures (body weight, waist circumference).
• Findings:
  • Semaglutide significantly reduced MACE incidence compared to placebo across all baseline weight and waist circumference categories.
  • Linear trends: lower baseline weight and waist circumference linked to lower MACE risk. In the semaglutide group, each 5kg lower bodyweight or 5cm smaller waist → 4% less risk (HR 0.96).
  • Notably: A third (33%) of cardiac benefits were mediated specifically by reductions in waist circumference (marker of visceral fat) rather than overall weight loss.
  • Waist circumference reductions at 20 and 104 weeks correlated with reduced MACE. Weight loss did not show the same trend.
  • Paradoxically, weight loss at 20 weeks associated with increased MACE risk in the semaglutide group, underscoring complexity.

Expert Insights

• Dr. Skolnik:

  "Now, the presumption at the time, or the question at the time was, 'Was that entirely related to weight loss?'…this trial shows...about 30% of the decrease in cardiac outcomes could be attributable to weight loss, primarily to a decrease in waist circumference, which reflects visceral fat, which is most closely tied to cardiac outcomes. But…there’s something else going on." (03:52)

• Other pleiotropic benefits discussed: semaglutide also lowers LDL, triglycerides, and blood pressure—effects likely contributing to risk reduction.

Clinical Practice Takeaway

• GLP-1 agonists, specifically semaglutide, should be considered in patients with overweight/obesity and ASCVD to reduce future MACE risk.
• The benefits extend beyond what can be explained by weight loss alone, emphasizing the role of visceral adiposity and other mechanisms.

2. Impact of Oral Semaglutide on Kidney Outcomes in T2DM (SOLE Trial)

Source: Diabetes Care
Segment Start: 06:50

Key Discussion Points

• Trial Design: SOLE was a double-blind RCT comparing oral semaglutide with placebo in 9,600+ adults with T2DM and established ASCVD/CKD.
• Kidney Outcomes: Pre-specified composite renal outcomes (5- and 4-point) included significant drops in GFR, dialysis initiation, and (for 5-point) CVD/kidney death.
• Results:
  • No significant reduction in progression to major kidney events for semaglutide vs placebo (both 5- and 4-point composites).
  • However: Semaglutide led to a slower annual decline in eGFR compared to placebo (p<0.0001).

Expert Insights

• Dr. Russell:

  "I think if you're gonna look at what is gonna play out in primary care offices over the next 20 years, we're gonna spend a lot of our time…trying to prevent the progression of kidney disease…this deserves its own study to really say is this one of the bullets we're going to have in our gun to decrease the progression? The injectable semaglutide has that indication. But...I would not reach for this medicine right now to say this is going to protect your kidneys." (08:24-09:53)

Clinical Practice Takeaway

• Oral semaglutide slows eGFR decline but does not (yet) have proven effect on major kidney endpoints for T2DM. Injectable form has the indication, but evidence here is preliminary for oral semaglutide.

3. Substituting Water for Artificially Sweetened Beverages (SODAS Trial)

Source: Diabetes Care
Segment Start: 09:53

Key Discussion Points

• Trial: The 24-week SODAS trial compared replacing artificially sweetened beverages with water in 181 adults with T2DM who regularly consumed these beverages.
• Primary Outcome: Change in HbA1c.
• Findings:
  • At 24 weeks, the mean difference in A1C (0.29%) actually favored the artificially sweetened beverage group over water—statistically significant but small and of uncertain clinical impact.
  • No significant differences in secondary measures: fructosamine, fasting glucose, insulin, body weight, CGM data.

Expert Insights

• Dr. Skolnik:

  “There has been so much research and so much controversy with regard to artificially sweetened beverages...this trial looked at that question in a different way, in a prospective randomized way, and said, hey, let's substitute...And what they found was there's essentially...not much difference. I think the important take home point is that there isn't a downside here of an artificially sweetened beverage. And this is consistent with other trials.” (11:39-13:48)

• Dr. Skolnik jokes with Dr. Russell’s fondness for “that cherry Coke Zero.”

• Extends to meta-analysis evidence: Prospective studies show artificially sweetened (AS) beverages are better than sugar-sweetened, and essentially on par with water for glycemic and anthropometric outcomes.

Clinical Practice Takeaway

• For patients with T2DM, consuming diet sodas in place of sugar-sweetened beverages is a reasonable option—and similar to water in metabolic impact.

4. Carbohydrate-Restricted Diets and Cardiovascular/Body Composition Outcomes (Meta-analysis)

Source: American Journal of Clinical Nutrition
Segment Start: 14:12

Key Discussion Points

• Meta-analysis: Pooled 174 RCTs (11,000+ participants) across different degrees of carb restriction (ketogenic, low-carb, moderate-carb, and higher-carb).
• Findings:
  • Low-carb diets reduced triglycerides (~15 mg/dL), systolic BP (2 mmHg), diastolic BP (~1.25 mmHg), C-reactive protein.
  • Slight increases in HDL (~3 mg/dL).
  • Modest increases in LDL/total cholesterol (~4 mg/dL).
  • All body composition markers improved (weight, fat mass).
  • Moderate-carb diets: Most balanced profile.
  • Ketogenic diets: Greater short-term weight loss but also greater LDL increase.

Historical Perspective—Notable Moment

Dr. Russell provides an entertaining and educational mini-history of low-carb dieting:

• From Banting’s “Letter on Corpulence” (1863) to seizure treatment in the 1920s, the Inuit diet, the DuPont executive experiment, to Atkins’ 1972 best-seller.

  “If you and I walk by the coffee machine in our office, the stuff that people bring in...tends to be a lot of carbohydrates. No one's bringing in bologna...But certainly, it's had some efficacy.” (19:00)

• Food for thought on the changing landscape of diet, portion sizes, and American eating habits.

Clinical Practice Takeaway

• Carb restriction is a viable dietary strategy for weight loss (especially short term) and lipid/triglyceride improvement.
• Patients should be counseled that moderation—and likely not “zero carb”—is best, especially as moderate-carb diets yielded the most favorable all-around metrics.
• Consider gender-specific CV risk nuance (e.g., triglycerides as more impactful for women).
• Emphasize increased protein, more vegetables, and rational portion control, reflecting both new evidence and evolving guidelines.

  “Maybe we can avoid that sweetened soda as we heard about earlier. Maybe we could split a fry with the family...But, you know, maybe we could put a lot more vegetables on our plates. Maybe we could have some lean pieces of protein.” (23:57)

Notable Quotes & Memorable Moments

• On Semaglutide’s pleiotropic effects:
  "But the other study...suggests there’s another pleiotrophic effect going on... MACE began to be lowered temporally before there was significant weight loss." — Dr. Skolnik, 04:36

• On low-carb diet history:
  “The term banting was synonymous with diet, going on a diet, dieting was banting. And…that lived for about 60 years…” — Dr. Russell, 17:05

• On clinical practicality:
  “Having a little bit of moderation in everything makes some sense. But we do need protein, and having some lean sources of protein, possibly at every meal, especially as you and I get older, might make a whole lot of sense.” — Dr. Russell, 25:15

Timestamps for Key Segments

• [00:02] – Episode overview, article lineup
• [01:27] – Semaglutide, adiposity, and cardiovascular outcomes (SELECT/Lancet)
• [06:50] – Oral semaglutide & kidney outcomes (SOLE/Diabetes Care)
• [09:53] – Water vs artificially sweetened beverages in T2DM (SODAS)
• [14:12] – Carbohydrate-restricted diets: Evidence & history (AJCN meta-analysis)
• [17:05] – Dieting history (Banting, Atkins, DuPont, etc.)
• [23:57] – Dietary takeaways & practice pearls

For references to all discussed articles, visit: www.diabetesjournals.org

Summary prepared for busy clinicians who seek to apply the latest ADA journal evidence in patient care.