Diabetes Core Update – January 2026

Podcast by the American Diabetes Association | Hosts: Dr. Neil Skolnick & Dr. John J. Russell
Episode Date: January 5, 2026 | Duration: ~26 min

Episode Overview

The January 2026 episode of Diabetes Core Update delivers concise, clinically oriented discussions of six newly published studies from leading medical journals, addressing advances and impactful findings in diabetes care. The hosts, Dr. Neil Skolnick and Dr. John Russell, parse through the latest research on LDL lowering in high-risk patients, SGLT2 inhibitors for kidney and frailty outcomes, tirzepatide in type 1 diabetes, and an innovative approach to hypoglycemia detection via voice analysis. Their aim is to equip frontline clinicians with actionable insights for day-to-day patient care.

Key Discussion Points & Insights

1. PCSK9 Inhibition (Evolocumab) in High-Risk Patients Without Prior MI/Stroke

Study Source: New England Journal of Medicine
Segment Start: 01:58

• Study Design:

  • Large, double-blind, randomized placebo-controlled trial of evolocumab (PCSK9 inhibitor) in high-risk patients (LDL ≥90 mg/dL) with atherosclerosis or diabetes but without prior MI or stroke (N=12,000+).
  • Participants: Median age 66, 43% women, 93% white; median follow-up 4.6 years.

• Primary Endpoints:

  • 3-point MACE (coronary heart disease death, MI, or ischemic stroke).
  • 4-point MACE (MACE plus ischemic-driven arterial revascularization).

• Results:

  • 3-point MACE: 6.2% (evolocumab) vs 8% (placebo); Hazard Ratio (HR) 0.75.
  • 4-point MACE: 13% vs 16.2%; HR 0.81.
  • No significant differences in safety events.

• Clinical Takeaways:

  • First evidence supporting PCSK9 use in primary prevention for high-risk groups without prior MI/stroke.
  • Observed a 20% reduction in all-cause mortality, though this is considered hypothesis-generating (statistical hierarchy issue).

• Quote:

  • “I think we are way underutilizing PCSK9s and this trial is going to be important in putting that to the forefront...establishing the evidence base to treat more people with PCSK9s who don’t have LDLs below those low goals.”
    — Dr. Neil Skolnick (04:52)

2. SGLT2 Inhibitors for CKD Progression by eGFR & Albuminuria

Study Source: JAMA (Meta-Analysis, Cardiorenal Trialist Consortium)
Segment Start: 06:00

• Summary:

  • Meta-analysis of 10 RCTs (N=70,000) assessing SGLT2i effects across a spectrum of eGFR and albuminuria levels, including patients with/without diabetes or heart failure.

• Key Findings:

  • SGLT2i reduced CKD progression risk by ~40% (HR 0.56), regardless of baseline eGFR or albuminuria.
  • Consistent reduction in annual eGFR decline across all subgroups.
  • Reduced risk of kidney failure and progression for patients, including those without overt albuminuria.

• Relevance to Guidelines & Access:

  • Contrasts with 2024 KDIGO guidelines that are cautious about SGLT2i use in non-albuminuric CKD.
  • With dapagliflozin becoming generic and others soon, cost barriers are falling.

• Quote:

  • “The takeaway from this study is in every instance that someone has CKD attached to them as a diagnosis … they would recommend that people get put on an SGLT2.”
    — Dr. John Russell (09:35)

3. SGLT2 Inhibitors & GLP-1 Receptor Agonists on Frailty in Older Adults with T2D

Study Source: Diabetes Care
Segment Start: 11:37

• Study Approach:

  • Retrospective cohort from Medicare: compared new users of DPP-4, GLP-1, SGLT2, and sulfonylureas regarding one-year frailty progression (claims-based frailty index).

• Key Results:

  • Significant reduction in frailty progression for GLP-1 users (mean Δ: -0.011) and SGLT2 users (-0.005) vs DPP-4s.
  • No effect for sulfonylureas; CV safety events only minimally contributed to outcome differences.

• Clinical Reassurance:

  • GLP-1s and SGLT2s are not only safe in older adults but may slow frailty development—addressing a key geriatric concern.
  • Mechanism remains speculative but effect is clinically meaningful.

• Quote:

  • “This trial just nails it in saying, yes, I can feel comfortable in using these two classes of medicines in my older adults without worry about inducing frailty.”
    — Dr. Neal Skolnick (13:48)

4. SGLT2 Inhibitor Outcomes by Diabetes Status and Albuminuria Level

Study Source: JAMA (meta-analysis, companion to previous SGLT2 study)
Segment Start: 15:58

• Analysis:

  • 8 RCTs, 58k+ participants, reviewing SGLT2i vs placebo stratified by diabetes status and urine albumin-to-creatinine ratio (UACR ≥/< 200).

• Findings:

  • SGLT2i lower kidney disease progression (HR 0.65 with DM; 0.74 without), acute kidney injury, and hospitalization in both diabetes and non-diabetes subjects.
  • Larger absolute benefit in those with UACR ≥ 200.

• Clinical Emphasis:

  • Any albuminuria justifies SGLT2i therapy, regardless of diabetes status.
  • Calls for routine screening (UACR) in at-risk populations beyond diabetics.

• Quote:

  • “If it is abnormal on more than two events, we should have a very low threshold for starting someone on an SGLT2 because we can prevent a lot of downstream misery.”
    — Dr. John Russell (18:34)

5. Tirzepatide for Overweight/Obese Adults with Type 1 Diabetes

Study Source: Diabetes Care
Segment Start: 18:55

• Study Design:

  • Phase 2, double-blind RCT ("turtle 1 trial"); overweight/obese adults with T1D received tirzepatide (2.5/5mg) or placebo, in addition to insulin, for 12 weeks.

• Outcomes:

  • Mean additional weight loss: 8.7 kg (8.8%).
  • A1C decreased by 0.4%.
  • 35.1% decrease in total insulin use, 49% reduction in bolus, 25% reduction in basal insulin.
  • No significant adverse effects.

• Implications:

  • Strong evidence for tirzepatide’s benefit in T1D patients with overweight/obesity, echoing results seen with GLP-1s.
  • Off-label use may be justified; larger trials still needed before FDA approval.

• Quote:

  • "Almost 80% of adults with type 1 diabetes aren’t achieving their glycemic targets and...about 2/3 of adults with type 1 also have overweight or obesity. So there’s a real need for additional medicines."
    — Dr. Neal Skolnick (21:10)

6. Voice-Based Artificial Intelligence Detection of Hypoglycemia

Study Source: Diabetes Care
Segment Start: 22:53

• Study Concept:

  • Exploratory study testing machine learning algorithms on >500 smartphone-recorded voice samples in people with T1D, distinguishing euglycemia vs hypoglycemia.

• Key Insights:

  • The AI system successfully identified hypoglycemia based solely on vocal features.
  • Mean age 37, A1C 7.1; N=22.

• Potential & Limitations:

  • Early-stage technology reminiscent of early digital thermometers—promising, but not yet clinical grade.
  • May be useful where traditional social supports or CGMs are unavailable.
  • Technology may evolve to complement CGMs, not replace them.

• Quote:

  • “You could imagine a time…your cell phone ... might be able to be like our mom and say, you know, Neil, something doesn’t sound right….we could get to a point that the devices in our home might be able to…be your monitors.”
    — Dr. John Russell (24:11)

Memorable Quotes by Timestamp

• 04:52 | Dr. Neal Skolnick:
  “I think we are way underutilizing PCSK9s and this trial is going to be important...establishing the evidence base to treat more people with PCSK9s who don’t have LDLs below those low goals.”

• 09:35 | Dr. John Russell:
  “The takeaway from this study is in every instance that someone has CKD attached to them as a diagnosis … they would recommend that people get put on an SGLT2.”

• 13:48 | Dr. Neal Skolnick:
  “This trial just nails it in saying, yes, I can feel comfortable in using [GLP-1s and SGLT2s] in my older adults without worry about inducing frailty.”

• 18:34 | Dr. John Russell:
  “If it is abnormal on more than two events, we should have a very low threshold for starting someone on an SGLT2 because we can prevent a lot of downstream misery.”

• 21:10 | Dr. Neal Skolnick:
  “Almost 80% of adults with type 1 diabetes aren’t achieving their glycemic targets and...about 2/3 of adults with type 1 also have overweight or obesity. So there’s a real need for additional medicines.”

• 24:11 | Dr. John Russell:
  “You could imagine a time…your cell phone ... might be able to be like our mom and say, you know, Neil, something doesn’t sound right….we could get to a point that the devices in our home might be able to…be your monitors.”

Noteworthy Timestamps

• [01:58] – Evolocumab in high-risk primary prevention: trial design & efficacy results
• [06:00] – Meta-analysis of SGLT2 inhibitors and CKD progression
• [11:37] – SGLT2/GLP-1s on frailty in older adults
• [15:58] – SGLT2 inhibitors across diabetes status and albuminuria
• [18:55] – Tirzepatide in obese/overweight adults with T1D
• [22:53] – Voice-based AI to detect hypoglycemia

Summary & Clinical Pearls

• PCSK9 inhibitors (evolocumab) have a meaningful role in primary prevention for high-risk diabetic and atherosclerotic patients with elevated LDL.
• SGLT2 inhibitors should be widely considered for nearly any CKD diagnosis—benefits are robust across all levels of eGFR and albuminuria, irrespective of diabetes status.
• In elderly T2D patients, GLP-1 and SGLT2 agent use does not appear to accelerate frailty, and may reduce it.
• Tirzepatide shows promising benefits in T1D patients with obesity—significant weight loss, reduced A1C, and lower insulin requirements.
• AI-driven voice analysis for hypoglycemia detection is a futuristic concept with early promise, potentially supplementing (not replacing) current monitoring tools.

For article links and further details, visit www.diabetesjournals.org.