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PubMed14 Apr 2026Annals of internal medicine● 5/10i

Endocrinology: What You May Have Missed in 2025.

Escudero C, Havranek K, Martinez Cruz M, Batch B

A review of 9 key endocrinology studies from 2025 examined treatment intensification strategies, emerging side effects of GLP-1 receptor agonists, and comparative safety data across diabetes and obesity therapies. Narrative review synthesizing published research from multiple clinical trials and observational studies. The compilation provides the first comprehensive assessment of GLP-1RA side effect concerns including nonarteritic anterior ischemic optic neuropathy alongside head-to-head comparisons of dulaglutide dose escalation versus tirzepatide switching. Limited by being a narrative review rather than systematic analysis of primary endpoints.

Strategic Signal

The emphasis on GLP-1RA side effects, particularly the rare but serious optic neuropathy signal, will likely prompt FDA and EMA to request additional safety monitoring in ongoing trials. This safety focus could influence prescriber confidence and payer coverage decisions, especially for higher-dose formulations. The dulaglutide versus tirzepatide comparison data will inform Lilly's competitive positioning against Novo's established GLP-1 franchise in diabetes intensification protocols.

GLP-1SGLT2Type 2 diabetesSide effectsDrug comparisonsEli LillyNovo Nordisk

Original Abstract

During 2025, endocrinology witnessed the expansion of pharmacotherapeutic options for type 2 diabetes (T2DM), obesity, and metabolic dysfunction-associated steatohepatitis (MASH); increasing complexity of treatment algorithms, including choices for intensification of therapy; and heightened concern about emerging side effects of commonly used medications. From the wealth of studies published in 2025, this article notes 9 studies that offer critical information for clinicians who manage or comanage patients with endocrine and metabolic disorders, including T2DM, obesity, and MASH. One of the 9 articles reviews the effectiveness of diabetes self-management education and support interventions, an important component of diabetes care, in improving hemoglobin A1c (HbA1c). Another is focused on comparing HbA1c lowering when escalating the dose of dulaglutide versus switching to tirzepatide in people with T2DM. Two of the 9 articles are focused on potential side effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs), including gastrointestinal side effects and nonarteritic anterior ischemic optic neuropathy. One article summarizes the risk for life-threatening pituitary immune-related adverse events caused by immune checkpoint inhibitors; another explores the use of GLP-1RAs in MASH. One additional study explores the risk for urogenital infections in patients with diabetes receiving sodium-glucose cotransporter-2 inhibitors (SGLT-2is) versus GLP-1RAs. Another study explores cardiovascular, kidney, and safety outcomes with canagliflozin (an SGLT-2i). The last article explores the efficacy and safety of finerenone in T2DM. The results of each study have a direct effect on clinical care for patients who often present to physicians who are not endocrinologists.

Related signals

Strategic Signal

FDA1 Apr 2026New Drug Approval (NDA/BLA)High impact● 10/10i

FDA Approves Foundayo (Orforglipron) — New Drug Approval (NDA/BLA)

FDA approved orforglipron (Foundayo, Eli Lilly) for type 2 diabetes -- a once-daily oral small-molecule GLP-1 receptor agonist. Orforglipron is the first non-peptide oral GLP-1 approved in the US; oral semaglutide (Rybelsus, Novo Nordisk) has been approved for T2D since 2019 and expanded to obesity in January 2026. Unlike Rybelsus, orforglipron requires no fasting or water volume restrictions before dosing.

GLP-1Type 2 diabetesPricing/accessEli LillyNovo Nordisk

Strategic Signal

Clinical Trial19 Mar 2026Phase 3High impact● 9/10i

Efficacy and Safety of Tirzepatide Once Weekly in Participants Without Type 2 Diabetes Who Have Obesity or Are Overweight With Weight-Related Comorbidities: A Randomized, Double-Blind, Placebo-Controlled Trial (SURMOUNT-1)

Phase 3 SURMOUNT-1 tests once-weekly tirzepatide at three doses versus placebo in adults without type 2 diabetes who have obesity or are overweight with comorbidities. The randomized, double-blind trial targets 2,539 participants with primary efficacy assessment at 72 weeks. This represents tirzepatide's pivotal obesity trial against placebo, potentially supporting Eli Lilly's bid to compete directly with Wegovy in the non-diabetic obesity market. A prediabetes subgroup continues long-term to assess diabetes prevention.

Weight lossGLP-1Eli Lilly

Strategic Signal

Clinical Trial17 Apr 2026Phase 3High impact● 8/10i

A Phase 3, Open-Label Study of Once Daily LY3502970 Compared With Insulin Glargine in Adult Participants With Type 2 Diabetes and Obesity or Overweight at Increased Cardiovascular Risk

Phase 3 open-label trial compared once-daily oral orforglipron versus insulin glargine in people with type 2 diabetes and obesity or overweight at increased cardiovascular risk. The study enrolled 2,749 participants with primary endpoint of time to first major adverse cardiovascular event, completed in March 2026. Eli Lilly is positioning orforglipron as a cardiovascular outcomes option in high-risk populations, directly competing with established insulin therapy in this indication. This represents the first cardiovascular outcomes trial for orforglipron following its April 2026 FDA approval for type 2 diabetes.

GLP-1Type 2 diabetesWeight lossCardiovascularEli Lilly

Strategic Signal

Clinical Trial13 Apr 2026Phase 3High impact● 8/10i

A Phase 3, Randomized, Double-Blind Study to Evaluate the Efficacy and Safety of Retatrutide Compared to Tirzepatide in Adults Who Have Obesity

Eli Lilly is conducting a Phase 3 head-to-head trial comparing retatrutide versus tirzepatide in adults with obesity. The double-blind study targets 800 participants over 89 weeks with primary endpoint of percent body weight change, completing December 2026. This represents the first direct comparison between Eli Lilly's next-generation triple receptor agonist retatrutide and its approved dual agonist tirzepatide in obesity. The trial positions Eli Lilly to potentially establish superiority claims for retatrutide ahead of expected regulatory submissions.

GLP-1Weight lossDrug comparisonsEli Lilly

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