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PubMed14 Apr 2026·Annals 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

FDA1 Apr 2026·New Drug Approval (NDA/BLA)● 10/10iHigh impact

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
ClinicalTrials19 Mar 2026·Phase 3● 9/10iHigh impact

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
ClinicalTrials17 Apr 2026·Phase 3● 8/10iHigh impactPick of the week

The Effect of Semaglutide in Subjects With Non-cirrhotic Non-alcoholic Steatohepatitis

Phase 3 trial evaluates semaglutide versus placebo in adults with non-cirrhotic NASH, measuring steatohepatitis resolution, fibrosis improvement, and cirrhosis-free survival over approximately 5 years. The study enrolled 1,205 adults and is active but not recruiting, with completion expected in 2029. This represents Novo Nordisk's push into NASH, a major unmet need with no approved GLP-1 therapies despite strong preclinical rationale. The trial's dual primary endpoints and 5-year duration suggest preparation for a pivotal regulatory filing in this large addressable market.

GLP-1Liver/NASHNovo Nordisk
ClinicalTrials17 Apr 2026·Phase 3● 8/10iHigh impact

A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study to Investigate the Efficacy and Safety of Retatrutide Once Weekly in Participants Who Have Obesity or Overweight and Chronic Low Back Pain

Phase 3 trial evaluating retatrutide for chronic low back pain in people with obesity or overweight, targeting dual primary endpoints of pain intensity reduction and weight loss. 586-person placebo-controlled study expected to complete September 2027, investigating a novel indication beyond traditional metabolic endpoints. Eli Lilly is exploring pain management as a potential expansion for their triple agonist, representing the first major trial of a GLP-1-based therapy specifically for chronic pain conditions.

GLP-1Weight lossOtherEli Lilly

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