Patrick Holmes

Diabetes Advocate | AE @DiabeticMed | Med ed @goggledocs | Advisor @MHRAgovuk 🕊️ #BeKind

[Patrick Holmes @drpatrickholmes]

📍Life expectancy ⤵️ by 3-4y for each decade diagnosis of #type2diabetes before 70y

📍driven by ⤴️ CV ☠️

👉 important to manage all, but the #T2Day cohort especially need our attention

@ShivaniM_KC
@kamleshkhunti @Dralbalawi1989

https://t.co/WjonzXKeBl

[GoggleDocs @GoggleDocs]

💉 Once-weekly basal insulin is here. MHRA has authorised Onswik (efsitora) for #T2D

🏛️NICE: an option, but use the least expensive suitable basal, NPH included. Likely role: people who need help to inject.

UK price confidential. Awaiting final TA + ICB pathways.

🔗https://t.co/NWqFJzuDrt

🔗https://t.co/4DDmgmz7Oq

[GoggleDocs @GoggleDocs]

🚨Retatrutide TRIUMPH-1 (NEJM)

80 wk weight: ⤵️25% on 12 mg vs -3.9% placebo.
⤵️28.3% headline = efficacy estimand.

👉9 vs 12 mg near identical; only 54% still on 12 mg at wk 80
⚠️⚡️Dysaesthesia, hypotension, MACE 9 v 1 (small n)

Treat to target, not max dose❓

🔗 https://t.co/EzUfsILnYI

[Patrick Holmes @drpatrickholmes]

@anothermarcusa @parthaskar @PNewlandJones @HannahBeba @ShivaniM_KC @FionaQuigs @ObesitySociety @ObesityAPPG @Rezaidi @iDrSunny @doctorcaldwell Sema

[Patrick Holmes @drpatrickholmes]

🆕NICE guidelines

Arguably the biggest shift in #type2diabetes care in over a decade.

Phenotype first. HbA1c second.

@drkevinfernando & I are running a free hour on what it actually changes in clinic.

Thu 10 Sept, 7-8pm BST

No industry funding

🔗https://t.co/hkZ3HZwPzv

[Kevin Fernando @drkevinfernando]

Join @drpatrickholmes & I for a free webinar exploring the 2026 NICE NG28 guideline for the management of #T2D

🗓️Thursday 10 September 2026 7-8pm

Sign-up here: https://t.co/LgrURjOMWw

No funding or sponsorship has been received for this webinar

[Partha S Kar 🇮🇳🇬🇧🏏🎥 @parthaskar]

This is an incredible article.

Absolutely incredible

Via the @bmj_latest -from @rcgp
9 current and former Presidents and Chairs

Posted on @LinkedIn
I know you all left @X to avoid any challenge...but...this is quite extraordinary.

My goodness.

Allow me to challenge- this absolute lack of any shape or form of accountability.

Link:
https://t.co/kikKL7x4iq

[Partha S Kar 🇮🇳🇬🇧🏏🎥 @parthaskar]

Something from nearly a decade ago.
2017.

Run by @bmj_latest -a few months into the @NHSEngland role for #Diabetes

So much has changed
So much hasn't

"The NHS isn't Disneyland. Nor is it Mordor..If you enjoy your job, everything else falls into place"

https://t.co/geC3dcFFhZ

[DSNforumUK @DSNforumUK]

📣 New: EXTOD Exercise Confidence Guides — 5 practical guides helping people with Type 1 Diabetes exercise safely, developed with DSN input.

Launching via @Ride4T1, with 5 free Community Days this Aug–Sept in Exeter, Bristol, Leeds, Edinburgh & Inverness 🚴

[GoggleDocs @GoggleDocs]

💊 The 82-year-old on a statin since their 60s. No ASCVD, no symptoms, no evidence either way

SAGA/SITE finally randomised it 🔬

📊 3-yr mortality 7.9% continue vs 7.2% stop
✅ Non-inferior (−0.68%, CI −3.95 to 2.60)
❗ No QoL gain from stopping

Shared decision, not a rule

🔗https://t.co/UFQBaL6OhF

[Partha S Kar 🇮🇳🇬🇧🏏🎥 @parthaskar]

Primary Care

The bedrock of #NHS work

And this is why I say that primary care leadership has failed within @NHSEngland in the decade or so NHSE has existed

If you haven't been able to make the case for increased funding in THE area which does need that?

I am afraid the outcomes follow the consequences of your inability to negotiate the funds.

So- we are here- where we are.

Leadership inactions or failures in a healthcare setting- always has consequences

Perhaps never for the individual- yet always for the population.

( Data via @HealthFdn )

[Kevin Fernando @drkevinfernando]

🔥UK first in Europe to authorise #orforglipron for weight management & #T2D🔥
🎯Orforglipron is a small-molecule, non-peptide oral #GLP1RA
See my @Medscape commentary piece on the ACHIEVE-1 trial from #ADA2025 for more background info - link in comments 👇🏾

[Kevin Fernando @drkevinfernando]

🔥Our @Medscape Primary Care #Hack on "Identification & Holistic Management of #CKD in Primary Care" has been updated for 2026!

🙏Thanks to my co-authors @EimearDarcy & Will Hinchliffe

PDF download in comments 👇

[Kevin Fernando @drkevinfernando]

I am pleased to share the launch of The CKM Collaborative.

The CKM Collaborative has been created to support healthcare professionals in working across traditional boundaries, sharing learning and strengthening integrated care.

Learn more: https://t.co/ytizbP53GG

[GoggleDocs @GoggleDocs]

🚨 Obicetrapib gets a positive CHMP opinion 🎉

@EMA_News

👉 A new lipid⤵️ 🔧

Oral once-daily CETP inhibitor:
🟢 LDL-C ↓33% (↓49% + ezetimibe)
🟢 Lp(a), ApoB & non-HDL all ↓

⚠️ No CVOT yet, so lipid-lowering only 'til PREVAIL. A 4th-line option to hit targets?

#CKM #CVRM

🔗https://t.co/3HBZKpyjhB

[Partha S Kar 🇮🇳🇬🇧🏏🎥 @parthaskar]

It’s a very slow burn - as predicted post @lengreview and @rcgp volteface

Throw in @nhsengland @DHSCgovuk acceptance of Leng Review

And am afraid this is no longer a viable career - as previously promised made by many in leadership roles

Folks- you were sold a pup.

And those who did?
Are now nowhere to be seen

#PhysicianAssistants

https://t.co/QgTYhG1Xnj

[Partha S Kar 🇮🇳🇬🇧🏏🎥 @parthaskar]

Best of luck in Defence @wesstreeting

Thanks for the memories.

A legacy of not quite sure what.

https://t.co/CLaT8krN1J

[Partha S Kar 🇮🇳🇬🇧🏏🎥 @parthaskar]

#T2Diabetes

At scale, the #NHS can only afford SGLT2i now because the drug has gone generic

And it will wait the same for GLP- 1 analogues

Till that time?
There will be talks, papers published,conferences held

It’s not the evidence that matters re outcomes - it’s the cost

[Dr Amar Puttanna 🎸 @AmarPut]

Great to see NICE approval for Teplizumab! Know firsthand the hard work behind the scenes to get to this. A new era in T1D care 🙌🏽

Await the full NICE TA being available soon

First drug to delay onset of type 1 diabetes made available on NHS

https://t.co/qhJEQT2g2R

[Zaher Toumi MD @ZaherToumi]

I have noticed in clinical practice patients who have been on highest #obesity medications for some time who feel:
1) Appetite increasing significantly
2) Food noise at a high level.
And some started experiencing:
Weight regain
Have you noticed this in practice?

[GoggleDocs @GoggleDocs]

What does metformin actually add in prediabetes beyond delaying diabetes❓

JAMA, 21-yr DPP/DPPOS follow-up (n=1,173):
🔹 Lifestyle reduced multimorbidity (≥2 long-term conditions): HR 0.79
🔸 Metformin did not: HR 0.91 (NS)
🔹 High-cost dyads: lifestyle HR 0.57. Metformin no signal

Layered on: no CV, mortality, cancer or frailty signal for metformin in prediabetes. Lifestyle has hard outcome data in Da Qing (CV events, mortality, +1.44 yr life expectancy).

And "lifestyle" here isn't a pamphlet. DPP was 16 individual sessions, 2 yr of monthly follow-up, structured ≥7% weight loss, ≥150 min/wk activity. Not soft.

The clinical question shifts:
👉Less "should we start metformin?"
👉More "what structured support gives this person the best chance over the next 20 years?"
🔗 https://t.co/7ChAxPPyNA