Ginny Eastwood, RD

NHS dietitian, Msc @FoodPolicyCity supporter of realistic, sustainable food choices for people living with long term health conditions.

[GoggleDocs @GoggleDocs]

🚨SURPASS-CVOT: What’s #tirzepatide’s REAL CV benefit vs placebo❓🚨

New Diabetes Care analysis uses imputed placebo comparison from REWIND

Tirzepatide vs imputed placebo:
🔹 MACE-3: HR 0.72 (0.55 to 0.94)
🔸 All-cause mortality: HR 0.61 (0.45 to 0.82)

⚠️ Caveats matter:
1️⃣Cross-trial comparison, not direct RCT
2️⃣SGLT2i use 31% vs 0% in REWIND
3️⃣Only 21% of REWIND met SURPASS-CVOT criteria

The real question: will regulators grant a CV indication?
FDA may agree (they already gave dulaglutide one). But EMA/MHRA never added formal CV indication to dulaglutide despite REWIND.

Stakes are high: licence change = guideline change = access change

🔗 https://t.co/RNq8kdU0Ry

[Prof Kamlesh Khunti @kamleshkhunti]

Systematic review

GLP-1RA cessation is associated with a predictable and decelerating pattern of weight regain

Plateau below pre-treatment levels, suggesting that partial weight-loss benefit may persist long-term but is substantially attenuated.

https://t.co/0M89a0YC9M

[Erica Richardson @EricaRi11822366]

After what seems like a long time in waiting the HCL competency framework is finally here:

https://t.co/76TIn8vwtI

Looking out for linked assessments via DTN

Have a fab day 😀

@drpratikc @LDC_tweets @DTN_UK @TrendDiabetes @DSNforumUK

[Prof Kamlesh Khunti @kamleshkhunti]

Why Do Patients Discontinue GLP-1 Medications for Obesity?

Adherence Challenges
❌ 50% stop treatment within 6 months

Top Reasons for Stopping
🤢 Side effects (mainly GI): 36%
🚗 Logistics (travel, time): 24%
💰 Cost & affordability: 23%

https://t.co/g1ucNoteNH

[EASO @EASOobesity]

An EASO publication in @NatureMedicine proposes a framework for diagnosing, staging & managing adult obesity. Prof. @busetto_luca highlights the need for comprehensive clinical evaluations beyond BMI.

https://t.co/ILz9QzWUpb

[Prof Kamlesh Khunti @kamleshkhunti]

❤️ Weight & HbA1c Reductions associated with mortality & cardiovascular benefits

Meta-regression of 44 trials

⚖️ Each 1 kg weight loss = 3.4% ↓ mortality risk

🩸 Each 1% HbA1c ⬇️ = 7.6% ↓ mortality risk

📉 Effects regardless of drug class

https://t.co/5ma5Yf9UkO

[Partha S Kar 🇮🇳🇬🇧🏏🎥 @parthaskar]

The 'Decision Support Tool' for those living with #T1Diabetes

Published January 2024 @NHSEngland
Built with many living with #T1D and clinical colleagues in the #T1D space

Do use, RT and cascade as you need to!

(Also available in Bengali; Polish; Urdu & Punjabi)

@BT1DUK @DiabetesUK @kamleshkhunti @GoggleDocs @NHSDiabetesProg @sugarydoc

Link:

https://t.co/ahM651ojZe

[Kevin Hall @KevinH_PhD]

For details see the following papers:

https://t.co/chh0IMCKH3

https://t.co/VV0ZWXZjLI

https://t.co/oLyKjaJyF5

[Kevin Hall @KevinH_PhD]

While I’m happy that our 2011 mathematical model was used by @nesta_uk to estimate the step reduction in daily calories would be required to address obesity in the UK, I wish they had read our later studies. Unfortunately, a constant intensity intervention to reduce calorie intake typically results in exponential waning of the effect over time (not a sustained step reduction) and will therefore only result in about 20% of the weight loss they predicted.

[Giuseppe Maltese @docmaltese]

The efficacy of intermittent scanning continuous glucose monitoring in the elderly*: A case-control study.

*Older people

Older people with diabetes benefit from is-CGM. HbA1c drops sustained for 2 years, few stop using it.

More support for CGM in older age!

#DiabetesCare

[Kevin Whelan @ProfWhelan]

Major survey of all Nutritionists and Dietitians in UK!

#AcademyNutritionSciences want to hear from every #Nutritionist or #Dietitian

What are your research experiences? Please take part, no matter whether you do no research, a little or a lot!

https://t.co/YYuIw5qcsJ

[Daniel J Drucker @DanielJDrucker]

Retrospective claims data reveals over 20 % of GLP-1 medicine users had nutritional deficiencies diagnosed within one-year of starting GLP-1RA treatment. https://t.co/UNDbW7pD9j

[Michael Weintraub, MD @MWeintraubMD]

Real-world comparison of semaglutide/tirzepatide (GLP‑1/GLP‑1+GIP) vs bariatric surgery.

📉 In a real-world matched study of 14,152 pts:
At 2 years:
• Surgery: −25.7% total weight loss (TWL)
• GLP-1s (semaglutide/tirzepatide): −5.3% TWL (ITT); −7.6% (per-protocol)
• HbA1c drop: Surgery −0.5 pts vs GLP-1s −0.2 pts (p<0.001)

⚖️ Conclusion: Surgery delivers greater, sustained weight loss & better glycemic control vs GLP-1s for eligible patients.

https://t.co/64QjVFoZ4J

[Michael Albert, MD @MichaelAlbertMD]

💉 GLP-1 meds don’t just curb appetite—sometimes they curb essential nutrients too.
- - -
📉 In a study of 460,000+ adults on GLP-1s (mostly with T2D):
🔹13% developed nutritional deficiencies in 6 months
🔹22% within 12 months
🔹Vitamin D deficiency was most common (13.6%)
🔹3% experienced muscle loss

🔍 Patients who saw a dietitian were more likely to have deficiencies identified—not because dietitians caused harm, but because they actually looked.

💡 Clinical translation:
🔹Appetite suppression can lower intake of protein, vitamins (D, B12, folate), and minerals.
🔹Without supervision, this can compromise muscle mass, hydration, and metabolic health.
🔹Older adults and those with obesity are especially vulnerable due to baseline deficiencies.

Treating obesity isn't just about weight loss—it's about preserving health while losing weight.
✅ That’s why supervised care with physicians + registered dietitians is non-negotiable.
✅ Monitor labs (Vit D, B12, iron, folate).
✅ Emphasize protein, strength training, and hydration.
📚https://t.co/zFOUF6CKcv
Credit to @drbutsch and colleagues.

[Ginny Eastwood, RD @ginny_rd]

@CourtNewsUK @EldersHuh is this true?

[Ginny Eastwood, RD @ginny_rd]

@sotonDSN Wouldn't be surprised if there's a rubber stamp and ink pad for trotting off "patient is non compliant" in the records of those alienated by these outdated attitudes. They paid for the sign..?

[The Lancet Diabetes & Endocrinology @TheLancetEndo]

Realigning #diabetes regimens in older adults: a 4S Pathway to guide simplification and deprescribing strategies https://t.co/4QtA0DIyTa
#T1D #T2D #olderadults
#FREE to read with registration (also FREE)
#ADA2025

[Prof Derek Connolly @DrDerekConnolly]

This is a very good review of type 2 diabetes

https://t.co/oZZcvGufMW

[Ali Aminian @Ali_Aminian_MD]

https://t.co/F8rbDGZ0RC #ADASciSessions #ADA2025

[EASO @EASOobesity]

Addressing #obesity can help prevent T2D.

@EASOobesity acknowledges the importance of addressing obesity as both a risk factor for diabetes — along with CVD and cancer — and a chronic disease in its own right.

#EASOpolicy