A mismatch between two common tests for kidney function may indicate a higher risk for kidney failure, heart disease, and death, a new study shows.
Healthcare providers for decades have measured blood levels of creatinine to track the rate at which kidneys filter waste from muscle breakdown in the bloodstream. According to more recent guidelines, levels of cystatin C, a small protein made by all cells in the body, can also be used to measure kidney function. Since these two tests are influenced by different factors – including some related to disease or aging – using both markers together can provide a better measure of kidney function and risk of organ failure than either one alone.
Led by NYU Langone Health researchers, the new work reveals that many people, especially those who are sick, often have a large gap between the two readings, which may be a signal of future disease. Specifically, the global study shows that more than a third of hospitalised participants had a cystatin C-based readout of kidney function that was at least 30% lower than one based on their creatinine levels.
“Our findings highlight the importance of measuring both creatinine and cystatin C to gain a true understanding of how well the kidneys are working, particularly among older and sicker adults,” said study co-corresponding author Morgan Grams, MD, PhD. “Evaluating both biomarkers may identify far more people with poor kidney function, and earlier in the disease process, by covering the blind spots that go with either test.”
Beyond detecting signs of disease, assessing patients’ kidney function is important for calculating the appropriate dosage for cancer medicines, antibiotics, and many other drugs, says Dr Grams, Professor of Medicine at the NYU Grossman School of Medicine.
During another investigation, the results of which were published the same day, the same research team found that a record number of people worldwide have chronic kidney disease, which is now the ninth leading cause of death globally. Having new ways to spot the condition early can help ensure that patients receive swift treatment and avoid more-dramatic interventions such as dialysis and organ transplantation, says Dr Grams.
For the recent investigation, the research team analysed healthcare records, blood tests, and demographic data collected from 860, 66 men and women of a half-dozen nationalities. All participants had their creatinine and cystatin C levels measured on the same day and received follow-ups 11 years later, on average. The team considered factors unrelated to kidney function that influence the biomarkers’ readings, such as smoking, obesity, and history of cancer.
Performed as part of the international Chronic Kidney Disease Prognosis Consortium, the study is the largest to date to explore differences between the two tests and whether they may signal potential health problems, the authors say. Established to better understand and treat the condition, the consortium provides evidence for global definitions of chronic kidney disease and related health risks.
According to the new findings, those whose cystatin C-based measures of kidney filtration were at least 30% lower than their creatinine-based measures were at higher risk for death, heart disease, and heart failure than those who had a smaller difference between the two metrics. The former group was also more likely to be diagnosed with severe chronic kidney disease that required dialysis or an organ transplant. The same was found for 11% of outpatients and seemingly healthy volunteers.
Dr. Grams notes that while cystatin C testing was first recommended in 2012 by the international organization Kidney Disease—Improving Global Outcomes, a 2019 survey revealed that less than 10 percent of clinical laboratories in the United States performed it in-house. The two largest laboratories, Quest Diagnostics and Labcorp, now offer the test.
“These results underscore the need for physicians to take advantage of the fact that more hospitals and healthcare providers are starting to offer cystatin C testing,” said study co-corresponding author Josef Coresh, MD, PhD, director of NYU Langone’s Optimal Aging Institute. “Physicians might otherwise miss out on valuable information about their patients’ wellbeing and future medical concerns.”
Dr Coresh cautions that among the hospitalised Americans in the study, less than 1% were tested for cystatin C.
The ratio of a person’s waist measurement compared to their height is more reliable than body mass index (BMI) at predicting heart disease risk, according to new research from UPMC and University of Pittsburgh physician-scientists.
This finding, published out now in The Lancet Regional Health—Americas, could reshape how clinicians and the public assess cardiovascular risk, especially for people who don’t meet the classic definition of obesity.
The team analysed data from 2721 adults who had participated in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The individuals had no cardiovascular disease at baseline and were followed for more than five years.
“Higher BMI, waist circumference and waist-to-height ratio at baseline were all associated with higher risk of developing future cardiovascular disease – until we adjusted for other classic risk factors, such as age, sex, smoking, exercise, diabetes, hypertension and cholesterol,” said lead author Thiago Bosco Mendes, clinical instructor of medicine at Pitt and obesity medicine fellow at UPMC. “When we did that, only waist-to-height ratio held as a predictor.”
Much of that predictive power is concentrated among individuals with a BMI under 30, which is below the classic threshold for obesity, who may not realise they are at risk for cardiovascular disease.
BMI doesn’t account for fat distribution or distinguish between harmful, visceral fat and protective, subcutaneous fat. By contrast, waist-to-height ratio (WHtR), calculated by dividing waist circumference by height, directly reflects central obesity, which is more closely linked to heart disease. That means that people with a BMI lower than 30, but a WHtR over 0.5, may be at higher risk of future coronary artery calcification, a key marker of cardiovascular disease, even in the absence of other risk factors.
“Using waist-to-height ratio as a cardiovascular screening tool could lead to earlier identification and intervention for at-risk patients who might otherwise be missed,” said senior author Marcio Bittencourt, associate professor of medicine at Pitt and cardiologist at UPMC. “It’s a simple and powerful way to spot heart disease risk early, even if a patient’s weight, cholesterol and blood pressure all seem normal.”
Study shows that resistance training outperforms endurance exercise in improving insulin sensitivity in obesity and Type 2 diabetes models.
Photo by Jonathan Borba on Unsplash
Running may help burn calories, but when it comes to preventing diabetes and obesity, pumping iron might have the edge, according to preclinical findings from Virginia Tech scientists at the Fralin Biomedical Research Institute at VTC.
The research, published in the Journal of Sport and Health Science, compared the effects of endurance and resistance exercise in mice fed a high-fat diet, a widely used model of obesity, hyperglycaemia, and Type 2 diabetes.
A team led by exercise medicine researcher Zhen Yan found that while both running and weightlifting helped the body clear excess sugar from the blood, resistance training was more effective in reducing subcutaneous and visceral fat, improving glucose tolerance, and lowering insulin resistance – key factors in preventing and managing diabetes.
“We all want to live a long, healthy life,” said Prof Yan, director of the Center for Exercise Medicine Research. “We all know the benefits of regular exercise. There is plenty of evidence in humans that both endurance exercise, such as running, and resistance exercise, such as weightlifting, are effective in promoting insulin sensitivity.”
But while both support metabolic function, a rigorous side-by-side comparison was lacking. Is one type of exercise better than the other?
What they did
To conduct the first direct, controlled comparison, members of the research team built something that had not previously existed: a mouse model of weightlifting.
In this model, mice lived in specially designed cages where food was accessed through a hinged, weighted lid. To eat, the mice had to lift the lid while wearing a small shoulder collar, causing a squat-like movement that engaged the muscle contractions people use during resistance exercise. The load was gradually increased over several days, mimicking progressive strength training.
For the endurance group, mice were given open access to a running wheel, an established model of aerobic exercise. Control groups included sedentary mice on either a normal or high-fat diet.
Over eight weeks, the researchers monitored weight gain, body composition, and fat distribution. They tested exercise capacity with treadmill runs, assessed heart and muscle function, and measured how well the mice regulated blood sugar. They also analyzed skeletal muscle tissue to study insulin signaling at the molecular level.
Using their novel model of resistance exercise, team members were able to directly compare how the two training styles affect obesity, blood glucose, and insulin sensitivity in a way that closely mirrors human exercise.
“Our data showed that both running and weightlifting reduce fat in the abdomen and under the skin and improve blood glucose maintenance with better insulin signaling in skeletal muscle,” Yan said. “Importantly, weightlifting outperforms running in these health benefits.”
Why this matters
Diabetes and obesity are major public health challenges, fuelled by sedentary lifestyles and high-fat diets. The findings underscore decades of clinical trials showing that endurance, resistance, and high-intensity interval training all reduce HbA1c while also lowering body mass index, blood pressure, and improving quality of life.
The new Virginia Tech study, which also involves collaborators from the University of Virginia, helps fill a critical gap by directly comparing voluntary running and weightlifting in a controlled, preclinical model of diet-induced obesity.
“The findings also bring good news for people who, for any number of reasons, cannot engage in endurance-type exercise,” Yan said. “Weight training has equal, if not better, anti-diabetes benefits.”
The researchers also saw changes in skeletal muscle signaling pathways that could inform new drug therapies for Type 2 diabetes.
Interestingly, the benefits of resistance training were not explained by changes in muscle mass or exercise performance, suggesting unique metabolic mechanisms at play.
Yan said the study underscores the idea that, while popular drug interventions like GLP-1 agonists can help with diabetes management and weight loss, they do not replace the unique, accessible, and comprehensive benefits of a well-balanced exercise programme.
“The take-home message is that you should do both endurance and resistance exercise, if possible, to get the most health benefit,” said Yan, who is also a professor in the Department of Human Nutrition, Foods, and Exercise in the College of Agriculture and Life Sciences at Virginia Tech.
This new technology offers people with diabetes two-hour and overnight predictive notifications
The Accu-Chek SmartGuide® continuous glucose monitoring (CGM) solution provides 14 days accuratereal-time glucose values for adults living with diabetes1
Artificial intelligence (AI)-enabled algorithms can predict glucose levels up to two hours ahead and overnight, empowering users to take action before a glucose excursion occurs2 proactively
Over 4.2 million people living with diabetes were recorded in 2024, in South Africa people living with diabetes could benefit from the Accu-Chek SmartGuide® CGM solution 3
Johannesburg, 4 November 2025 – Roche (SIX: RO, ROG; OTCQX: RHHBY) announced today that its Accu-Chek® SmartGuide continuous glucose monitoring (CGM) solution is now available in South Africa. This significant milestone means that people living with diabetes over the age of 18 can now benefit from the solution’s enhanced glucose monitoring and artificial intelligence (AI)-enabled predictive insights1,2.
Diabetes is one of today’s most urgent healthcare challenges. In South Africa, 4.2 million people are living with the condition as of 2024 3. If left unmanaged, diabetes can lead to secondary complications including cardiovascular disease, kidney disease, nerve damage, blindness, lower limb amputation and mental health issues4. In a study conducted by GWI in partnership with Roche, 58% of people living with diabetes stated that they feel a mental burden associated with managing their diabetes.
Since it was introduced, CGM technology has significantly improved diabetes care5, yet a significant number of people still have difficulty keeping their glucose in the right range when using current systems.6 Hypoglycaemia is common amongst persons who have type 1 diabetes, with an annual incidence of severe hypoglycemia ranging from 3.3% to 13.5%.7
“The Accu-Chek SmartGuide CGM solution is a significant step towards providing greater peace of mind for people living with diabetes, due to the AI-enabled predictive capabilities it offers. This empowers patients to take action before undesired events occur,” said Merilynn Steenkamp, General Manager, Southern Africa, Roche Diagnostics.“Our new Accu-Chek SmartGuide® CGM solution puts the power of prediction into the hands of people living with diabetes with its integrated AI-enabled algorithms that predict glucose levels for the next 2 hours as well as imminent and nocturnal hypoglycaemia. People with diabetes should have the freedom to plan the day ahead and get a good night’s sleep at the end of it all.”
Nighttime hypoglycaemia can present a particular challenge for people with diabetes. Approximately 2-5% of deaths in people with type 1 diabetes under the age of 40 are due to episodes of very low glucose during the night8,9. The unpleasant symptoms and negative consequences of hypoglycaemia can result in actual fear of hypoglycaemia with possible significant implications for the diabetes management, metabolic control and subsequent health outcomes.10
The Accu-Chek SmartGuide® CGM solution uses AI-enabled algorithms to predict where an individual’s glucose levels are likely headed in the next 30 minutes, 2 hours, and even overnight. This means people with diabetes can move from a reactive to a proactive approach to their daily management, preparing for and managing potential episodes in advance, rather than waiting for alerts when they happen.
The Accu-Chek SmartGuide® CGM solution includes a wireless, water-resistant sensor, worn on the back of the upper arm, and the apps where the users can see their current glucose levels and their future glucose development through predictive analytics. Every five minutes, the sensor sends glucose values measured in real-time to the Accu-Chek SmartGuide app. The Accu-Chek SmartGuide® predict app then uses those glucose values and other optional information entered by the user such as food intake and insulin doses to detect patterns and predict future glucose levels. Supported by AI-trained algorithms, it provides key predictions of likely hypoglycaemia within 30 minutes as well as general estimated predictions of glucose levels within 2 hours and during a defined 7-hours nighttime period.11
Clinical studies have demonstrated the new Roche CGM solution’s high system accuracy, with an overall mean absolute relative difference (MARD) of 9.2% and 99.8% of measured glucose values falling within zones A and B on the Parkes Error Grid.1, 12 The evaluation of the predictive capabilities showed that all advanced predictive features exceeded high performance requirements as e.g. accuracy, sensitivity and specificity.13
Roche is committed to bringing improved and proactive relief to diabetes management across South Africa with the immediate availability of the Accu-Chek SmartGuide® CGM solution.
About the Accu-Chek SmartGuide® CGM solution
Accu-Chek SmartGuide® is a continuous glucose monitoring (CGM) solution developed by Roche providing accurate1 real-time glucose readings and AI-enabled predictions for different timeframes7. The solution includes three elements: the Accu-Chek SmartGuide® CGM sensor, the Accu-Chek SmartGuide® App and the Accu-Chek SmartGuide® Predict App. With an all-in-one applicator and 14-day wear time, Accu-Chek SmartGuide® is designed for people living with diabetes, 18 years of age and older. It aims at empowering people living with diabetes to be prepared for the future development of glucose levels and take preventive action by making the appropriate therapy adjustments in good time.
The Accu-Chek SmartGuide® CGM solution can be seamlessly integrated with the Accu-Chek® Care platform, offering healthcare professionals (HCPs) access to comprehensive and accurate1 therapy-relevant data provided by the CGM solution. This integration allows HCPs to analyse together with their patients how lifestyle and therapy impact their glucose levels and make more informed decisions.
About Roche
Founded in 1896 in Basel, Switzerland, as one of the first industrial manufacturers of branded medicines, Roche has grown into the world’s largest biotechnology company and the global leader in in-vitro diagnostics. The company pursues scientific excellence to discover and develop medicines and diagnostics for improving and saving the lives of people around the world. We are a pioneer in personalised healthcare and want to further transform how healthcare is delivered to have an even greater impact. To provide the best care for each person we partner with many stakeholders and combine our strengths in Diagnostics and Pharma with data insights from the clinical practice.
For over 125 years, sustainability has been an integral part of Roche’s business. As a science-driven company, our greatest contribution to society is developing innovative medicines and diagnostics that help people live healthier lives. Roche is committed to the Science Based Targets initiative and the Sustainable Markets Initiative to achieve net zero by 2045.
Genentech, in the United States, is a wholly owned member of the Roche Group. Roche is the majority shareholder in Chugai Pharmaceutical, Japan.
All trademarks used or mentioned in this release are protected by law.
References [1] Mader, J. K., Waldenmaier, D., Mueller-Hoffmann, W., Mueller, K., Angstmann, M., Vogt, G., Rieger, C. C., Eichenlaub, M., Forst, T., & Freckmann, G. (2024). Performance of a Novel Continuous Glucose Monitoring Device in People With Diabetes. Journal of diabetes science and technology, 18(5), 1044–1051. https://doi.org/10.1177/19322968241267774
[2] Simulation study, Data on file, Roche Diabetes Care GmbH, 2025.
[3] Ngassa Piotie P, Rheeder P. UP Expert Opinion: South Africa has more than 4 million people living with diabetes – many aren’t getting proper treatment. University of Pretoria Diabetes Research Centre News. 2024 Mar 11 [cited 2025 Oct 8]. Available from: https://www.up.ac.za/diabetes-research-centre/news/post_3214595-up-expert-opinion-south africa-has-more-than-4-million-people-living-with-diabetes-many-arent-getting-proper-treatment
[4] Tomic D, Shaw JE, Magliano DJ. The burden and risks of emerging complications of diabetes mellitus. Nat Rev Endocrinol. 2022 Sep;18(9):525-539. doi: 10.1038/s41574-022-00690-7. Epub 2022 Jun 6. PMID: 35668219; PMCID: PMC9169030.
[6] DeSalvo DJ, et al., Journal of Diabetes Science and Technology. 2023;17(2):322-328.
[7] Nakhleh A, Shehadeh N. Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention. World J Diabetes. 2021 Dec 15;12(12):2036-2049. doi: 10.4239/wjd.v12.i12.2036. PMID: 35047118; PMCID: PMC8696639.
[8] Secrest AM et al. Characterizing sudden death and dead in bed syndrome in Type 1 diabetes: analysis from two childhood onset Type 1 diabetes registries. Diabet. Med. 2011. 28, 293–300.
[9] Jones J et al. Dead in bed – A systematic review of overnight deaths in type 1 diabetes. Diabetes Res Clin Pract. 2022. 191:110042.
[10] Wild, Diane et al. “A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education.” Patient education and counseling vol. 68,1 (2007): 10-5. doi:10.1016/j.pec.2007.05.003
[12] Parkes Error Grid – a tool to evaluate the accuracy of glucose monitoring systems (BGM and CGM).
[13] Herrero, P., Andorrà, M., Babion, N., Bos, H., Koehler, M., Klopfenstein, Y., Leppäaho, E., Lustenberger, P., Peak, A., Ringemann, C., & Glatzer, T. (2024). Enhancing the Capabilities of Continuous Glucose Monitoring With a Predictive App. Journal of diabetes science and technology, 18(5), 1014–1026. https://doi.org/10.1177/19322968241267818.
Across 2384 Indian adults with type 2 diabetes, 31% achieved remission through a comprehensive mobile-based programme combining diet, exercise, stress management, and medical support
Photo by Ketut Subiyanto on Unsplash
Nearly one-third of people with type 2 diabetes (T2D) in an Indian cohort achieved remission through an intensive lifestyle intervention program, according to a new study publishing October 22, 2025, in the open-access journal PLOS One by Pramod Tripathi of Freedom from Diabetes Clinic & Diabetes Research Foundation, India, and colleagues.
Type 2 diabetes affects more than 72 million people in India. While lifestyle interventions have shown promise for diabetes management in Western populations, limited data exists on their effectiveness in India, where genetic and lifestyle factors place the population at higher risk.
In the new study, researchers analysed data from 2384 adults with T2D who enrolled in a one-year online intensive lifestyle intervention programme at the Freedom from Diabetes Clinic in India between May 2021 and August 2023. The intervention, provided by a six-member care team through a mobile application, included a personalised plant-based diet, structured physical activity, group therapy and individual psychological counselling, and medication management.
Overall, 744 participants (31.2%) achieved diabetes remission, defined as maintaining glycated haemoglobin (HbA1c) levels below 48mmol/mol for at least three months without glucose-lowering medications. The remission group showed significantly greater improvements than the non-remission group in weight (8.5% vs 5.2% reduction), body mass index (8.6% vs 5.2% reduction), HbA1c (15.3% vs 12.4% reduction), fasting insulin (26.6% vs 11.4% reduction), and insulin resistance (37.3% vs.19.7% reduction). People under 50 years of age, with higher BMI, no prior medication use, and a shorter duration of diabetes (<6 years) were most likely to achieve remission.
The study was limited by its retrospective design and lack of a control group. Because the programme required a subscription and participants who lacked follow up data were excluded from the analysis, there may have been selection biases. However, the authors conclude that a significant proportion of individuals with T2D can achieve remission through a comprehensive, culturally adapted lifestyle programme.
The authors add: “Our research demonstrates that nearly one-third of individuals with type 2 diabetes can achieve remission through a scientifically designed, culturally tailored, and structured lifestyle intervention. This represents the first large-scale evidence from India highlighting the potential of intensive lifestyle modification in achieving type 2 diabetes remission.”
A new gene therapy approach aimed at protecting people with type 1 diabetes from developing diabetic kidney disease – a serious and common complication of the condition, has shown promising results in a University of Bristol study.
One in three people with type one diabetes will develop kidney damage during their lifetime, which can develop silently over many years, often going undetected until it becomes severe.
Current treatments can slow kidney damage but there are none that act on the root cause: a tiny filter called the glomerulus. A new study published in Molecular Therapy, demonstrated a 64% reduction in a damage indicator for kidney disease, paving the way for a potential new treatment.
The study, driven by first author, Dr Aldara Martin Alonso and led by Dr Rebecca Foster, Associate Professor of Microvascular Medicine at Bristol Medical School: Translational Health Sciences, explored the potential of delivering a protein called VEGF-C directly into kidney cells.
Previous studies have shown VEGFC could protect against kidney disease as it helps keeps blood vessels in the kidney filter healthy, repairing early signs of diabetes-related kidney damage.
To test whether this new approach could be used to treat or slow down kidney disease, the team used a harmless virus to deliver VEGF-C directly into the kidney cells of diabetic mice.
Their results showed that this approach not only helped the kidneys work better, but also protected a key part of the kidney filter that normally helps prevent damage. It led to a 64% reduction in albuminuria. Importantly, this reduction is more than twice the reduction recommended by the American Diabetes Association to slow the progression of chronic kidney disease.
Dr Foster, the study’s senior author, explained: “Currently, there are no drugs specifically available to protect people with type 1 diabetes from kidney disease, despite their higher risk of developing kidney disease. This gap in treatment highlights the urgent need for new therapeutic approaches. Our goal was to investigate whether gene therapy could offer a viable solution by delivering VEGFC in a more targeted way.”
Dr Foster added: “This gene therapy approach has not been explored before in pre-clinical models and offers a long-term solution for these patients who are at risk of developing kidney disease.”
Photo by Kampus Production: https://www.pexels.com/photo/a-man-in-blue-sweater-sitting-beside-man-in-white-long-sleeves-7551646/
Low cholesterol can reduce the risk of dementia, a new University of Bristol-led study with more than a million participants has shown.
The research, led by Dr Liv Tybjærg Nordestgaard while at the University of Bristol and the Department of Clinical Biochemistry at Copenhagen University Hospital – Herlev and Gentofte, found that people with certain genetic variants that naturally lower cholesterol have a lower risk of developing dementia.
Some people are born with genetic variants that naturally affect the same proteins targeted by cholesterol-lowering drugs, such as statins and ezetimibe. To test the effect of cholesterol-lowering medication on the risk of dementia, the researchers used a method called Mendelian Randomisation – this genetic analysis technique allowed them to mimic the effects of these drugs to investigate how they influence the risk of dementia, while minimising the influence of confounding factors like weight, diet, and other lifestyle habits.
By comparing these individuals to individuals without these genetic variants, the researchers were able to measure differences in the risk of dementia. They found reducing the amount of cholesterol in the blood by a small amount (one millimole per litre) to be associated with up to 80% reduction in risk of developing dementia for certain drug targets.
“What our study indicates is that if you have these variants that lower your cholesterol, it looks like you have a significantly lower risk of developing dementia,” said Dr Nordestgaard, who now works in the Department of Clinical Biochemistry at Copenhagen University Hospital – Bispebjerg and Frederiksberg hospital.
The results suggest that having low cholesterol, whether due to genes or medical treatment, can help reduce the risk of dementia. However, the study does not say anything definitive about the effect of the medicine itself.
One of the challenges is that dementia typically does not appear until late in life, and therefore research in the area typically requires a very long period of follow-up.
It is still not known exactly why high cholesterol can increase the risk of dementia, but one possible explanation proposed by Dr Nordestgaard is that high cholesterol can lead to atherosclerosis.
“Atherosclerosis is a result of the accumulation of cholesterol in your blood vessels,” Dr Nordestgaard said. “It can be in both the body and the brain and increases the risk of forming small blood clots – one of the causes of dementia.
“It would be a really good next step to carry out randomised clinical trials over 10 or 30 years, for example, where you give the participants cholesterol-lowering medication and then look at the risk of developing dementia,” Dr Nordestgaard added.
The study used data from the UK Biobank, the Copenhagen General Population Study, the Copenhagen City Heart Study, the FinnGen study, and the Global Lipids Genetics Consortium.
New study uncovers natural hormone shift that could transform type 2 diabetes treatment
A 3D map of the islet density routes throughout the healthy human pancreas. Source: Wikimedia CC0
A new study from Duke University School of Medicine is challenging long-standing views on blood sugar regulation — and pointing to a surprising new ally in the fight against type 2 diabetes.
Published in Science Advances, the research reveals that pancreatic alpha cells, once thought to only produce glucagon – a hormone that raises blood sugar to maintain energy when fasting or exercising – also generate GLP-1, a powerful hormone that boosts insulin release from beta cells and helps regulate glucose. GLP-1 is the same hormone mimicked by blockbuster drugs like semaglutide.
Using mass spectrometry, Duke researchers found that human alpha cells may naturally produce far more bioactive GLP-1 than previously believed.
Led by Duke scientist Jonathan Campbell, PhD, the team of obesity and diabetes researchers analysed pancreatic tissue from mice and from humans across a range of ages, body weights, and diabetes statuses. They found that human pancreatic tissue produces much higher levels of bioactive GLP-1 and that this production is directly linked to insulin secretion.
“Alpha cells are more flexible than we imagined,” said Campbell, an associate professor in the Division of Endocrinology in the Department of Medicine and a member of the Duke Molecular Physiology Institute. “They can adjust their hormone output to support beta cells and maintain blood sugar balance.”
This flexibility could change the approach to treating type 2 diabetes, where beta cells in the pancreas can’t make enough insulin to keep blood sugar at a healthy level. By boosting the body’s own GLP-1 production, it may offer a more natural way to support insulin and manage blood sugar.
Switching gears
In mouse studies, when scientists blocked glucagon production, they expected insulin levels to drop. Instead, alpha cells switched gears – ramping up GLP-1 production, improving glucose control, and triggering stronger insulin release.
“We thought that removing glucagon would impair insulin secretion by disrupting alpha-to-beta cell signaling,” Campbell said. “Instead, it improved it. GLP-1 took over, and it turns out, it’s an even better stimulator of insulin than glucagon.”
To test this further, researchers manipulated two enzymes: PC2, which drives glucagon production, and PC1, which produces GLP-1. Blocking PC2 boosted PC1 activity and improved glucose control. But when both enzymes were removed, insulin secretion dropped and blood sugar spiked – confirming the critical role of GLP-1.
Implications for diabetes treatment
While GLP-1 is typically made in the gut, the study confirms that alpha cells in the pancreas can also release GLP-1 into the bloodstream after eating. This helps to lower blood sugar by increasing insulin and reducing glucagon levels.
Common metabolic stressors, like a high-fat diet, can increase GLP-1 production in alpha cells – but only modestly. That opens the door to future research: If scientists can find ways to safely boost GLP-1 output from alpha cells they may be able to naturally enhance insulin secretion in people with diabetes.
But measuring GLP-1 accurately hasn’t been easy. The team developed a high-specificity mass spectrometry assay that detects only the bioactive form of GLP-1 – the version that actually stimulates insulin — not the inactive fragments that often muddy results.
“This discovery shows that the body has a built-in backup plan,” Campbell said. “GLP-1 is simply a much more powerful signal for beta cells than glucagon. The ability to switch from glucagon to GLP-1 in times of metabolic stress may be a critical way the body maintains blood sugar control.”
A new movement in weight management is taking hold in South Africa as the country confronts weight-related illnesses. A powerful class of medication known as GLP-1 therapies is proving highly effective in cutting obesity rates, lowering cancer risk, and improving overall metabolic health. Their growing popularity marks a new frontline in the fight against sugar-driven disease.
A landmark study published in JAMA Oncology has revealed that patients using GLP-1 medications – a class of therapies originally developed for type 2 diabetes – experienced a 17% lower overall risk of cancer.
The data, drawn from over 86 000 patients, showed striking reductions in specific cancers: ovarian cancer risk nearly halved, meningioma cases fell by 31%, and endometrial cancer dropped by 25%.
Dr Tommie Smook, medical practitioner at Dr Smook & Partners (managed by RXME Group), says these findings reinforce the urgent need to fight back against sugar-related disease:
“We are witnessing the medical consequences of unchecked sugar consumption every day in practice. Obesity has become one of the greatest epidemics of our time. If we are serious about safeguarding public health, we must declare a national war on sugar – and GLP-1s are among the most powerful tools we now have to help people reclaim their health.”
What GLP-1s actually do
The body naturally produces GLP-1 – a hormone that regulates blood sugar, appetite, and digestion. GLP-1 medications mimic this process:
• They slow stomach emptying,
• Reduce hunger and cravings,
• Help patients feel satisfied with smaller portions, and
• Stabilise blood sugar levels.
The result is sustained weight loss. Clinical trials consistently show patients losing 10-15% of body weight, particularly when therapy is combined with nutrition, exercise, and professional support. In South Africa, several GLP-1s are now formally registered for obesity and chronic weight management.
But the benefits don’t end at weight loss. International studies have demonstrated improvements in cardiovascular health – lowering blood pressure, reducing inflammation, and decreasing the risk of heart attacks and strokes. Emerging evidence also suggests neuroprotective effects, with potential to reduce risks of dementia and Alzheimer’s disease.
From diabetes treatment to disease prevention
“GLP-1s are no longer just diabetes drugs,” says Dr Smook. “They are transforming the way we think about weight, chronic disease, and prevention. When used responsibly under medical guidance, these therapies can change not only waistlines, but lifespans.”
At Dr Smook & Partners, patients gain access to GLP-1 therapy under the supervision of qualified medical doctors. Medications are prepared only through SAHPRA-approved compounding pharmacies, ensuring quality and safety. This is supported by a multidisciplinary team – dietitians, biokineticists, nurses, and sports physicians, providing holistic care.
Here are the five essentials you should consider before starting GLP-1 therapy:
See a doctor first – these medications require proper screening and monitoring.
Think beyond injections – lifestyle, diet, and exercise remain vital.
Expect an adjustment phase – side effects like nausea are usually temporary.
Protect lean muscle – resistance training and adequate protein intake are essential.
Avoid shortcuts – unregulated, black-market products are unsafe and unpredictable.
A turning point for public health
Obesity is a modern epidemic, and sugar is at the heart of it. GLP-1 medications are not a “quick fix,” but they represent one of the most promising advances in decades – a way to tackle both the causes and consequences of excess weight.
Dr Smook concludes: “The stigma around GLP-1s must end. These therapies are not about vanity – they are about survival. Every patient who regains control of their health is one step closer to breaking sugar’s grip on our society.”
A large Cleveland Clinic study has found that people with obesity and type 2 diabetes who undergo weight-loss surgery live longer and face fewer serious health problems compared with those treated with GLP-1 receptor agonist medicines alone.
Patients who had weight-loss surgery (also known as bariatric or metabolic surgery) lost more weight, achieved better blood sugar control, and relied less on diabetes and heart medications over 10 years. The research is published in Nature Medicine.
“Even with today’s best medicines, metabolic surgery offers unique and lasting benefits for people with obesity and diabetes,” said Ali Aminian, MD, director of Cleveland Clinic’s Bariatric & Metabolic Institute and primary investigator of the study. “The benefits we observed went beyond weight loss. Surgery was linked to fewer heart problems, less kidney disease, and even lower rates of diabetes-related eye damage.”
GLP-1 (glucagon-like peptide-1) receptor agonists are a class of medications widely used to treat type 2 diabetes and obesity and to reduce health risks. Both metabolic surgery and GLP-1 medicines improve cardiovascular health and metabolism.
The M6 study (Macrovascular and Microvascular Morbidity and Mortality after Metabolic Surgery versus Medicines) followed 3932 adults with diabetes and obesity who received care at Cleveland Clinic for up to 10 years. Among them, 1657 underwent metabolic surgery (including gastric bypass or sleeve gastrectomy), while 2275 were treated with GLP-1 medicines (including liraglutide, dulaglutide, exenatide, semaglutide, and tirzepatide).
At the end of the study, patients who had metabolic surgery had a:
32% lower risk of death
35% lower risk of major heart problems (such as heart attack, heart failure, or stroke)
47% lower risk of serious kidney disease
54% lower risk of diabetes-related eye damage (retinopathy)
On average, people who had metabolic surgery lost 21.6% of their body weight over 10 years, compared with 6.8% weight loss in people who took GLP-1 medicines. Hemoglobin A1c, a marker of average blood sugar, improved more with surgery (-0.86%) than with GLP-1 medicines (-0.23%). Patients in the surgery group also required fewer prescriptions for diabetes, blood pressure, and cholesterol.
“Even in the era of these powerful new drugs to treat obesity and diabetes, metabolic surgery may provide additional benefits, including a survival advantage,” said Steven Nissen, MD, Chief Academic Officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic and senior author of the study.
“Our findings indicate that surgery should remain an important treatment option for obesity and diabetes,” said Dr Aminian. “These long-term benefits are harder to achieve with GLP-1 medicines alone, as many patients stop using the medications over time.”
According to the authors, the study has some limitations. It was observational rather than a randomized comparison of drugs and surgery, and it did not focus exclusively on the newest and most effective GLP-1 medicines. The researchers note that future studies should directly compare surgery with newer GLP-1 therapies, such as semaglutide and tirzepatide, to further guide treatment decisions.
