GLP-1RA Use May Lower Overall Cancer Risk but Increase Kidney Cancer Risk in Obese Patients: JAMA

USA: A new study published in JAMA Oncology has revealed that glucagon-like peptide-1 receptor agonists (GLP-1RAs), widely used for type 2 diabetes management and weight loss, may have an impact on cancer risk among adults with obesity.

The research, led by Hao Dai and colleagues from the Department of Biostatistics and Health Data Science, Indiana University School of Medicine, explored the association between GLP-1RA use and the likelihood of developing cancer.
GLP-1RAs have become increasingly popular as anti-obesity medications, but their long-term safety profile, particularly to cancer, has remained unclear. To address this, the investigators conducted a retrospective cohort study using electronic health record data from OneFlorida+, a large multicenter health research network, covering the period from 2014 to 2024. The analysis followed a target trial emulation approach to ensure robust comparisons between users and nonusers of GLP-1RAs.
The study population included 86,632 adults aged 18 years and older, all eligible for anti-obesity medications and free from prior cancer diagnoses. Participants were matched in a 1:1 ratio using propensity scores, resulting in two groups: 43,317 individuals who used GLP-1RAs and 43,315 who did not. The average age of participants was 52.4 years, and women constituted 68.2% of the sample.
Researchers evaluated the incidence of 14 cancers, including 13 obesity-related types—such as liver, pancreatic, colorectal, breast, and endometrial cancers—along with lung cancer.
The key findings of the study were as follows:
  • The overall cancer incidence rate was 13.6 per 1,000 person-years among GLP-1RA users compared to 16.4 per 1,000 person-years in nonusers.
  • This difference reflected a significantly lower overall cancer risk for GLP-1RA users, with a hazard ratio (HR) of 0.83.
  • GLP-1RA use was associated with a reduced risk of endometrial cancer, with an HR of 0.75.
  • The risk of ovarian cancer was also lower among GLP-1RA users, with an HR of 0.53.
  • Meningioma risk showed a decrease as well, with an HR of 0.69 in individuals taking GLP-1RAs.
  • A marginal, nonsignificant increase in kidney cancer risk was noted among GLP-1RA users, with an HR of 1.38.
The authors concluded that while GLP-1RA therapy appears to lower the overall risk of cancer in individuals with obesity, the possibly elevated risk for kidney cancer warrants attention. They emphasized the importance of long-term follow-up studies to better understand these associations and uncover the underlying biological mechanisms.
These findings add an important dimension to the discussion around GLP-1RA use, suggesting potential protective effects against several cancers while highlighting the need for ongoing safety evaluations as these drugs continue to be widely prescribed.
Reference:
Dai H, Li Y, Lee YA, et al. GLP-1 Receptor Agonists and Cancer Risk in Adults With Obesity. JAMA Oncol. Published online August 21, 2025. doi:10.1001/jamaoncol.2025.2681

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Stress Hyperglycemia Ratio and Hypertension Closely Associated with Stroke Risk: Study

A new study published in the BMC Cardiovascular Diabetology found the importance of a novel metabolic marker, the stress hyperglycemia ratio (SHR), in predicting stroke risk-especially when combined with hypertension.

The study used data from the China Health and Retirement Longitudinal Study (CHARLS), followed 9,682 stroke-free participants aged 45 years and older from 2011 through 2020. This research calculated SHR using 2 indicators, the fasting blood glucose and glycated hemoglobin (HbA1c), to integrate both short-term stress-induced changes and long-term glycemic levels.

The participants were divided into 4 groups based on whether they had high or low SHR and whether they had hypertension. Over a median follow-up of 8.43 years, covering more than 81,000 person-years, the study documented 764 new stroke cases. This translated to an incidence rate of 9.36 strokes per 1,000 person-years.

The individuals with both high SHR and hypertension faced the highest risk of stroke, with a hazard ratio of 2.94 when compared to the individuals with low SHR and no hypertension. Even when considered separately, both SHR and hypertension independently increased the risk of stroke.

The risk escalated progressively from having neither risk factor, to one of the two, and peaked in individuals with both. The subgroup analyses showed that this pattern held true across both men and women, as well as across different age categories.

To test the predictive strength of SHR, the team performed a receiver operating characteristic (ROC) curve analysis. While hypertension alone is a known predictor of stroke, adding SHR significantly improved the ability to discriminate who was at higher risk. The combined model achieved an area under the curve (AUC) of 0.653 which suggested better performance than traditional risk factors alone.

The findings suggest that SHR reflects both acute stress responses and chronic glucose imbalances, making it a more comprehensive indicator of metabolic stress than fasting glucose or HbA1c alone.

Overall, this research suggests that measuring SHR along with blood pressure screening could improve stroke risk assessment tools, particularly in populations already burdened by hypertension. This integrated approach may open the door to earlier interventions and more targeted prevention strategies, ultimately reducing the global stroke burden.

Reference:

He, Y., Cao, Y., Xiang, R., & Wang, F. (2025). Predictive value and robustness of the stress hyperglycemia ratio combined with hypertension for stroke risk: evidence from the CHARLS cohort. Cardiovascular Diabetology, 24(1), 336. https://doi.org/10.1186/s12933-025-02898-z

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Low-Dose Glucagon Reduces Exercise-Induced Hypoglycemia in Type 1 Diabetes, finds study

Exercise can dramatically lower blood glucose levels and trigger hypoglycemia in people with type 1 diabetes (T1D), even when insulin doses are adjusted. A new systematic review and meta-analysis, published in Diabetes Care, found that low-dose glucagon effectively reduces the risk of exercise-induced hypoglycemia and time spent below target glucose range (TBR) in this population.

The authors pooled data from 12 randomized and crossover trials involving 248 adolescents and adults with T1D. Low-dose glucagon reduced the risk of hypoglycemic events by about 46%, with a pooled risk ratio of 0.54 (95% CI 0.35–0.84). It also lowered TBR by an average of approximately 3.9 percentage points (95% CI –6.27 to –1.54), indicating a meaningful reduction in time spent with glucose below 3.9 mmol/L. Despite these promising effects, low-dose glucagon was associated with a higher rate of mild adverse events-a pooled risk ratio of 2.75 (95% CI 1.07–7.08)-though most were mild gastrointestinal symptoms or injection-site discomfort.

The authors emphasize that optimizing the dose and timing of glucagon relative to different exercise types and durations requires further investigation to ensure real-world effectiveness and safety.

They also note varying methodologies across included studies, suggesting cautious interpretation and the need for standardized protocols in future work. Clinically, this analysis supports using low-dose glucagon as an adjunctive strategy for preventing exercise-induced hypoglycemia in T1D, especially for active individuals facing daily glucose fluctuations. It can offer an alternative to carbohydrate loading-which may interrupt activity or risk hyperglycemia-while maintaining glycemic stability.

However, patients and clinicians should balance benefits against mild side effects and await more data on dosing strategies.

Reference:
Nørgaard, K., Laugesen, C., & Ranjan, A. G. (2025). Low-dose glucagon reduces exercise-induced hypoglycemia and time below range in type 1 diabetes: A systematic review and meta-analysis. Diabetes Care, 48(9), 1637–1645. https://doi.org/10.2337/dc25-0702

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Inhaled Insulin Shows Promise as Safe Option for diabetes management in Pregnancy: Study

A study published in Pregnancy suggests that inhaled technosphere insulin may be a safe alternative to rapid-acting insulin analogs for diabetes management during pregnancy. Cases demonstrated effective postprandial blood glucose control, and researchers recommend further studies comparing efficacy and safety with rapid-acting insulin analogs.

The case series, conducted by researchers from the University of Texas, reported outcomes in pregnant women with diabetes who used technosphere insulin during the gestational period. The investigators observed that inhaled insulin was effective at reducing post-meal glucose spikes, a key challenge in diabetes management during pregnancy. Importantly, no major maternal or neonatal safety concerns were identified.

Technosphere insulin, delivered via inhalation, has been previously studied as a non-invasive alternative to subcutaneous injections in patients with type 1 and type 2 diabetes. In pregnancy, where insulin requirements fluctuate due to hormonal changes, the ability to achieve tighter postprandial control without increasing hypoglycemia risk is particularly valuable.

The study highlights the potential benefits of inhaled insulin for pregnant patients who face challenges with multiple daily injections or who experience significant anxiety related to injectable therapy. Researchers also noted that patient adherence and satisfaction appeared higher with inhaled insulin, which could translate to improved long-term glycemic outcomes.

However, the authors caution that the current evidence is limited to small case series, and randomized controlled trials are needed to directly compare inhaled technosphere insulin with established rapid-acting analogs in pregnant populations. Until such data are available, the use of inhaled insulin in pregnancy should be considered experimental and reserved for carefully selected cases under close supervision.

The findings add to the growing discussion on expanding treatment options for diabetes management in pregnancy, where balancing maternal safety and fetal health remains critical.

Reference:
Parchem, J. G., Anderson, K. R., Alfaris, N., Sarma, V., Henry, R. R., & Demirci, C. (2025). Technosphere inhaled insulin use during pregnancy: Case series. Pregnancy. Advance online publication. https://doi.org/10.1097/PR9.0000000000000166

Keywords: inhaled insulin, technosphere insulin, pregnancy, diabetes management, gestational diabetes, type 1 diabetes, type 2 diabetes, maternal outcomes, neonatal safety, rapid-acting insulin analogs

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GLP-1 Agonists Tied to Slightly Increased Risk of New-Onset Diabetic Retinopathy: JAMA

USA: A large retrospective cohort study has revealed that the use of GLP-1 receptor agonists was associated with a 7% higher risk of developing new-onset diabetic retinopathy, although it did not increase the progression to proliferative retinopathy or diabetic macular edema. Regular eye screening is recommended for all patients taking these medications. 

The research, published in JAMA Network Open by David J. Ramsey, MD, PhD, MPH, from the Department of Ophthalmology, Tufts University School of Medicine, Boston, and colleagues, examined whether glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with sight-threatening eye complications in patients with type 2 diabetes (T2D). While GLP-1 RAs are increasingly used for glycemic control and weight loss, concerns remain regarding their ocular safety profile.

Using data from the TriNetX database, the investigators analysed records from 185,066 adults with T2D and a hemoglobin A1c of at least 6.5%. Participants were matched through propensity score methods based on whether they had received at least two GLP-1 RA prescriptions, spaced six months apart. The follow-up period spanned two years, with outcomes assessed using Cox proportional hazard models.

Key Findings

  • GLP-1 RA use was linked to a modest but statistically significant increase in the incidence of diabetic retinopathy (HR, 1.07).
  • There was no significant increase in cases of nonarteritic anterior ischemic optic neuropathy (HR, 1.26).
  • In patients with preexisting diabetic retinopathy, GLP-1 RAs did not associate with progression to proliferative diabetic retinopathy (HR, 1.06) or diabetic macular edema (HR, 0.98).
  • Treatment was associated with reduced rates of vitreous hemorrhage (HR, 0.74), neovascular glaucoma (HR, 0.78), and new-onset blindness (HR, 0.77).

The findings suggest that while GLP-1 RAs may slightly raise the risk of developing diabetic retinopathy, they do not accelerate its advancement to more severe stages and may even reduce the occurrence of serious vision-threatening complications.

The authors noted several limitations, including reliance on electronic health records, which may vary in coding practices and completeness, and the absence of consistent HbA1c measurements to assess the role of rapid glucose lowering. Additionally, the study could not account for all social determinants of health or differences in access to ophthalmic care, which might influence detection and treatment rates. The lack of eye examination data, reliance on administrative coding for blindness, and the inability to distinguish among specific GLP-1 agents also constrain the interpretation.

Despite these limitations, the researchers emphasize the importance of regular ophthalmologic monitoring for all T2D patients prescribed GLP-1 RAs, regardless of their baseline retinal status. Further studies are needed to clarify whether the protective association with certain complications translates into long-term reductions in vision loss.

Reference:

Ramsey DJ, Makwana B, Dani SS, et al. GLP-1 Receptor Agonists and Sight-Threatening Ophthalmic Complications in Patients With Type 2 Diabetes. JAMA Netw Open. 2025;8(8):e2526321. doi:10.1001/jamanetworkopen.2025.26321

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Chitinase-3-like protein 1: a novel biomarker for liver disease diagnosis and management, finds study

The identification of Chitinase-3-like protein 1 (CHI3L1) as a crucial biomarker in liver disease is revolutionizing how clinicians approach the diagnosis, monitoring, and treatment of various liver conditions. As a member of the glycoside hydrolase family 18, CHI3L1 is recognized for its unique ability to bind to ligands and influence multiple pathophysiological processes, despite lacking enzymatic activity. This distinctive protein plays a key role in mediating cell proliferation, inflammation, fibrosis, and carcinogenesis.

Liver diseases, including hepatitis-related fibrosis, non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), and hepatocellular carcinoma (HCC), represent significant global health challenges. Early and accurate diagnosis is critical to managing these conditions effectively, but traditional methods such as liver biopsy are invasive and not ideal for frequent monitoring. Serum biomarkers offer a non-invasive alternative, and CHI3L1 has emerged as a reliable marker, especially for diagnosing and staging hepatic fibrosis. Elevated levels of CHI3L1 correlate with fibrosis severity, particularly in patients with chronic hepatitis B (CHB) and chronic hepatitis C (CHC), where it demonstrates superior diagnostic efficacy compared to conventional markers like hyaluronic acid (HA) and FIB-4.

In addition to its diagnostic capabilities, CHI3L1 plays a significant role in evaluating fibrosis progression and monitoring the efficacy of antiviral therapies. The protein’s levels increase proportionally with the advancement of liver fibrosis, making it a practical tool for assessing treatment response. Furthermore, CHI3L1 has shown promise in distinguishing between simple steatosis and non-alcoholic steatohepatitis (NASH), which is vital for identifying patients at higher risk of progressing to cirrhosis or HCC. Combining CHI3L1 with other markers, such as alpha-fetal protein (AFP) and platelet count, enhances diagnostic accuracy, particularly in detecting significant fibrosis and advanced stages of liver disease.

One of the most promising applications of CHI3L1 is its potential to predict the prognosis of HCC. Studies indicate that elevated CHI3L1 levels correlate with poor survival rates, especially after curative resection. When combined with AFP, CHI3L1 significantly improves the diagnostic accuracy for HCC, offering clinicians a more reliable method for early detection and risk assessment. The integration of CHI3L1 measurements with routine clinical practice could transform patient management by enabling more precise risk stratification and tailored therapies.

The growing body of evidence supports the use of CHI3L1 not only as a biomarker for liver fibrosis but also as a potential therapeutic target. As a key regulator of fibrosis and inflammation, targeting CHI3L1 could mitigate disease progression and improve outcomes for patients suffering from chronic liver diseases. Further research into the molecular mechanisms underlying CHI3L1’s actions will enhance our understanding of liver pathology and pave the way for novel therapeutic strategies.

Reference:

Chao Tian, Shizhou Deng, Ming Yang, Baochen Bai, Lai Wei, Role of chitinase-3-like protein 1 in liver diseases: A comprehensive review, Genes & Diseases,  https://doi.org/10.1016/j.gendis.2025.101653.

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UP DGME Releases NEET MDS Stray Vacancy Revised Schedule 2025

Lucknow: The Directorate General of Medical Education and Training (DGME), Uttar Pradesh, has released the revised time schedule for the Stray Vacancy Round of Online Counseling for UP NEET MDS-2025.

In continuation of the revised time-table issued by Medical Counselling Committee (MCC), New Delhi for counseling of NEET MDS course, the revised time-table of Stray Vacancy Round of online counseling for admission of state quota seats of MDS course in Government/Private Dental Colleges/Universities of the State is as follows:-

S.No. Description Dates Total Days
1 Date of online registration 26th
August 2025 (From 11:00 AM) to 29th August 2025 (Till 11:00 AM)		 03 days
2 Date of depositing registration fee and security Fee 26th
August 2025 (From 11:00 AM)
to 29th
August 2025 (Till 02:00 PM )		 04 days
3 Date of declaration of merit list 29th
August 2025		 01 days
4 Date of online choice filling 29th
August 2025 (From 05:00 PM) to 02nd September 2025 (Till 02:00 PM )		 04 days
5 Date of declaration of result of seat allotment 03rd September 2025 01 days
6 Date for downloading allotment letters and admission process 04th
September 2025 to 06th September 2025 & 08th September 2025		 04 days

To participate in the stray vacancy round, it is mandatory for all eligible candidates to get fresh registration done by paying Rs. 3000/- (Rs. Three Thousand only) as online registration fee separately.

To view the official notice click here: https://medicaldialogues.in/pdf_upload/1919-and-1921-298454.pdf

The Medical Counselling Committee (MCC) has extended the National Eligibility and Entrance Test-Master of Dental Surgery (NEET-MDS) Stray vacancy Round Counselling schedule for the academic year 2025 for the All India Quota and State Quota seats.

As per the new schedule, the NEET-MDS Stray vacancy Round counselling for the students who qualified the UG medical entrance test will now commence on 26th July for the All India Quota/Deemed/Central Universities seats. Whereas, the academic session for the UG courses shall commence from 8th September 2025.

Also Read:MCC Extends NEET MDS 2025 Stray Vacancy Round Counselling, Registration Begins August 26

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MBBS, BDS 2025: Adhere to Court orders, NMC guidelines- TN private medical colleges warned

Tamil Nadu- The Tamil Nadu private medical colleges have been warned to adhere to Supreme Court, High Court orders and the National Medical Commission guidelines with respect to the MBBS and BDS admissions 2025.

The Tamil Nadu (TN Health) has issued a notification for all the Deans and Principals of Self-Financing Medical Institutions regarding the admission into the MBBS & BDS counselling for the academic year 2025-2026.

Through the notification, all the Deans and Principals of Self-Financing Medical Institutions are advised to strictly adhere to the Directions of the Hon’ble Supreme Court of India and High Court orders and National Medical Commission (NMC) guidelines without fail.

Also Read: TN NEET Round 1 Counselling Seat Allotment Result OUT, Candidates Must Report by August 24

However, if any Self Financing Institutions refuse to admit the candidate in any round of MBBS & BDS counselling for the academic year 2025-2026 and demand a Higher fee other than the fee prescribed by the Fee Fixation Committee, strict action will be initiated against the institutions by the Government.

On receipt of any specific complaints from the candidates, action will be taken against the respective institution, including the withdrawal of approval or cancellation of affiliation of the college through the appropriate authorities.

The Tamil Nadu National Eligibility and Entrance Test-Undergraduate (NEET UG) Counselling 2025 Round 1 Seat Allotment Result on August 18, 2025. 

On this, Medical Dialogues has reported that candidates who have secured their seats in MBBS and BDS courses must download their allotment letter and report to their allotted colleges/institutions with their official personal and academic documents to proceed with the admission procedures to confirm their seats by August 24, 2025. Failure to comply will result in the cancellation of the seat.

However, those who are not allotted any seat in Round 1 will get a second chance in Round 2 counselling, for which the schedule is likely to be released soon. Those who want to upgrade the seat can also apply for the second round.

To view the notification, click the link below

https://medicaldialogues.in/pdf_upload/tn-health-warns-self-financing-medical-colleges-for-mbbs-bds-admission-2025-26-298491.pdf

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Mandatory Excipients Disclosure on Drug Labels from March 2026: Health Ministry

New Delhi: All drug labels will now be required to clearly disclose the qualitative details of excipients along with the date of expiry, as the Union Health Ministry has notified the Drugs (Second Amendment) Rules, 2025 through a Gazette notification. The amended rules will come into force from March 1, 2026.

According to the Gazette notification, Rule 96 of the Drugs and Cosmetics Rules, 1945, has been revised to strengthen transparency in drug labelling. “The qualitative details of the excipients used in the drug along with the date of expiry of potency, wherever applicable, shall be printed on the label of the innermost container of the drug,” the amendment states.

Rule 96 of the Drugs and Cosmetics Rules, 1945, governs the labelling requirements for all pharmaceutical products sold in India. It specifies the information that must appear on drug packaging, including the name and quantity of active ingredients, manufacturing and expiry dates, storage conditions, batch number, and directions for use. The recent amendment now mandates that the qualitative details of excipients—the inactive substances used in drug formulation—be printed on the label of the innermost container, ensuring greater transparency for healthcare professionals and patients.

The move follows recommendations of the Drugs Technical Advisory Board (DTAB), which had earlier emphasized the importance of including excipient details on labels to enhance patient safety and prescribing decisions.

The Health Ministry also noted that the changes were introduced after due consultation and are aimed at ensuring better compliance and safety standards for consumers as well as healthcare professionals.

Also Read: CDSCO Panel Approves Phase IV Protocol Amendment for Bristol-Myers Squibb’s Mavacamten Study

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CDSCO Cancels Import Licence of Mediderma Salipeel Products

New Delhi: The Central Drugs Standard Control Organisation (CDSCO) has cancelled the import registration of two cosmetic products of Satnam and Company after finding them in violation of the Cosmetics Rules, 2020, due to excessive concentration of salicylic acid beyond permissible limits.

According to the order issued by the Licensing Authority, a show cause notice had been served to the firm on April 7, 2025, for violation of Rule 39 of the Cosmetics Rules, 2020 and condition number 03 of the Registration Certificate. The notice was issued after scrutiny revealed that “the cosmetic product MEDIDERMA – SALIPEEL PLUS was found to contain salicylic acid in concentration at 25% as per the label claim and another product MEDIDERMA – SALIPEEL LIC was found to contain salicylic acid in concentration of 15% as per the list of ingredients.”

As per regulatory provisions, Salicylic acid (CAS No. 69-72-7) is allowed as a cosmetic ingredient only at restricted levels—“3% and 2% concentration for rinse-off hair products and other products respectively”—under Serial Number 98 of Annex B of IS 4707 (Part 4:2017).

The CDSCO order notes that the firm admitted in response to the show cause notice that these products are no longer part of its import activities in India.

Taking into account the violations, Dr Raghuvanshi, Drugs Controller General (India) and Central Licensing Authority, stated in the cancellation order, “Keeping in view of the violation of Rule 39 of the Cosmetics Rules, 2020 and condition number 03 of the Registration Certificate, thereby order to cancel the registration of the products containing salicylic acid, registered under RC/COS-003827 mentioned at serial Nos.76 and 81 from the date of issue of this order.”

The cancelled registration pertained to RC/COS-003827, originally granted to the firm on May 2, 2023, valid until May 1, 2028. The order has been circulated to all Zonal, Sub-Zonal and Port Offices of CDSCO, as well as State Drug Controllers, to ensure compliance.

Also Read: Sun Pharma’s Dapagliflozin, Glimepiride, Metformin FDC Fails to Secure CDSCO Panel Nod Over Safety, Utility Concerns

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