The findings, published in Communications Medicine, are based on nearly two decades of electronic health records from more than 650,000 U.S. adults with IBS, making it the largest real-world study to examine the long-term safety of IBS treatments.

IBS is a chronic gastrointestinal condition affecting about 10% of the U.S. population. There is no cure, but dietary modifications, behavioral therapy and medications can help manage symptoms.

“Many patients are diagnosed with IBS at a young age and may remain on medications for years,” said Ali Rezaie, MD, medical director of the GI Motility Program at Cedars-Sinai and senior author of the study. “However, most clinical trials of these medications last less than a year, so we know very little about their long-term safety. This study begins to address that gap.”

Researchers assessed patients taking Food and Drug Administration-approved IBS medications, as well as antidepressants, antispasmodics and opioid-based antidiarrheal drugs, such as loperamide and diphenoxylate—widely used and recommended in IBS care. They found that long-term antidepressant use was associated with a 35% higher risk of death, and that loperamide and diphenoxylate use were associated with roughly double the risk of death.

The study does not establish that these medications directly cause death; rather, the observed associations may reflect higher rates of adverse outcomes, such as cardiovascular events, falls and stroke, which were more frequent among exposed patients.

Although antidepressants are not FDA-approved for IBS, they are commonly prescribed for IBS patients to help reduce pain, calm symptoms and make the condition easier to manage. The study found that other recommended treatments, including FDA-approved medications and antispasmodics, were not associated with increased mortality risk.

Researchers emphasized that while the increase in risk is significant and may sound concerning, the overall risk to any individual patient is small.

“IBS patients should not panic, but they do need to understand and weigh the small but meaningful risks when considering long-term treatments,” said Rezaie, the director of Bioinformatics at the Medically Associated Science and Technology (MAST) Program at Cedars-Sinai. “Patients should speak with their healthcare provider about the safest and most effective options for managing their symptoms.”

Rezaie said more research is needed to confirm these findings and identify which patients may be at greatest risk. He also called for future treatment guidelines to better address the long-term safety of medications commonly used to manage IBS.

In the meantime, he emphasized a more personalized approach to IBS patient care.

“Treatment for IBS patients should focus on identifying the underlying causes and using the safest, evidence-based options available rather than relying on a single class of medications for long-term management,” Rezaie said.

Additional Cedars-Sinai authors include Sepideh Mehravar, MD, Yee Hui Yeo, MD, and Mark Pimentel, MD.

Other authors include Parnian Naji, MD, Wee Han Ng, Nils Burger, PhD, and Will Takakura, MD.

Conflicts of Interest: Mark Pimentel is also a consultant for and received grant support from Bausch Health. Ali Rezaie reports serving as a consultant for Bausch Health and Ardelyx. In addition, Cedars-Sinai Medical Center has a licensing agreement with Gemelli Biotech. Ali Rezaie and Mark Pimentel have equity in Gemelli Biotech and Good LFE. The remaining authors disclose no conflicts.

In the past few years there has been a lot of criticism of the BMI system due to its inability to accurately capture body fat percentage or distribution, in order to correctly categorise weight status based on adiposity explains Professor Marwan El Ghoch, of the Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.  He adds that, despite these concerns, BMI as a weight classification system continues to be used in the general population in primary healthcare (i.e. general practitioners) and non-clinical (i.e. policy and health insurance) settings.

In this new study, Professor El Ghoch and researchers from the University of Verona in Italy and Beirut University in Lebanon set out to determine the validity of the BMI classification system, specifically regarding its ability to identify correctly those with overweight and obesity, in a sample of the general population who had all had their body fat measured using DXA. With DXA, the person’s age and body fat percentage is used to decide their weight status category according to their level of adiposity.*

The study included 1351 adults of mixed gender aged between 18 and 98 years (60% female) all of whom were referred to the Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy. All the participants in this study where White Caucasian (due to BMI variations in different ethnicities).

According to the WHO BMI system, among these participants there were 19 (1.4%) underweight individuals (BMI under 18.5), 787 (58.3%) normal weight (BMI 18.5-25), 354 (26.2%) with overweight (BMI 25-30), and 191 (14.1%) with obesity (BMI over 30). The overall prevalence of approximately 41% for overweight and obesity combined is consistent with the local population in the Veneto region of Italy. Participants were then re-categorised according to adiposity based on body fat percentage (BF%) measured by DXA.

DXA revealed that more than one third (34%) of those with obesity defined by BMI had been misclassified and should be in the overweight category. For those with an overweight BMI, DXA showed that more than half – 53% – had been misclassified – three quarters of those misclassified fall into the normal weight category, while the other quarter should have been classified as having obesity.

BMI and DXA had better agreement when considering those with a normal weight BMI (18.5 to 25), with DXA agreeing in 78% of cases. But 22% of those with normal weight were given a different category with DXA (9.7% underweight, 11.4% overweight and 0.8% obesity). Finally, despite the small absolute numbers, the biggest BMI-DXA disagreement was found in the underweight group – two thirds (13 of 19; 68.4%) in the underweight category defined by BMI (under 18.5) were in the wrong category when analysed by DXA – and should have been classified as having normal weight.

With all the correct and misclassifications combined, the DXA analysis found that the prevalence of overweight and obesity across the cohort was at around 37% overall (23.4% overweight, and 13.2% obesity, compared to 26.2% and 14.1% with BMI).

Professor El Ghoch, who led the study, says: “Our main finding highlights the fact that a large proportion of individuals, exceeding one-third of adults among the Italian general population, is misclassified and placed in an incorrect weight status category, when relying on the traditional WHO BMI classification resulting in an overestimation of the prevalence of underweight, overweight, and obesity when compared to the classification based on body fat percentage as measured by the gold standard technique of dual-energy X-ray absorptiometry (DXA).”

Study co-author, Professor Chiara Milanese, of the University of Verona, adds: “Another key finding of our study is that, even though both systems identify a similar overall prevalence of overweight and obesity,  we are talking in some cases about different people – or in other words the individuals identified by DXA are not all the same as those from BMI classification. This is due to the disagreement between WHO BMI and DXA-derived BF% classification systems in determining weight status in the general population among body weight ranges and age groups of both genders.”

Accordingly, the authors conclude: “Public health guidelines in Italy need to be revised to consider combining direct body composition or their surrogate measures such as skinfold measurement or body circumference – such as the waist-to-height ratio – with BMI while assessing weight status in the general population. We believe a similar level of misclassification can be expected in White Caucasian populations in other countries in Europe and Worldwide. However, to confirm this, and if a similar effect exists in other ethnicities, future research should extend the aim of our analysis to other countries across Europe and globally, as well as seeing if such misclassification occurs in people of other ethnicities.”

Professor Marwan El Ghoch, University of Modena and Reggio Emilia, Modena, Italy. T) +39 0592055371 E) m.elghoch@unimore.it

Tony Kirby in the ECO Media Centre. T) +44 7834 385827 E) tony.kirby@tonykirby.com

The authors confirm no conflicts of interest.

This press release is based on oral presentation 0360 at the European Congress on Obesity (ECO) in Istanbul, Turkey, 12-15 May. The material has been peer reviewed by the congress selection committee. The full paper has been published in the journal Nutrients. As such, the full paper is provided in place of the abstract.

The following thresholds are used in DXA – body fat values to give weight status:

For males:

18–39 years BF% < 8% (underweight); ≥8% (normal weight); ≥21% (overweight); ≥26% (obesity); 40–59 years BF% < 11% (underweight); ≥11% (normal weight); ≥23% (overweight); ≥29% (obesity) 60–98 years BF% < 13% (underweight); ≥13% (normal weight); ≥25% (overweight); ≥31% (obesity).

For females:

18–39 years BF% < 21% (underweight); ≥21% (normal weight); ≥33% (overweight); ≥39% (obesity); 40–59 years BF% < 23% (underweight); ≥23% (normal weight); ≥35% (overweight); ≥41% (obesity); 60–98 years BF% < 26% (underweight); ≥26% (normal weight); ≥36% (overweight); ≥41% (obesity).

For full paper, click here

The authors show that existing regulatory requirements for approval have so far only partially addressed many of these so-called “human factors-related risks”. This can create gaps that impact the safety and quality of care. To address these, the researchers identify seven key risks and develop practical recommendations for action that can be integrated into existing regulatory and documentation processes.

Risks in the use of AI systems

AI-based medical devices can be used in various areas of clinical environments. In radiology, for example, they assist in detecting cancer. Clinical decision support systems help select personalized therapies for patients.  AI can also support real-time monitoring and early warning systems, as well as chatbots for applications such as patient communication and software that automatically generate medical reports or summarize findings. The analysis focuses on risks that may arise in the practical use of such AI systems. These include, for example, an increased likelihood of outputs being misunderstood or misinterpreted due to the sometimes-opaque nature of AI systems. Problems can also occur when trust in the application is miscalibrated: resulting in users either relying too heavily on AI assistance or ignoring relevant recommendations. The researchers also point to the risk of automation bias: the tendency to uncritically adopt recommendations from automated systems, potentially overlooking errors or forgoing independent judgment. Additional risks include potential deskilling, technostress among users, an unchecked expansion of indications beyond the originally intended scope (indication creep), and errors related to system changes or different operating modes. Such factors can create additional burdens or unexpected failures in clinical practice – even when the technical performance of a system itself is strong.

A practical guide for manufacturers and evaluators

For their analysis, the research team evaluated existing standards on usability and safety, regulatory guidelines, alongside the scientific literature on AI in healthcare. In addition, expert discussions from the fields of clinical application, regulation, and human factors were incorporated. The result is a practical guide, that fills a gap in current standards, with seven recommendations. These are intended to support manufacturers and evaluators both before and after a product is placed on the market. The aim is to identify AI-specific risks in interaction with human users at an early stage and to address them systematically.

The framework recommends developing and deploying AI-based medical devices in a way that clearly defines the users, in which context the systems are applied, and which tasks are assigned to humans and which to the system. Furthermore, results should be presented in a way that is easy to understand, integrated into existing clinical workflows, and supplemented by training where needed as well as safe fallback options in the event of system failures. The authors emphasize the importance of continuous monitoring after market entry. Usage patterns, potential misuse, or overreliance on AI systems should be systematically observed and corrected as needed. Changes to the systems must also be communicated transparently so that work processes can be adjusted accordingly.

The recommendations are deliberately formulated in general but regulatory-aligned terms so that they can be applied to different AI-enabled medical devices and application scenarios. In a next step, the researchers aim to test and further develop their recommendations based on concrete pilot applications with AI-enabled medical devices. In the long term, human factors should be systematically considered in the regulation and evaluation of AI-based health technologies – reducing avoidable risks while supporting safe innovation in medicine.

The article was authored by researchers from TU Dresden (EKFZ for Digital Health, Chair of Industrial Design Engineering, and Faculty of Business and Economics), in collaboration with experts from the University of Oxford (United Kingdom) and Geneva University Hospital (Switzerland).

Publication

Rebecca Mathias, Anne Schmitt, Mateo Campos, Baptiste Vasey, Sebastian Lorenz, Peter McCulloch, Stephen Gilbert: Evaluation of Human Factors-Related Risks in AI-Enabled Medical Devices: A Practical Guide, NEJM AI, 2026. Link: https://ai.nejm.org/doi/full/10.1056/AIpc2501297

Else Kröner Fresenius Center (EKFZ) for Digital Health

The EKFZ for Digital Health at the Faculty of Medicine at TUD Dresden University of Technology and University Hospital Carl Gustav Carus Dresden was established in September 2019. It receives funding of around 40 million euros from the Else Kröner Fresenius Foundation for a period of ten years. The center focuses its research activities on innovative, medical and digital technologies at the direct interface with patients. The aim here is to fully exploit the potential of digitalization in medicine to significantly and sustainably improve healthcare, medical research and clinical practice.

This ‘overview’ of systematic reviews summarises existing evidence from several systematic reviews and makes the findings more accessible.  The overview pooled the evidence from fourteen systematic reviews of smoking cessation interventions from 2014 to 2023.

Findings from higher-quality reviews consistently showed greater smoking cessation with nicotine-containing e‑cigarettes than other interventions. Lower-quality reviews produced more variable and imprecise estimates. When restricted to higher-quality evidence, results consistently favoured nicotine e‑cigarettes over nicotine replacement therapy, non-nicotine e-cigarettes, and other comparators.

The overview also created an ‘Evidence and Gap Map’ (EGM) to identify gaps in the current evidence that urgently need to be filled.  There are currently no high-quality systematic reviews directly comparing nicotine e-cigarettes with cytisine, bupropion, or nicotine pouches.  Also, direct evidence comparing nicotine e-cigarettes with varenicline is extremely limited, with only a single small trial at high risk of bias.

The EGM also showed that current evidence of serious adverse events associated with e-cigarettes is inconclusive, and that most of the studies collected data from high-income countries.  Future primary research on e-cigarettes for smoking cessation should continue to collect data on serious adverse events and expand its data collection to include low-and middle-income countries.

Lead author DrAngela Difeng Wu, Senior Researcher and Lecturer at the Nuffield Department of Primary Care Health Sciences, University of Oxford, says “We hope this overview and Evidence and Gap Map can lay to rest some claims that evidence is ‘mixed’ regarding the impacts of nicotine e-cigarettes on smoking abstinence.  In fact, the evidence is clear and consistent across all of the meta-analyses we consulted:  e-cigarettes are effective at helping people stop smoking.”

To speak with lead author Dr Angela Difeng Wu, please contact her at the Nuffield Department of Primary Care Health Sciences, University of Oxford by email (angela.wu@phc.ox.ac.uk).

Full citation for article: Wu AD, Conde M, Butler AR, Knight E, Lindson N, Livingstone-Banks J, Hajek P, McRobbie H, Begh R, Theodoulou A, Notley C, Turner T, Zhitnik E, and Hartmann-Boyce J. Electronic Cigarettes for Smoking Cessation: An Overview of Systematic Reviews and Evidence and Gap Map.  Addiction. 2026. DOI: 10.1111/add.70388.

The study, published in the journal Health Psychology, found that adults who followed more routine eating patterns, such as repeating the same meals and keeping calorie intake steady over time, lost more weight during a 12-week behavioral weight loss program than those who ate a more varied diet.

“Maintaining a healthy diet in today’s food environment requires constant effort and self-control,” said lead author Charlotte Hagerman, PhD, of the Oregon Research Institute. “Creating routines around eating may reduce that burden and make healthy choices feel more automatic.”

Researchers analyzed detailed, real-time food logs from 112 overweight or obese adults who were enrolled in a structured behavioral weight loss program. Participants were asked to track everything they ate each day using a mobile app, along with daily weigh-ins using a wireless scale. To ensure the data reflected consistent habits, researchers focused on the first 12 weeks of the program — a period when participants are typically most engaged and accurate in tracking their food intake.

The researchers then measured how “routinized” each person’s diet was in two ways. First, they looked at caloric stability, or how much a person’s daily calorie intake fluctuated from day to day and between weekdays and weekends. Second, they examined dietary repetition, tracking how often participants logged the same meals and snacks over time, rather than constantly choosing new foods.

In the end, those who repeated many of the same foods rather than eating a wide variety lost an average of 5.9% of their body weight, compared with 4.3% among those whose diets were more varied. The study also found that greater day-to-day calorie consistency was linked to better results. For every 100-calorie increase in daily fluctuation, weight loss decreased by about 0.6% over the study period.

The findings suggest that simplifying food choices, such as creating a rotation of go-to meals and maintaining a steady calorie intake, may help people build sustainable habits in a challenging food environment. However, the researchers caution that the study shows a correlation, not cause and effect, and that factors like motivation or self-discipline may also play a role.

The authors also acknowledge that previous research has linked dietary variety with better health status. However, these studies have mostly focused on dietary variety within healthy food groups, like fruits and vegetables. “If we lived in a healthier food environment, we might encourage people to have as much variety in their diet as possible,” Hagerman said. “However, our modern food environment is too problematic. Instead, people may do best with a more repetitive diet that helps them consistently make healthier choices, even if they might sacrifice some nutritional variety.”

One unexpected finding of the study was that participants who logged higher calorie totals on weekends compared with weekdays also lost more weight. Hagerman said this most likely reflects stronger tracking habits rather than higher food intake, since people often are not as consistent with their tracking on weekends.

Still, says Hagerman, the takeaway is straightforward: when it comes to weight loss, consistency may matter more than variety.

Article: “Do Routinized Eating Behaviors Support Weight Loss? An Examination of Food Logs from Behavioral Weight Loss Participants,” by Charlotte Hagerman, PhD, Oregon Research Institute; Asher E. Hong, B.S., Drexel University; Nicole T. Crane, PhD, Drexel University; Meghan L. Butryn, PhD, Drexel University; Evan M. Forman, PhD, Drexel University. Health Psychology, published online March 26, 2026.

Contact: Charlotte Hagerman, PhD, can be reached at chagerman@ori.org.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA’s membership includes 190,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve lives.

Research led by the University of Southampton and King’s College London examined the experiences of parents navigating waiting lists for ADHD diagnosis with Child and Adolescent Mental Health Services (CAMHS) in the UK.

NHS data for the end of September 2025 shows that of those children (up to 17 years old) waiting for an assessment with the service, over 63 percent spent more than a year on the list, and a third of these were waiting over two years.

“CAMHS are experiencing  enormous demand to offer timely support to young people. Staff working in these services are under huge pressure, and in-turn, parents and their children, are also suffering – with some concern that long wait times could exacerbate ADHD symptoms,” explains lead author Dr Ellen Hedstrom.

She adds: “Through our study, we wanted to better understand how parents experience the time between their child’s referral, an ADHD assessment, and a diagnostic outcome. Also, what impact this has on them and their child.”

Study findings are published in the journal Health Expectations.

The researchers conducted anonymised interviews with a total of 41 parents of children aged between five and 11 years old. Their wait times ranged between seven months and over two years. Thirty percent of participants fell between an 18 and 24 month wait, and ten percent over two years. About 50 percent of children hadn’t had their initial ADHD assessment at the time of interview.

Strong feedback was given to the research team by parents. Many of felt that:

• Communication about wait time status was either non-existent or unsatisfactory.

• Lengthy wait times negatively impacted the mental health and wellbeing of both themselves and their child.

• Uncertainty led them to feelings of powerlessness, anxiety and being forgotten.

• Finding a crisis care contact was a struggle, or that support they’d accessed was inadequate.

• There’s pressure to get a diagnosis because it can be essential to access support or treatment, for example at school.

Many parents believed there was a disparity between the support they felt they needed and the support they received.

As one parent, Jayne, put it: “It’s hard because there is no support, at the moment, until you get that diagnosis and you’re forever in limbo.”

Another, Jaz, said: “We’ve wasted over 2 years of her education, it is a huge percentage. And in that time, she was just getting further and further behind.”

Others were grappling with whether they should try and find the money to go private, as in the case of Sarah: “We are struggling a bit and it would be nice to know whether we should be trying to save up to get him seen privately, if it’s gonna be years and years, then that’s what we’d do. If it’s gonna be another 6 months, then we’ll wait.”

At the same turn, there was also empathy for health care staff and understanding that clinical services are under enormous strain. Some parents said they wanted to place as few demands as possible on staff, due to this.

Parents’ suggestions for improvement included regular updates of their status on the waiting list, including confirmation of wait times; a digitised system where parents could logon, check any progress, or book appointments; also, the idea of a named key-worker who they could turn to for help and support while waiting. Parents also expressed the need for help with skills and strategies for themselves to manage the behaviour of their children.

Meanwhile, the authors of the study point to a recent successful local authority scheme which piloted a neurodiversity tool – offering early profiling from trained professionals. This gave parents and schools  knowledge for early intervention to help children while they wait for formal diagnosis.

“Many tools and platforms already exist, or could be developed to meet the needs of CAMHS,” concludes Dr Hedstrom. “This would not only give parents more autonomy in the way that they manage their time on a wait list and how they access much-needed information, but also alleviate the burden on mental health services, resulting in a more efficient service.”

1. The paper, ‘Until You Get the Diagnosis You’re Forever in Limbo’—Parents’ Experiences of Waiting for an Attention-Deficit/Hyperactivity Disorder Assessment With Child and Adolescent Mental Health Services, is published in the journal Health Expectations – DOI: 10.1111/hex.70569 and can be read here: https://onlinelibrary.wiley.com/doi/10.1111/hex.70569
2. For interviews contact, Steve Williams, Media Manager, University of Southampton. +44 23 80593 212
3. The University of Southampton drives original thinking, turns knowledge into action and impact, and creates solutions to the world’s challenges. We are among the top 100 institutions globally (QS World University Rankings 2026). Our academics are leaders in their fields, forging links with high-profile international businesses and organisations, and inspiring a 25,000-strong community of exceptional students, from over 135 countries worldwide. Through our high-quality education, the University helps students on a journey of discovery to realise their potential and join our global network of over 300,000 alumni. www.southampton.ac.uk
4. For more about KCL visit: https://www.kcl.ac.uk/

DIY test kits for human papillomavirus (HPV) – a group of viruses responsible for more than 90% cervical cancer cases – will be offered to women across the UK who have delayed or been unable to attend their traditional screenings.

Announced as part of the NHS 10-Year Health Plan, the kits contain a vaginal swab similar to a long cotton-wool bud. The scheme is due to be rolled out later this year. Traditional screenings, commonly known as ‘smear tests,’ are generally conducted in person at GP clinics.

The new scheme aims to tackle barriers that discourage women from attending in-person screenings, such as discomfort, embarrassment and cultural sensitivities. While there are currently no plans to routinely offer them as an option for physically Disabled women, at-home kits will be offered to women who are under-screened or have never been screened.

Disabled women often face unique barriers to traditional cervical screening, such as challenges in getting to appointments, a lack of accessible clinic facilities, difficulties in getting into the required position for the test, and a lack of understanding from healthcare providers.

The National Institute for Health and Care Research (NIHR)-funded study, which surveyed 1,493 UK-based women and people with a cervix with physical disabilities or impairments, found a broadly positive response to at-home testing:

• 63 per cent said they would be able to perform the test themselves.
• Over half would choose a home-testing kit over an in-person screening if given the choice.

Sue Sherman, a Professor of Psychology from the University of Sheffield, said: “Physically Disabled women face significant barriers when it comes to accessing healthcare, and cervical screening is no different.

“Our study is the first of its kind to explore the attitudes of physically Disabled women and people with a cervix to self-testing as an alternative to clinician-led cervical screening.

“Our research indicates that many physically Disabled women – particularly those who have delayed, missed or never attended a screening – would find this option easier and preferable.

“Ultimately, introducing self-testing will move us closer to ensuring that everyone has access to potentially life-saving screening, regardless of their physical condition.”

Contributor to the study Alycia Hirani, who lives with Osteogenesis Imperfecta (colloquially known as ‘brittle bone disease’), said: “Disabled women deserve choice in healthcare. Expanding testing options and knowledge of alternatives like HPV screening can give so much more access, autonomy and can be life-saving to so many people.”

The study also found that over 70 per cent of the women surveyed had concerns about performing the test correctly. To help address this, researchers recommend

tailored instructions catering to different physical needs and improved training for clinicians to ensure equitable screening access for all.

Read the study in full in the Journal of Medical Screening.

The results suggest that the five-year risk of major cardiovascular events such as heart attacks and the risk of end-stage kidney disease were reduced by 15% and 19%, respectively, for the patients taking GLP-1-RA drugs such as semaglutide (Ozempic) and tirzepatide (Mounjaro). For the study, the researchers analyzed electronic health records data on about 175,000 type 1 diabetes patients in the U.S.

About 2 million Americans, including 314,000 children and adolescents, have been diagnosed with type 1 diabetes, according to the Centers for Disease Control and Prevention. The autoimmune disorder destroys the pancreas’s insulin-producing cells and requires lifelong insulin injections to control blood sugar levels.

The risks of side effects of particular concern for type 1 diabetes patients taking GLP-1-RAs—severe hypoglycemia and diabetic ketoacidosis; a severe lack of insulin, causing acid accumulation in the blood—were not increased among the patients taking these drugs.

The findings were published online March 19 in Nature Medicine.

“These risk reductions for heart and kidney disease outcomes are comparable to what we’ve seen for type 2 diabetes patients taking GLP-1-RA drugs, and it’s reassuring that we saw no sign of any new safety issues,” says study senior author Jung-Im Shin, MD, PhD, an associate professor in the Bloomberg School’s Department of Epidemiology.

Patients with type 1 diabetes face high lifetime risks of cardiovascular and kidney disease. Chronic excess blood sugar promotes atherosclerosis that leads to heart attacks and strokes, and elevated blood-sugar levels can damage the kidney’s urine-filtering structures. There have been few GLP-1-RA clinical trials that measure these outcomes in patients with type 1 diabetes.

Landmark clinical trials have found that GLP-1-RA drugs lower the risks of major cardiovascular events and kidney failure in type 2 diabetes patients by roughly 20%. An estimated 29 million Americans have been diagnosed with type 2 diabetes, according to the CDC.

“The type 1 diabetes population, compared to the type 2 diabetes population, is relatively small and relatively young, so it is inherently difficult to conduct a large-scale clinical trial that can show clear differences in cardiovascular and kidney event rates in this population within a reasonable time,” Shin says.

Two small trials in type 1 diabetes patients a decade ago suggested that the combination of insulin treatment and a GLP-1-RA could cause potentially severe low blood sugar levels (hypoglycemia), and reducing insulin to minimize this risk could cause a different serious complication called diabetic ketoacidosis.

For the new study, the researchers used de-identified electronic health records from a large commercial database covering patients from more than 60 health systems across the U.S. The analysis included 174,678 type 1 diabetes patients and covered January 2013 through March 2024. The team used a “sequential target trial emulation” design—mimicking a clinical trial-type protocol—and accounted for baseline differences between those who began taking GLP-1-RAs and those who didn’t.

The average five-year risk of major cardiovascular events was 4.3% in the GLP-1-RA group vs. 5.0% in the non-GLP-1-RA group, a relative risk reduction of about 15%. The data also suggested a risk reduction of about 21% for heart attacks and 16% for all-cause mortality. The five-year risk of end-stage kidney disease was 1.6% for the GLP-1-RA group vs. 1.9% for the non-GLP-1-RA group, for an estimated relative risk reduction of 19% among those taking GLP-1-RA.

The analysis also found that the GLP-1-RA group had estimated risk reductions of 18% for heart failure, and 28% for major adverse liver events. Patients who initiated GLP-1-RAs also were about 22% more likely to achieve weight loss of at least 10% over five years.

Safety-related outcomes were similarly encouraging. Estimated risks of hospitalization for hypoglycemia and for diabetic ketoacidosis were significantly lower—18% and 17% respectively—in the GLP-1-RA group.

“These findings suggest that physicians are being relatively careful when selecting the type 1 diabetes patients who will receive these drugs, and that the patients are adjusting their insulin doses appropriately,” Shin says. “While our study fills a critical knowledge gap and informs clinical practice for type 1 diabetes patients, ultimately large clinical trials are needed to confirm these findings.”

This study has limitations, including unmeasured confounding due to the nature of observational study design despite the rigorous adjustment methods, and potential misclassification of type 1 diabetes. In addition, only hospitalized cases of hypoglycemia and diabetic ketoacidosis were captured in this study.

“Glucagon-Like Peptide-1 Receptor Agonists for Major Cardiovascular and Kidney Outcomes in Type 1 Diabetes” was co-authored by Yunwen Xu, Natalie Daya Malek, Alexander R. Chang, Justin B. Echouffo-Tcheugui, Elizabeth Selvin, Morgan E. Grams, Michael Fang, and Jung-Im Shin.

Support for the study was provided by the National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK139324, R01 DK115534, K01 DK138273).

The Inflation Reduction Act of 2022 mandated an out-of-pocket cap of $35 for a 30-day insulin supply for Medicare Part D beneficiaries starting January 1, 2023. This is the first time the federal government has imposed caps on insulin prices for all Medicare beneficiaries.

For their study, the researchers analyzed Medicare claims data covering nearly 3.8 million patients who had at least one claim for insulin during the five-year period from 2019 to 2023.

The percentage of these patients who paid $35 or less out of pocket for a 30-day equivalent supply increased from 48% in 2019 to 75% in 2023.

The findings were published online in a peer-reviewed research letter March 19 in JAMA.

The study also showed that the mean out-of-pocket cost for that quantity of insulin dropped from $50.87 in 2019 to $21.98 in 2023. Cost decreases during 2019–2023 were seen in every U.S. state. The study is thought to be the first to analyze the Inflation Reduction Act’s insulin-cap impacts.

“This is compelling evidence that Medicare policies in recent years have done what they were meant to do—improve insulin access and affordability,” says study lead author Michael Fang, PhD, MHS, assistant professor in the Bloomberg School’s Department of Epidemiology. “Insulin costs are now at historically low levels for people on Medicare.”

The researchers note that the finding that about one-quarter of Medicare beneficiaries paid more than $35 for a 30-day supply of insulin in 2023 was unexpected. Their analysis found that these beneficiaries had at least one prescription that was not prorated to the Inflation Reduction Act limit.

Approximately 3.8 million Medicare beneficiaries use insulin as a treatment for type 1 or type 2 diabetes. Insulin replaces the natural metabolic hormone of the same name, whose production is virtually nonexistent in type 1 diabetes, and is also compromised in many cases of type 2 diabetes.

To help rein in insulin costs for beneficiaries, the Centers for Medicare & Medicaid Services (CMS) capped out-of-pocket cost at $35 for a 30-day supply in 2021 as a limited, voluntary initiative. The Inflation Reduction Act of 2022’s mandated $35 cap for out-of-pocket cost for a 30-day supply for Medicare Part D beneficiaries took effect January 1, 2023.

The study covered all Medicare Part D patients who had at least one claim for insulin during the study window and were not receiving Medicare low-income subsidies. The researchers grouped the claims data into five calendar years from 2019 to 2023 for their analysis.

As for the insulin-using Medicare Part D beneficiaries still paying more than $35 for a 30-day supply in 2023, Fang notes that CMS’s formal guidance is for the $35 rule to be applied only for full multiples of 30 days. “If the prescription falls in between, the patient can be charged up to the next full multiple of a month,” Fang says. “For example, health plans can treat a 45-day supply the same as a 60-day supply and charge up to $70.”

He adds that variations in average 30-day insulin costs by state—from $10.36 in Washington, D.C., to $31.09 in Minnesota in 2023—may partly reflect state-level differences in how pro-rating is handled by Medicare insurance plans.

The researchers are now exploring the issue of prorating prescriptions that fall outside the current 60- and 90-day supply window to see in more detail how average costs vary across plans, and whether policy changes are needed to close the gap.

“Trends in Insulin Out-of-Pocket Costs Among U.S. Medicare Beneficiaries” was co-authored by Michael Fang, Chen Dun, Dan Wang, Caitlin Hicks, Elizabeth Selvin, Jung-Im Shin, and Mariana Socal.

Support for the research was provided by the National Institute of Diabetes and Digestive and Kidney Diseases (K01DK138273, R01DK139324).

High blood pressure (hypertension) damages the heart and is an indicator of heart disease risk. Taking proactive steps to control blood pressure can help prevent life-threatening cardiac events, yet the risks of uncontrolled hypertension may be overlooked among young women and their clinicians. Previous research has examined hypertensive heart disease risks primarily in men and post-menopausal women; this study is among the first to focus on younger women.

“Rising mortality for young women with hypertensive heart disease reflects an underestimation of cardiovascular risk, delayed diagnosis and missed opportunities for early intervention,” said Alexandra Millhuff, DO, a resident physician at the University of New Mexico and the study’s lead author. “This study underscores the urgent need for specific prevention strategies.”

Lifestyle modifications such as quitting smoking, eating a heart-healthy diet and exercising more are the first steps in managing high blood pressure, with the option to add blood pressure lowering medications if needed. If left unmanaged, having high blood pressure for an extended period can weaken the heart muscle and lead to heart failure, coronary artery disease, heart attacks and strokes. The new ACC/AHA Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults emphasizes the importance of earlier treatment to keep blood pressure below 130/80 mm Hg.

Researchers analyzed death certificate data from U.S. women who died between the ages of 25 years and 44 years to assess rates of death attributed to hypertensive heart disease during the study period. In 1999, the results showed that hypertensive heart disease accounted for 1.1 of every 100,000 deaths that occurred in young women. By 2023, that rate had risen over fourfold, accounting for 4.8 out of every 100,000 deaths within this population. Over 29,000 women died from hypertensive heart disease-related death during the study period.

The study also revealed striking differences based on factors like race and geography. Non-Hispanic Black women had the highest hypertension-related mortality rate over the study period at 8.6 per 100,000, compared to 2.3 per 100,000 in non-Hispanic White Americans. Across U.S. regions, women in the South had the highest hypertension-related mortality rate at 3.8 per 100,000, compared to 2.8 in the Midwest, 2.2 in the Northeast and 1.9 in the West. No differences were found among women living in urban versus rural areas.

Many studies have shown that women are prescribed blood pressure lowering medications at lower rates than men, and researchers said that heart disease treatment and awareness efforts have often focused on men or postmenopausal women, with less attention to assessing cardiovascular risk in younger women.

“We need to be screening patients of this demographic for hypertension more aggressively, and that includes mitigating risk factors and possibly using antihypertensive medications,” Millhuff said. “Even though hypertension is more prevalent in older populations, it’s something that we need to be vigilant about in younger populations, as well.”

The researchers said that women face specific cardiovascular risks related to hormonal and other physiological changes that occur during pregnancy and perimenopause. They emphasized the importance of controlling blood pressure and addressing other risk factors to ensure women are in optimal health before going through menopause or considering becoming pregnant.

Since most young women do not regularly see a cardiologist, the researchers emphasized the role of primary care and women’s health providers in screening for and managing hypertension in this patient population. They said that women can play an active role by asking their doctors about their cardiovascular risk and opportunities to better manage their health.

For more information about high blood pressure, visit www.CardioSmart.org/BloodPressure.

Millhuff will present the study, “Rising Hypertensive Heart Disease Mortality in Young Women: 25-Year Trends and Disparities,” on Sunday, March 29, at 9:30 a.m. CT / 14:30 UTC in Posters, Hall E.

ACC.26 will take place March 28-30, 2026, in New Orleans, bringing together cardiologists and cardiovascular specialists from around the world to share the newest discoveries in treatment and prevention. Follow @ACCinTouch, @ACCMediaCenter and #ACC26 for the latest news from the meeting.

The World Health Organization estimates that 1 in 10 medications ranging from cancer treatment to contraceptives are either fake or otherwise “substandard.” Though this primarily affects the developing world, there are also gray markets for weight-loss or anti-aging drugs in the U.S.

“Watered-down or illicit versions of drugs like Botox or popular GLP-1 inhibitors have caused serious injuries or death,” said William Grover, associate bioengineering professor at the University of California, Riverside.

In response to this problem, Grover’s laboratory has developed a fake drug detector that could be manufactured for under $30, and potentially for as little as $5. Open-source plans to build the device are detailed in a new paper in the journal Analytical Chemistry.

At its core is a low-cost infrared sensor made for use in toy robots able to follow lines drawn on paper. The researchers repurposed the sensors to instead track the rate at which pills dissolve in water.

All pills of a given drug dissolve — or should dissolve — at roughly the same rate.  Legitimate medications don’t necessarily dissolve any faster or slower than counterfeit ones. But they were made by different people at different facilities and with different ingredients, so their dissolution rates form a “fingerprint” that makes them identifiable and different from that of a fake drug.

“The theory here is that if it’s a legitimate medicine, the manufacturer made every pill identical enough that they’ll all behave roughly the same way when they dissolve,” Grover explained. “So if you test a suspect pill, and it dissolves at a different rate than the real thing, this suggests the suspect pill is counterfeit.”

While others have used dissolution rates to determine a medication’s legitimacy, Grover’s laboratory made the tests more sophisticated by creating an electronic device that converts a pill’s dissolution into a digital signature that they call a “disintegration fingerprint.”

After designing the device, the researchers sought to create a library of these fingerprints that could be used to identify a suspect pill. The group tested over 30 different medications ranging from antibiotics and vitamin supplements to prescription opioids and over-the-counter painkillers. They found that 90% of these pills could be correctly identified using the fingerprinting method.

The group also tested whether their technique could distinguish name-brand and generic versions of the same drug.

“We took Bayer aspirin pills and drug-store-brand aspirin — these are basically identical medicines with the same active ingredient and very similar inactive ingredients,” Grover said, “but when ran through our tests, we could easily tell the difference between the two products.”

The research team even recruited their friends and family to collect samples of drug products from across the U.S. and Canada. They found that pills of the same product typically have similar disintegration fingerprints regardless of where they were purchased. However, some manufacturers make slightly different versions of products for different countries and fingerprinting successfully distinguished U.S. and Canadian versions of a product.

Though there are high-quality pharmaceuticals widely available in the U.S., the CDC warns that there is a public health risk for people ordering what they believe to be prescription medications from disreputable online pharmacies. These medications are frequently found to be fakes.

Other times, a medication could contain irregularities because of manufacturing mistakes. “A facility could get a drum of mislabeled ingredients that can get incorporated into the medicine,” Grover said. “But even an honest error can lead to death.”

In the future, Grover would like to use this method to detect fake antimalarial drugs. These are drugs that treat malaria, a major cause of death in many tropical regions.  Malaria is treatable with the right medications.

“Unfortunately, bad actors know they can make money preying on the need for antimalarials. They sell pills that have the same packaging as authentic antimalarials, but  don’t contain the active ingredients,” Grover said. “If someone gives these pills to their child, they won’t cure their infection.”

Grover hopes to get his tool into the hands of those who can use it to fight fake antimalarials and other fake drugs.

“I can’t imagine a more despicable person than someone who would sell fake medicine to a child. I hope our work makes those criminals’ lives a little harder.”

Image: By counting the particles formed when a pill dissolves in a water-filled cup, the team’s device can identify fake medications.

View more Credit: William Grover/UCR

Safe Sips: Navigating Drink Spiking is a free event in which members of ARU’s Spiking Research Team will explain what drink spiking is, outline its effects on survivors and share the latest national findings.

Since 2021, forensic science academics at ARU have partnered with the UK’s leading alcohol charity Drinkaware to track the prevalence of drink spiking through national surveys, undertaken by YouGov.

The most recent survey, carried out in summer 2025 and involving 7,256 UK adults, found that approximately 2% of adults reported being a victim of drink spiking in the previous 12 months. When extrapolated across the UK population, this equates to nearly one million people.

However, fewer than one in four (23%) of those who experienced drink spiking contacted the police. The most common reasons given for not reporting were not believing action would be taken by the police (39%) and not clearly remembering what had happened (38%).

Women were more likely to experience spiking, accounting for 58% of cases. The most frequently reported locations were bars (41%), social events (26%) and nightclubs (25%), with the highest number of incidents reported by adults aged 25-34.

Drink spiking involves adding a substance to someone’s drink without their knowledge. Substances may include illegal or pharmaceutical drugs, or alcohol, and incidents are most commonly associated with sexual assault, physical assault, theft and “pranks”. Giving someone stronger alcohol than they asked for, for example a double shot rather than a single, would also be classed as drink spiking.

As well as investigating the scale of drinking spiking in the UK, the ARU Spiking Research Team carry out extensive research into the types of samples that can be tested following suspected spiking and the detection kits and protective products that are marketed to the public.

The Cambridge Festival event will be led by Dr Lata Gautam, an expert in forensic and analytical chemistry, whose research focuses on drug analysis, the detection of drugs in spiked drinks and drug-facilitated sexual assaults.

Dr Gautam, Associate Professor in Forensic Science at ARU, said: “Drink spiking has increased in the public’s consciousness in recent years, but our latest findings show that far too many cases still go unreported. With more than three quarters of victims not coming forward, it’s vital that we raise awareness about the importance of contacting the police and seeking support.

“At the same time, there remain significant challenges in identifying the different substances used in spiking. This talk will share our latest research into analysing drink residues, as well as our evaluations of drink testing kits and other anti-spiking products that are being sold to the public.”

Annabelle Bonus, Director of Research, Strategy and Impact at Drinkaware, said: “Drink spiking is a serious crime that can happen to anyone, anywhere. With our survey suggesting that more than a million people are affected each year, it is vital that victims feel confident reporting it to the police.

“For more information, advice and support visit the Drinkaware website or the UK government support pages on drink spiking.”

Safe Sips: Navigating Drink Spiking will take place at ARU’s Cambridge campus on Saturday, 21 March at 3pm and is one of more than 40 free Cambridge Festival events hosted by ARU. To register, visit https://www.aru.ac.uk/events/cambridge-festival/safe-sips-navigating-drink-spiking