Epinephrine Nasal Spray Shows Comparable Efficacy to Injection, With Thomas Casale, MD

ARS Pharmaceuticals recently reported that 

epinephrine nasal spray (neffy) performed as effectively as epinephrine injections

 in treating anaphylaxis during routine clinical practice.

 Findings from this large-scale real-world analysis will be published later this year in 

Annals of Allergy, Asthma, and Immunology

, the official journal of the American College of Allergy, Asthma, and Immunology.

The company announced that the epinephrine nasal spray successfully treated about 9 out of 10 patients. A single 2 mg dose successfully treated 486 patients, with 59 patients requiring a second dose.

This finding was identical to the historic response rate found with epinephrine injection. Compared to the epinephrine injection’s 88.9% success rate, a single dose of epinephrine nasal spray resulted in an 89.2% success rate.

 spoke with investigator Thomas B. Casale, professor of Medicine and Pediatrics and chief of Clinical and Translational Research in the USF Health Morsani College of Medicine at the University of South Florida, about what this means for allergists.

“[The biggest benefit [of this study] is even though neffy, through a number of…trials to get FDA approval, show equivalent levels of epinephrine in the blood and relevant PD changes—that is, changes in pulse rate and blood pressure—a lot of physicians want to make sure: does it really work? And I think this study is very important in showing that it did,” Casale said. “Before this, there [were] only a couple of small clinical studies. One was 15 patients doing oral food challenges that showed that [epinephrine nasal spray] treated them successfully.”

The US Food and Drug Administration (FDA) approved epinephrine nasal spray, marketed as neffy, for type 1 allergic reactions in adults and children aged ≥ 4 years who weigh > 33 lbs. The approval opened a new anaphylaxis treatment for patients who fear needles or experience portability issues.

Many patients delayed or avoided auto-injectors due to their fears. In 2023, of the 20 million patients treated for severe reactions, only 3.2 million filled an auto-injector prescription, and half consistently carried it. Now, seen with this large analysis, epinephrine nasal spray not only eliminates many patients' fears but is as effective as having an injection.

“We know from a number of pieces of data that about 90% of patients get better with a single dose of epinephrine, and of the 10% that need a second dose, more than half of those get better with the second dose,” Casale said. “These data show that the numbers were very similar, and that with the first dose of neffy, 90% of patients got better when they had signs and symptoms of anaphylaxis. So again, very reassuring that have performed similar to what we've seen and noted with injectable epinephrine.”

Real-World Evidence Supports Clinical Effectiveness of neffy® (epinephrine nasal spray) in Patients Experiencing Anaphylaxis - ARS Pharmaceuticals. ARS Pharmaceuticals. Published 2025. Accessed September 12, 2025. 

https://ir.ars-pharma.com/news-releases/news-release-details/real-world-evidence-supports-clinical-effectiveness-neffyr

Derman, C. Epinephrine Nasal Spray as Effective as Injection for Anaphylaxis in Real-World Data. HCPLive. September 12, 2025. 

https://www.hcplive.com/view/epinephrine-nasal-spray-effective-as-injection-anaphylaxis-real-world-data

Videos

Real-world data show epinephrine nasal spray achieved an 89.2% success rate in treating anaphylaxis, nearly identical to the injection’s response rate.

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The HCPLive anaphylaxis page is a comprehensive resource for clinical news and insights on acute allergic reactions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for preventing anaphylaxis, and more.

Ryan Livingston joined the MJH Life Sciences team in March of 2025, shortly after graduating from TCNJ with a bachelor’s degree in English. He enjoys creative writing, reading, and scuba diving. He can be reached at rlivingston@mjhlifesciences.com.

Image Credit: US Food and Drug Administration

The US Food and Drug Administration (FDA) has approved bumetanide nasal spray (Enbumyst) for the treatment of edema associated with 

Announced by Corstasis Therapeutics on September 15, 2025, the FDA’s decision is in response to the unmet need in edema and fluid overload, which are the main causes of hospitalization and readmission for patients with CHF, cirrhosis, and CKD.

Loop diuretics are the first-line treatment for congestion, used to control volume status in patients with heart failure (HF). Most patients admitted to the hospital for HF are given intravenous (IV) loop diuretics irrespective of perfusion status. This is because the high plasma content in loop diuretics is needed to cross the threshold to rapid and effective diuresis. However, chronic use of loop diuretics can lead to a blunted response in acute decompensated HF, which is attributed to functional and structural tubular remodeling.

Bumetanide nasal spray is an intranasal loop diuretic designed for absorption through the nasal application. Developed to circumvent the absorption block presented by an overreliance on intravenous loop diuretics in managing diuresis, bumetanide nasal spray saw its star begin to rise with positive results from the RSQ-777-02 trial. It was conducted from December 2023 to April 2024 and included 68 adults, ages 18 to 55 years, without HF or risk of HF before enrollment.

"[Bumetanide nasal spray] was designed in direct collaboration with cardiologists to address practical challenges in the outpatient care setting," Brian Kolski, MD, chief medical director of Corstasis and director, non-invasive vascular lab at the Orange County Heart Institute and director of structural heart disease at Providence St. Joseph Hospital in Orange, California, said in a statement.

During the study, investigators gave patients all 3 forms of bumetanide – nasal, oral, and intravenous – in a varied order. The nasal spray was safe and well-tolerated throughout, with no significant nasal irritation observed. The team also noted an absorption variability of 27% in the nasal and IV forms of bumetanide, while the oral, pill form had a variability of >40%. Additionally, BNS had fewer treatment-emergent adverse events than the oral version.

Ultimately, bumetanide nasal spray met its primary endpoint of equivalence to oral bumetanide, and no significant difference in maximum plasma concentration was noted between the treatments. Additionally, a higher time to maximum concentration was observed in bumetanide nasal spray versus the oral tablets, indicating earlier detection of peak plasma drug concentrations after the nasal application.

Corstasis Therapeutics presented the results at the American Heart Association Scientific Sessions in 2024 and submitted the New Drug Application for BNS shortly afterwards. The FDA accepted the application in January of 2025.

"[Bumetanide nasal spray] offers the potential to change the standard of care by enabling earlier, outpatient intervention," Anuradha Lala-Trindade, MD, director of heart failure research at the Mount Sinai Fuster Hospital in New York, said in a statement. "This innovation may meaningfully improve outcomes while potentially easing the economic burden on the healthcare system."

According to the press release, Corstasis expects to launch bumetanide nasal spray in the US during the fourth quarter of 2025.

Corstasis Therapeutics. Corstasis Therapeutics Announces FDA Approval of ENBUMYST (bumetanide nasal spray) for the Treatment of Edema Associated with Congestive Heart Failure, Liver Disease, and Kidney Disease. 

. September 15, 2025. Accessed September 15, 2025. 

https://www.businesswire.com/news/home/20250915243998/en/Corstasis-Therapeutics-Announces-FDA-Approval-of-ENBUMYST-bumetanide-nasal-spray-for-the-Treatment-of-Edema-Associated-with-Congestive-Heart-Failure-Liver-Disease-and-Kidney-Disease

Biegus J, Ponikowska B, Canonico ME, Damman K, Palazzuoli A, Ambrosy AP. Bumetanide nasal spray: a novel approach to enhancing diuretic response and advancing ambulatory heart failure care?. Heart Fail Rev. 2025;30(5):1123-1126. 

American College of Cardiology. RSQ-777-02: New Nasal Spray Form of Bumetanide as Effective as Oral and IV Forms in Patients Without HF or HF Risk. November 18, 2024. Accessed September 11, 2025. 

https://www.acc.org/latest-in-cardiology/articles/2024/11/13/21/17/mon-930am-rsq77702-aha-2024

Iapoce C. FDA Accepts New Drug Application for Bumetanide Nasal Spray. 

. January 27, 2025. Accessed September 11, 2025. 

https://www.hcplive.com/view/fda-accepts-new-drug-application-for-bumetanide-nasal-spray

Articles

The FDA has approved bumetanide nasal spray (ENBUMYST) for treating edema linked to congestive heart failure, liver disease, and chronic kidney disease. This approval addresses the unmet need for effective outpatient management of fluid overload, a major cause of hospitalizations. Bumetanide nasal spray, developed to overcome limitations of intravenous loop diuretics, demonstrated safety and efficacy in clinical trials, showing equivalence to oral forms with fewer adverse events. The nasal spray offers potential for earlier intervention and improved patient outcomes, with a US launch expected in late 2025.

The US Food and Drug Administration has approved bumetanide nasal spray for the treatment of edema in outpatient heart, liver, and kidney diseases.

FDA News

Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

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Chronic Kidney Disease

FDA Approves Bumetanide Nasal Spray for Edema with Congestive Heart Failure

Amy Y. Chen, MD, is a fellowship-trained dermatologist at Central Connecticut Dermatology and Middlesex Health.

The Medical Sisterhood: Calendars, Clinics, and Chaos, With Amy Chen, MD

In this episode of The Medical Sisterhood, host Mona Shahriari, MD, assistant clinical professor of dermatology at the Yale University School of Medicine and associate director of clinical trials at Central Connecticut Dermatology Research, is joined by her colleague and practice partner Amy Y. Chen, MD, a fellowship-trained dermatologist at Central Connecticut Dermatology and Middlesex Health. Together, the 2 physicians open up about the shared challenges of navigating demanding medical careers while raising young children, offering candid insights and practical strategies for clinician mothers.

Chen begins by describing the annual “September chaos,” when the back-to-school season collides with the unrelenting pace of clinical practice. With late school buses, shifting sports schedules, and unpredictable logistics, she stresses the importance of flexibility and organization. Her solution has been to centralize all family activities in a color-coded Google Calendar—managed solely by her—to reduce confusion, alongside weekly index cards posted at home outlining pickup and drop-off duties. These small systems, she explains, help her family maintain order amid the flux of school and extracurricular commitments.

The conversation turns to the “mental load” of motherhood, a burden that often defaults to women despite the presence of supportive partners. Chen candidly admits that she frequently wakes in the night worrying about forgotten school supplies or missed deadlines. Shahriari likens this experience to having dozens of browser tabs open at once—some frozen, some endlessly buffering—yet all demanding attention. Both acknowledge that this invisible labor can lead to burnout, underscoring the need for physician mothers to carve out moments of rest and transition.

Chen shares that she finds small windows of “me time” in unexpected places: sitting quietly in her car after work, scrolling social media before bed, or simply allowing herself to stare at the wall during her children’s practices. Shahriari echoes the importance of these mental resets, describing how she switches deliberately between her “dermatologist hat” and her “mom hat” to remain present in each role.

On parenting philosophy, Chen advises relinquishing the pursuit of perfection—accepting mismatched outfits, less-than-Pinterest-worthy lunches, or occasional scheduling mishaps as inevitable trade-offs in a busy life. For her, the non-negotiables remain high-quality patient care and being present for her children’s important moments.

Both physicians reflect on how motherhood has deepened their empathy for patients, particularly those juggling similar demands. They close by reminding listeners that self-compassion and grace are essential: even for high-achieving women in medicine, it is both normal and necessary to let some things slide.

Want to join The Medical Sisterhood community? Click here to join our LinkedIn Group!

This episode highlights the challenges of navigating demanding medical careers while raising young children, with insights and practical strategies.

The Medical Sisterhood, with Mona Shahriari, MD

The Medical Sisterhood, hosted by Mona Shahriari, MD, is a podcast dedicated to empowering female physicians by providing a platform for shared experiences, mentorship, and support. 

Each episode delves into the unique challenges women in medicine face, including work-life balance, leadership roles, and overcoming gender biases. Shahriari aims to inspire women to lead fulfilling professional and personal lives on their own terms through candid discussions and expert interviews. 

e as we foster a community where women can uplift and support each other in achieving their goals!

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Abigail Brooks is an assistant editor for 

She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

Krystal Biotech has announced the United States Food and Drug Administration (FDA) approval of a label update for beremagene geperpavec-svdt (Vyjuvek) that expands the treatment eligible patient population to include 

 patients from birth and provides patients full flexibility with respect to beremagene geperpavec-svdt application and managing wound dressings.

According to a September 15, 2025, press release from the Company, in addition to allowing patients with DEB and their caregivers to apply beremagene geperpavec-svdt at home on their own, the label update also affords patients greater flexibility in managing wound dressings, as they are now permitted to be removed as part of the next dressing change rather than waiting 24 hours.

“The updates to the [beremagene geperpavec-svdt] label are yet another significant and impactful step forward for all those living with DEB” Brett Kopelan, Executive Director of DEBRA of America, said in a statement.

 “Enabling caretakers to apply [beremagene geperpavec-svdt] during their standard of care regimen is an enormous positive change allowing for increased convenience without sacrificing safety. The Krystal team has always prioritized patient safety and convenience when it comes to the use of [beremagene geperpavec-svdt] and them advocating for these updates is not surprising given Krystal’s patient centric approach. This aspect of the update to the label will only increase the quality of life of those living with this challenging disorder and that is exactly what our community needs.”

A non-invasive, topical, redosable genetic medicine, beremagene geperpavec-svdt is designed to deliver 2 copies of the 

 gene when applied directly to DEB wounds. It was designed to treat DEB at the molecular level by providing the patient’s skin cells the template to make normal COL7 protein, thereby addressing the fundamental disease-causing mechanism. Beremagene geperpavec-svdt is approved in the United States, Europe, and Japan.1

The FDA approved beremagene geperpavec-svdt for the treatment of DEB in 2023, making it the first-ever redosable gene therapy and the first and only medicine approved by the FDA for the treatment of DEB, both recessive and dominant, that can be administered by a healthcare professional in either a healthcare professional setting or in the home.

The decision was based on data from 2 clinical studies, GEM-1/2 and GEM-3. GEM-1/2 was an intra-patient, open label, single center, randomized, placebo-controlled study showing that repeat topical applications of beremagene geperpavec-svdt were associated with durable wound closure, full-length cutaneous COL7 expression, and anchoring fibril assembly with minimal reported adverse events.

The GEM-3 trial was an intra-patient, double-blinded, multi-center, randomized, placebo-controlled study that met both its primary endpoint of complete wound healing at 6 months and its key secondary endpoint of complete wound healing at 3 months. Beremagene geperpavec-svdt was well tolerated with no drug-related serious adverse events or discontinuations due to treatment-related events.

The September 15, 2025, label update is based on real-world data collected since beremagene geperpavec-svdt launched in the United States as well as results from the open label extension study conducted in the United States, reinforcing the long-term safety and efficacy of beremagene geperpavec-svdt across patients of all ages, including in cases of patient or caregiver application.

“We believe these changes further reinforce [beremagene geperpavec-svdt]’s leadership position as the most flexible, convenient, and disease modifying medicine to treat DEB patients in the United States,” said Krish Krishnan, Chairman and CEO of Krystal Biotech.

 “Moreover, by providing patients and their caregivers the ability to apply [beremagene geperpavec-svdt] themselves, we have made it easier for patients to integrate [beremagene geperpavec-svdt] into their daily routines and lifestyle. Overall, we believe that these advancements solidify [beremagene geperpavec-svdt] as the standard of care for all DEB wounds, regardless of wound size and severity, and will further improve compliance.”

Krystal Biotech. Krystal Biotech Announces FDA Approval of Updated VYJUVEK® Label. September 15, 2025. Accessed September 15, 2025. 

https://ir.krystalbio.com/news-releases/news-release-details/krystal-biotech-announces-fda-approval-updated-vyjuvekr-label

Smith T. FDA Approves B-VEC Topical Gene Therapy for Dystrophic Epidermolysis Bullosa. HCPLive. May 19, 2023. Accessed September 15, 2025. 

https://www.hcplive.com/view/fda-bvec-topical-gene-therapy-dystrophic-epidermolysis-bullosa

Krystal Biotech's beremagene geperpavec-svdt (Vyjuvek) has received FDA approval for a label update, expanding its use to dystrophic epidermolysis bullosa (DEB) patients from birth. This update allows patients and caregivers to apply the treatment at home, offering flexibility in wound dressing management. The therapy, a non-invasive topical gene medicine, delivers the COL7A1 gene to DEB wounds, addressing the disease at a molecular level. Clinical trials demonstrated its efficacy and safety, reinforcing its position as a standard of care for DEB.

The label update expands the treatment eligible population to include dystrophic epidermolysis bullosa patients from birth and allows at-home application.

FDA Approves Beremagene Geperpavec-svdt (Vyjuvek) Label Update in DEB

Emmy Keysendal, PhD candidate at Karolinska Institute | Image Credit: Karolinska Institute

Individuals with any history of smoking have a substantially higher risk of all 4 subtypes of 

 compared to those who have never smoked, according to data presented at the European Association for the Study of Diabetes.

Conducted in Stockholm, Sweden by Emmy Keysendal, a PhD candidate at Karolinska Institute, this trial compared smoking status across the previously defined 4 subcategories of T2D. These categories include:

Severe insulin-resistant diabetes (SIRD), characterized by insulin resistance,

Severe insulin-deficient diabetes (SIDD), characterized by a lack of insulin,

Mild obesity-related diabetes (MOD), associated with obesity and younger onset age, and

Mild age-related diabetes (MARD), which develops later in life.

The team collected data on 3325 individuals with T2D – 495 were categorized as SIDD, 477 as SIRD, 693 as MOD, and 1660 as MARD. An additional 3897 participants were included as controls. All data was sourced from the long-running HUNT diabetes study in Norway, wherein patients exhibited an average follow-up time of 17 years, and the ESTRID case-control study in Sweden.

Based on these data, patients who had smoked at any point in their lives were 2.15 times more likely as those who had never smoked to develop SIRD (95% CI, 1.64-2.82). A 20% increase was found for SIDD (risk ratio [RR], 1.2; 95% CI, 0.98-1.47), 29% for MOD (RR, 1.29; 95% CI, 1.06-1.57), and 27% (RR, 1.27; 95% CI, 1.12-1.44) for MARD. It was also determined to be responsible for >1/3 of SIRD cases, but <15% of the other subcategories.

Smoking heavily – defined as 20 cigarettes a day for 15 years or equivalent – increased the risk of all 4 subtypes. Heavy smokers were 2.35 times more likely to develop SIRD (RR, 2.35; 95% CI, 1.72-3.23), SIDD (RR, 1.52; 95% CI, 1.19-1.95), MOD (RR, 1.57; 95% CI, 1.22-2.02) and MARD (RR, 1.45; 95% CI, 1.22-1.69). Additionally, heavy smokers with a predisposition to T2D or reduced insulin secretion were particularly vulnerable.

The association between smoking and all T2D subtypes was then confirmed by the MR study (odds ratios [ORs] SIDD, 1.49; 95% CI, 1.05-2.12; SIRD, 1.55; 95% CI, 1.10-2.19; MOD, 1.52; 95% CI, 1.09-2.11; MARD, 1.26; 95% CI, 0.96-1.64).

Ultimately, investigators noted a higher risk of T2D across all subtypes due to heavy smoking, with a stronger association for SIRD. This indicates a negative effect of smoking on insulin sensitivity.

“These findings underscore the importance of refraining from smoking in the prevention of T2D,” wrote Keysendal and colleagues.

European Association for the Study of Diabetes. Smoking increases the risk of type 2 diabetes, regardless of its characteristics. 

 September 13, 2025. Accessed September 13, 2025. 

https://www.eurekalert.org/news-releases/1097810

Keysendal E, Ahlqvist E, Åsvold B, et al. Tobacco Use, Genetic Susceptibility, and the Risk of Type 2 Diabetes Subtypes. Abstract presented at the European Association for the Study of Diabetes in Vienna, Austria, September 15-19.

Smoking significantly elevates the risk of developing all four subtypes of type 2 diabetes (T2D), with the most pronounced effect on severe insulin-resistant diabetes (SIRD). A study conducted in Stockholm analyzed data from the HUNT diabetes study and the ESTRID case-control study, revealing that individuals with any smoking history are more likely to develop T2D subtypes. Heavy smoking further exacerbates this risk, particularly for those predisposed to T2D or with reduced insulin secretion. The findings emphasize the importance of smoking cessation in T2D prevention.

New research from Stockholm, Sweden, has shown the correlation between smoking and insulin sensitivity, with genetic susceptibility increasing the risk further.

Endocrinology

The HCPLive endocrinology page is a comprehensive resource for clinical news and insights on endocrine system conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for diabetes, hormonal disease, and more.

Type 2 Diabetes

Smoking Increases Risk of All Type 2 Diabetes Subtypes

Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

This review highlights several evidence-based approaches to promoting skin longevity and preventing signs of aging.

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Stay updated with the latest healthcare breakthroughs, including FDA news and the voluntary withdrawal of obeticholic acid, in this week's essential news roundup.

Hepatology

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Research shows reduced risk of death, major adverse cardiovascular events, and myocardial infarction, and a non-significant reduction in stroke and cardiovascular death.

Atherosclerotic Cardiovascular Disease

Stroke

On the HCPLive stroke page, resources on the topics of medical news and expert insight into CVA can be found. Content includes articles, interviews, videos, podcasts, and breaking news on stroke medicine, and more.

Lipid-Lowering Therapy Adherence Reduces Cardiovascular Risk in Patients with ASCVD

Akin discussed updated data on elenestinib from the HARBOR trial in indolent systemic mastocytosis.

Insights

 Insights page is a resource for professional video interviews with leading clinical experts and investigators across all specialties of medicine.

KIT Targeting: A New Frontier in ISM Management, With Cem Akin, MD

These interviews with Chovatiya and Stein Gold highlight a variety of key points from the dermatology-centric EADV Congress 2025 meeting in Paris, France.

Conference

 conference coverage page features articles, videos, and expert-led live coverage from major medical meetings throughout the year.

What to Expect at EADV Congress 2025, With Raj Chovatiya, MD, PhD, and Linda Stein Gold, MD

Chelsie Derman is an associate editor for 

who covers psychiatry, sleep medicine, geriatrics, migraine, and allergy. She joined MJH Life Sciences in September 2023 after graduating from The College of New Jersey with a bachelor’s degree in journalism and professional writing. In her free time, she enjoys creative writing and reading.

In over 500 patients, a single dose of neffy achieved an 89% success rate, matching injection outcomes and supporting its use as a needle-free alternative.

Epinephrine Nasal Spray as Effective as Injection for Anaphylaxis in Real-World Data

Jessica Gandhi, PA, is a physician assistant at Capital Digestive Care.

Gandhi describes the crucial role APPs play in GI bleeding care and the importance of collaborative management of these patients.

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Gastroenterology condition center page is a comprehensive resource for clinical news and insights on digestive and GI conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for 

, IBS and IBD, Crohn's disease, and more.

Optimizing Care Pathways in Gastrointestinal Bleeding, With Jessica Gandhi, PA

Victoria Johnson joined the MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and now HCPLive. You can reach her at vjohnson@mjhlifesciences.com

Red light photodynamic therapy with 10% ALA gel shows superior clearance rates compared to vehicle treatment.

10% ALA Gel With PDT Demonstrates High Clearance Rates in Superficial BCC

Hilary Ugras, NP, is a nurse practitioner in GI motility at Beth Israel Deaconess Medical Center.

Ugras describes recent evolutions in EoE, including new FDA-approved therapies, updated clinical guidelines, and better understanding of its pathophysiology.

Empowering Providers in Eosinophilic Esophagitis Care, With Hilary Ugras, NP

Compared to standard devices, the first-of-its-kind AIRE-CHB model indicated incident CHB risk, outperforming standard ECG devices.

Latest News

Epinephrine Nasal Spray Shows Comparable Efficacy to Injection, With Thomas Casale, MD

FDA Approves Bumetanide Nasal Spray for Edema with Congestive Heart Failure

The Medical Sisterhood: Calendars, Clinics, and Chaos, With Amy Chen, MD

FDA Approves Beremagene Geperpavec-svdt (Vyjuvek) Label Update in DEB

Smoking Increases Risk of All Type 2 Diabetes Subtypes