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.

Dapagliflozin Reduces Insulin Requirements at Discharge After CABG in Patients With T2D | Image Credit: Pexels

 given dapagliflozin during hospitalization for coronary artery bypass graft (CABG) surgery required lower basal insulin and bolus insulin doses at discharge, according to recent research.

Endocrine Society (ENDO) Annual Meeting 2026

 in Chicago, Illinois, by Manasi Sanjiv Shah, MD, assistant professor at Virginia Health Sciences at Old Dominion University/Eastern Virginia Medical School, these data reflect significant support for the utilization of other SGLT2 inhibitors among similar populations.

Those with T2D make up roughly 1 in every 3 patients affected by cardiovascular disease, among which coronary heart disease is the most common and the primary cause of death in patients with T2D mellitus. Additionally, insulin resistance and hyperglycemia tied to T2D mellitus could lead to endothelial dysfunction and vascular complications, causing a worse prognosis. Patients with T2D mellitus also tend to have a higher rate of multivessel coronary stenosis, which can lead to plaque rupture, acute intracoronary thrombosis, and adverse clinical events.

According to previous studies, patients with T2D undergoing CABG surgery are prone to worse prognoses after treatment, with diabetes increasing mortality risk by 1.85 folds in some cases. Altered glucose homeostasis and insulin resistance due to diabetes can result in over-inflammation, thereby triggering an increased expression of SLGT2 receptors. To this end, past studies have investigated the efficacy of various SGLT2 inhibitors like empagliflozin to reduce cardiovascular and all-cause mortality.

In the present study, Shah and colleagues collected medical records of patients with T2D mellitus who underwent CABG surgery from 2019 to 2025 at the Old Dominion University hospital. A total of 765 patients were enrolled – of these, the 166 who received dapagliflozin during hospitalization were contrasted against the 599 who did not. Patients with prior use of SGLT2 inhibitors were included, but the team only examined the effects of dapagliflozin due to formulary restrictions.

Shah and colleagues implemented Chi-square, t-tests, and logistic regression to determine the relationship between inpatient SGLT2 inhibitor usage and baseline characteristics, insulin requirements, mean glucose values, occurrence of arrhythmias, 90-day readmission rates, and post-operative mortality.

The average age among the 765 included patients was 64 years, with a majority (N = 557) being male. The patient population had an average body mass index (BMI) of 31.3 kg/m

. Among both cohorts, 97% of patients received insulin during their hospitalization, while 22% received dapagliflozin with mean initiation on post-operative day 3.

Shah and colleagues noted that, among variables studied, BMI, baseline creatinine, glargine, and lispro insulin dosing on the day before discharge, 

heart failure with preserved ejection fraction (HFpEF)

 all <.05) had the greatest association with SGLT2 inhibitor use. In a multivariable logistic regression model, only HFpEF and baseline creatinine retained their significant association with dapagliflozin use following adjustment for covariates.

Patients with concomitant HFpEF were substantially less likely to receive dapagliflozin (odds ratio [OR], 0.48; 

 = .0458). Treatment with dapagliflozin also did not significantly impact mean glucose values, total and ICU lengths of stay, 90-day readmission rates, major arrhythmia occurrence during admission, or post-operative mortality.

Ultimately, Shah and colleagues concluded that patients with T2D who received dapagliflozin during hospitalization following CABG surgery needed lower insulin at discharge. On average, among the investigated patients, dapagliflozin initiation occurred roughly 3 days following surgery.

“While patients with HFpEF were less likely to receive this drug in our study, further studies are required in this specific population post-CABG surgery,” Shah and colleagues wrote.

Shah M, Bittner M, Ding E, et al. Effect of Dapagliflozin on Glycemic Management and Cardiovascular Outcomes in the Immediate Post-Operative Period in Patients with Type 2 Diabetes Mellitus (T2DM) Undergoing Coronary Artery Bypass Graft (CABG) Surgery. Abstract presented at the Endocrine Society (ENDO) Annual Meeting 2026, Chicago, IL. June 13-15, 2026.

Sardu C, Massetti M, Testa N, et al. Effects of Sodium-Glucose Transporter 2 Inhibitors (SGLT2-I) in Patients With Ischemic Heart Disease (IHD) Treated by Coronary Artery Bypass Grafting via MiECC: Inflammatory Burden, and Clinical Outcomes at 5 Years of Follow-Up. Front Pharmacol. 2021;12:777083. Published 2021 Nov 15. 

Articles

In a retrospective cohort of 765 patients with T2D undergoing CABG, inpatient dapagliflozin use (22%; initiated around post-operative day 3) was associated with lower glargine and lispro dosing on the day before discharge, without differences in mean glucose or major in-hospital clinical outcomes. Length of stay, ICU duration, arrhythmias, 90-day readmissions, and post-operative mortality were not significantly impacted. Baseline creatinine and HFpEF independently correlated with dapagliflozin utilization, with HFpEF associated with lower likelihood of receipt, prompting need for focused evaluation in this subgroup.

New data presented at ENDO 2026 have indicated substantially lower basal insulin and bolus insulin dose requirements in this population following discharge.

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Dapagliflozin Reduces Insulin Requirements at Discharge After CABG in Patients With T2D

Tips on Treating Hemangiomas and Molluscum Contagiosum in Children, With Lisa Swanson, MD

2026 Society of Dermatology Physician Assistants (SDPA)

 Summer Dermatology Conference, Lisa Swanson, MD, of Ada West Dermatology, spoke with 

 about several practical treatment strategies for common pediatric dermatology conditions, focusing on molluscum contagiosum, infantile hemangiomas, and pyogenic granulomas.

Molluscum contagiosum will eventually resolve on its own, but newer treatments such as berdazimer gel offer an effective option for families seeking active management.

Hemangiomas involving high-risk locations, large size, or ulceration often warrant prompt treatment to prevent complications and scarring.

Topical timolol may provide a painless, noninvasive alternative to surgical treatment for selected pediatric pyogenic granulomas.

Will Molluscum Contagiosum Go Away on Its Own?

“It will, if you do nothing, it will eventually go away,” Swanson said. “That can take up to two to three years, the average is one year, so it can take a while.”

Discussing molluscum contagiosum, Swanson noted the importance of setting realistic expectations for families. She explained that molluscum is ultimately a self-limited condition and will resolve without treatment, though clearance can take anywhere from 1 - 3 years, with approximately 1 year being common. While treatment is never needed, Swanson expressed that many families looking for specialty care have already decided they would prefer active intervention.

Among available agents, Swanson pointed to berdazimer gel, a nitric oxide-releasing topical treatment that became available within the last year. Based on her clinical experience, she described the medication as highly effective in routine practice. Although some individuals experience mild burning or stinging, Swanson explained, most are able to continue their therapy successfully and attain meaningful improvement.

Swanson also reviewed key factors that should prompt clinicians to consider treatment for infantile hemangiomas. Location, she stated, remains 1 of the most important considerations. This is especially true for lesions involving the eyelids, nose, lips, or diaper area, as these sites carry increased risks of functional impairment, cosmetic concerns, or ulceration.

Size is another critical factor, as larger hemangiomas are less likely to resolve without lasting sequelae. She also emphasized the value of recognizing and treating ulcerated hemangiomas, which can be painful and lead to permanent scarring. Beyond clinical risk factors, Swanson noted that patient and parent preferences should also play a role in treatment decisions.

What Are Some Treatment Options for Pyogenic Granulomas?

The session concluded with discussion of pyogenic granulomas, for which Swanson presented topical timolol as a valuable noninvasive alternative to surgical removal in selected pediatric patients. While shave excision and cautery remain standard treatment options, she explained that these procedures can be particularly challenging in young children.

Topical timolol, an inexpensive ophthalmic medication commonly used for glaucoma, can provide a painless treatment option when applied directly to the lesion. Swanson noted that improvement is often visible within a month, with complete resolution frequently occurring within 1 - 3 months, making it an attractive option for children and families seeking to avoid procedural intervention.

Disclosures: Swanson previously disclosed serving as a consultant for AbbVie, Alphyn, Arcutis, Boehringer Ingelheim, Castle, Dermavant, Galderma, Incyte, Janssen, Leo, Lilly, Novan, Pfizer, Sanofi-Regeneron, and Verrica.

Swanson L. Pediatric Track: Pediatric Pearls. Presented at SDPA Summer 2026. Jun 10-14, 2026.

Swanson L. What Are Some Clinical Pearls in Pediatric Dermatology? With Lisa Swanson, MD. HCPLive. June 13, 2026. Accessed June 14, 2026. 

https://www.hcplive.com/view/what-clinical-pearls-pediatric-dermatology-lisa-swanson-md

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This SDPA Summer Conference interview with Lisa Swanson, MD, highlights several notable treatment options for molluscum and hemangiomas.

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Rosemarie Lajara, MD, FACE, is a staff physician at Southern Endocrinology and Diabetes Associatess 

Treating Patients With Hypothyroidism Symptoms Despite “Normal” Labs, With Rosemarie Lajara, MD

In patients with hypothyroidism who continue to experience symptoms despite “normal” laboratory values, clinicians should first consider alternative causes before attributing symptoms solely to thyroid dysfunction, explained an endocrinologist.

Rosemarie Lajara, MD, FACE, a staff physician at Southern Endocrinology and Diabetes Associates, spoke about managing patients with hypothyroidism who continue to experience symptoms despite laboratory results considered within the normal range during the 

 and later discussed clinical considerations in an interview with 

Looking Beyond TSH in Hypothyroidism Management, With Rosemarie Lajara, MD

In Part 2 of our interview, Lajara emphasized the importance of avoiding diagnostic anchoring on thyroid laboratory values alone and ensuring that other common contributors to fatigue are appropriately evaluated.

“I think you have to exclude other confounders,” Lajara said. “Make sure that the vitamin panels are in range, making sure that we're not dealing with an adrenal issue, that we're not dealing with absorption problems like celiac, IBS, or other comorbid conditions that can be masked through the fatigue.”

She noted that fatigue is a nonspecific symptom that requires a broader diagnostic approach, as it may reflect multiple underlying conditions beyond thyroid dysfunction.

“Fatigue is such a general term,” she said. “It could be anything from thyroid to anemia, right? So we need to make sure that we're trying to do a little bit of detective work here as a clinician and try to find out whether there's something else contributing to the symptoms.”

In cases where other causes have been excluded, Lajara said clinicians should also consider whether medication absorption or formulation differences may be preventing optimal treatment response in individual patients.

“If everything else is normal, then you can decide and have a discussion about different formulations, because absorption may be the driver of not being in an optimized range for that individual,” she said.

Lajara added that clinicians should remain attentive to patient-reported experiences and avoid over-reliance on laboratory markers, particularly when time constraints can limit more detailed evaluation.

Ultimately, she encouraged a structured yet individualized approach to assessment, ensuring that persistent symptoms are not dismissed solely on the basis of “normal” laboratory result.

Editor’s Note: Lajara reports relevant disclosures with AstraZeneca, Boehringer Ingelheim, Eli Lilly Company, Novo Nordisk, Sanofi and Zealand, and others.

Lajara R. BEYOND THE NUMBERS: Unmasking the Symptom Gap in Hypothyroidism Management. Lecture presented at: ENDO Annual Conference; June 13, 2026; Chicago, IL.

Razvi S, Mrabeti S, Luster M. Managing symptoms in hypothyroid patients on adequate levothyroxine: a narrative review. 

At ENDO 2026, persistent symptoms in hypothyroidism may reflect non-thyroid causes, underscoring the need for broader clinical evaluation

Identifying Confounders in Persistent Hypothyroidism Symptoms, With Rosemarie Lajara, MD

Despite achieving “normal” thyroid lab targets, patients with 

 may continue to experience symptoms that affect quality of life.

Rosemarie Lajara, MD, FACE, a staff physician at Southern Endocrinology and Diabetes Associates, presented on unmasking the symptom gap in hypothyroidism management at the

 Endocrine Society (ENDO) Annual Meeting 2026

 and later spoke with HCPLive about the challenges of treating patients whose symptoms persist despite biochemical control.

Hypothyroidism is typically diagnosed and monitored using thyroid function tests (TFTs), including thyroid-stimulating hormone (TSH) and free thyroxine (free T4). For most patients, treatment with levothyroxine effectively normalizes thyroid hormone levels and improves symptoms. However, some individuals continue to experience fatigue, cognitive difficulties, and other symptoms despite laboratory values falling within the reference range.

According to Lajara, this disconnect highlights an important limitation of relying solely on laboratory measurements when assessing treatment response.

"As clinicians, we get a little focused on the labs and tend to forget how the patients are feeling, the lived experience, and we see that the labs are normalizing, and it gives us reason to believe that the patients are feeling better," Lajara told HCPLive. "But when you start asking more specific questions, the patients may verbalize, 'I'm not back to my normal self. I still feel quite fatigued. I am still having mental fog,' or some other issues that suggest the patient's thyroid function may not be optimized."

Lajara suggested part of the challenge stems from applying population-based reference ranges to individual patients. While TSH remains the primary surrogate marker used to guide treatment decisions, patients may experience symptom improvement at different points within the normal range.

"We're trying to see if population data, which is where we get our TSH from, applies to that one particular individual, and I think that's where somehow we miss the mark," Lajara said.

She noted that current treatment goals should include both normalization of thyroid function tests and improvements in patient well-being. Rather than focusing exclusively on a laboratory target, Lajara advocates for combining serial TSH measurements with ongoing assessment of patient-reported symptoms to identify an individual's optimal treatment range.

"I think it's important to keep in mind there is a range, and it's a tenfold range in what you need," Lajara said. "In my opinion, you need to do serial determinations of the TSH and try to match that with the patient's symptoms."

Although overtreatment remains a concern, Lajara emphasized the importance of considering the broader clinical picture when patients continue to report symptoms commonly associated with hypothyroidism. She encouraged clinicians to evaluate potential contributing factors while remaining attentive to the patient's experience.

"I think it's important to not be dismissive of what the patients are telling us," Lajara said.

At ENDO 2026, persistent fatigue and brain fog despite normal thyroid labs underscored the need for individualized care.


Alex Hillenbrand is an assistant editor for 

. She earned her BA in English from Lafayette College in 2023 and went on to write for pop culture, entertainment, and sports media outlets before joining MJH Life Sciences in 2025. In her free time, Alex enjoys cooking, going on walks, and meeting new people. Contact her at mjhlifesciences.com.

In a retrospective chart review of adolescents with 

 treated with semaglutide, greater reductions in body mass index (BMI) were associated with improvements in triglycerides, the triglyceride-to-HDL ratio, and HbA1c. Improvements in triglycerides and markers of insulin resistance were also observed in some patients who did not lose weight, according to data presented at the 

The late-breaking poster, presented by Robert Daly, MS4, a medical student at Rutgers Robert Wood Johnson Medical School, examined clinical variability in response to semaglutide among 96 adolescents with severe obesity, defined as a BMI > 30, treated for 6 months to 2 years

“While many patients achieve significant reductions in body weight, a subset demonstrates suboptimal or minimal response,” Daly and colleagues wrote. “The mechanisms underlying this variability are not fully understood and may involve differences in central appetite regulation, pharmacogenomics, insulin resistance, and behavioral factors.”

How Adolescents Were Grouped by BMI Response to Semaglutide

The cohort had a mean age of 16.5 ± 2.6 years and a mean baseline BMI of 40 ± 7.5 kg/m², and 68.8% (66 of 96) were female. Overall, 56 patients (61.5%) were classified by the investigators as having achieved meaningful weight loss.

Daly and colleagues stratified patients into 4 groups based on the effect of semaglutide on BMI:

≥10% BMI reduction. Includes 33 patients (34.4% of total cohort), BMI decreased from 38.9 ‡ 7.1 to 31.4 = 6.5 kg/m?, Mean reduction: 19 = 8.3%, 1 patient (3%) had diabetes.

5-9% BMI reduction. Includes 26 patients (27.1%), including 9 males, BMI decreased from 40.5 ‡ 7.4 to 37.8 = 6.5 kg/m?, Mean reduction: 6.7 = 1.3%, 7 patients (27%) had diabetes

Weight gain. Includes 18 patients (18.8%), including 6 males, BMI increased from 40.1 = 8.5 to 42.3 = 9.4 kg/m?, Mean increase: 5.3 ‡ 4.5% 5 patients (28%) had diabetes.

No significant BMI change. Includes 19 patients (19.7%), 8 males, BMI changed from 41.3 = 7.9 to 40.4 = 7.8 kg/m?, Mean change: -0.9 = 0.5%; 6 patients (31.5%) had diabetes. 

Metabolic Marker Changes Varied by BMI Response Group

According to investigators, several metabolic markers changed significantly (

 < .05) in the groups with greater BMI reduction, according to data reported on the poster. In the group with a BMI reduction of ≥ 10%, mean triglycerides decreased from 152 to 105.7 mg/dL, the triglyceride-to-HDL ratio decreased from 3.4 to 2.2, and HbA1c decreased from 6.0% to 5.3%; LDL, ALT, and AST did not change significantly. In the group with a 5% to 9% BMI reduction, triglycerides, the triglyceride-to-HDL ratio, ALT, and AST all decreased significantly, while HbA1c and LDL did not change significantly.

Among the 18 patients who gained weight, mean triglycerides nonetheless decreased from 121.2 to 91.9 mg/dL, and the triglyceride-to-HDL ratio decreased from 2.9 to 2.1, while the other measured markers did not change significantly. In the group with no significant BMI change, none of the measured metabolic markers showed a statistically significant change.

Semaglutide treatment in adolescents with severe obesity showed heterogeneous BMI responses over 6 months to 2 years, yet cardiometabolic improvements tracked most strongly with greater BMI reduction. Patients achieving ≥10% BMI reduction experienced significant decreases in triglycerides, triglyceride-to-HDL ratio, and HbA1c, whereas those with 5%–9% reductions improved triglycerides, triglyceride-to-HDL ratio, and transaminases. Notably, some adolescents who gained weight still demonstrated improved triglyceride metrics, suggesting weight-independent effects on lipid metabolism in a subset.

Greater BMI reduction with semaglutide in adolescents with severe obesity was tied to improved triglycerides, TG/HDL ratio, and HbA1c

Obesity Management

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Greater BMI Reduction With Semaglutide Tied to Metabolic Improvements in Adolescents With Severe Obesity

At SDPA, Swanson highlighted a variety of key tips for clinicians, including strategies for treating hemangiomas and warts in children.

What Are Some Clinical Pearls in Pediatric Dermatology? With Lisa Swanson, MD

Ernesto Nakayasu, MD, is a senior researcher at Pacific Northwest National Laboratory. 

Analysis of plasma EVs identified 448 proteins associated with islet autoimmunity and potential early T1D biomarkers.

Plasma EV Analysis Identifies Proteins Associated With T1D Risk, With Ernesto Nakayasu, PhD

Mishal Ali is a graduate researcher at the University of Chicago.

Alan Hutchison, MD, PhD, and Mishal Ali discuss the substantially increased risk of long-term mortality caused by diabetes in patients undergoing major organ transplants.

Type 1 Diabetes

Diabetes Increases Mortality Risk Across All Major Organ Transplants

Hannah Rodriguez, MPAS, PA-C, is derm PA at Pennsylvania Dermatology Group.

This Q&A interview highlights ways to counsel patients regarding the safety of various sunscreens, photoprotection, and UV radiation's impact on skin cancer.

How to Counsel Patients About Skincare Safety, Sunscreen Safety, and Product Ingredients

New systematic review of 7012 kidney transplant recipients with T2D finds GLP-1 receptor agonists cut major adverse kidney events and mortality by 61%.


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GLP-1 RAs Show Renal, Survival Benefits in Kidney Transplant Recipients With Type 2 Diabetes

New data from ENDO 2026 reflect the accompanying reductions in HbA1c, lipids, and other major biomarkers in patients treated with GLP-1 RAs.

Weight Loss Improves Cardiometabolic Biomarkers in Digital Metabolic Reset Program

New data from ENDO 2026 have indicated a statistically significant increase in hypotension and related events in adults receiving GLP-1s who are already hypertensive.

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GLP-1 Initiation Associated With Increase in Hypotensive Events in Patients With Hypertension

This interview at the SDPA Summer Conference highlights the environment and climate change's impact on skin health and triggers of different conditions.

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MiniMed 780G improved HbA1c and time in range in real-world diabetes data presented at ENDO 2026, with minimal hypoglycemia risk.

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Latest News

Dapagliflozin Reduces Insulin Requirements at Discharge After CABG in Patients With T2D

Tips on Treating Hemangiomas and Molluscum Contagiosum in Children, With Lisa Swanson, MD

Identifying Confounders in Persistent Hypothyroidism Symptoms, With Rosemarie Lajara, MD

Looking Beyond TSH in Hypothyroidism Management, With Rosemarie Lajara, MD

Greater BMI Reduction With Semaglutide Tied to Metabolic Improvements in Adolescents With Severe Obesity