Rethinking Diabetes and Obesity Care: EASD 2026 and New WHO Guidelines
Medical Doctor | Medical Writer (Preventive & Metabolic Health)
Dr. Jody-Ann McLean holds an MBBCH (Bachelor of Medicine, Bachelor of Surgery) and has a background in clinical medicine and pathology. Her work focuses on evidence-based health content and the interpretation of medical research.
Trial status and details compiled from ClinicalTrials.gov. Results and topline data drawn from sponsor releases or publications, where applicable. Regulatory information drawn from the FDA. Research accurate as of: 10/10/2026
The 62nd EASD annual meeting featured the latest research and updated recommendations for type 2 diabetes care, which broaden the focus from managing glucose levels towards a more individualized approach with an aim to improve long-term health outcomes. At the meeting, there were also presentations of clinical trial results from rapidly developing treatments targeting obesity and associated metabolic complications, including Eli Lilly’s oral GLP-1 medicine Foundayo (orforglipron), investigational triple agonist retatrutide, and investigational combination drug EloraTZP, as well as Novo Nordisk’s CagriSema. The findings highlight the importance of tolerability versus greater treatment efficacy. The World Health Organization has issued its first global guidelines on managing obesity in children and adolescents, and in regulatory news, a first treatment has been approved for a rare genetic thyroid hormone transport disorder.
EASD 2026: New Holistic Management For Type 2 Diabetes
Metformin has traditionally been prescribed as the first-line treatment for lowering blood sugar levels in type 2 diabetes, owing to its high efficacy in reducing HbA1c levels (a measure of a person’s average blood sugar levels over the past few months), its low risk of causing hypoglycemia (low blood sugar) when used alone, and the fact that it is cost-effective with a good safety profile. Other medications were often added to metformin if blood sugar targets were not being achieved.
An updated joint consensus report on type 2 diabetes management by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) was presented at the annual EASD 2026 meeting and published on the 2nd of October 2026 in Diabetologia and Diabetes Care. It widens the focus of type 2 diabetes management to include healthy lifestyles, psychological support, and appropriate weight management. The report notes metformin’s value, but states that other approaches and medications may be recommended for certain people, and moves the treatment model away from the traditional stepwise approach focusing on blood glucose levels alone to a more individualized care approach with early initiation of medicines like SGLT2 (sodium-glucose cotransporter 2) inhibitors and GLP-1 medicines for heart, kidney, or liver protection. The report also recommends early consideration of combination use of SGLT2 inhibitors and GLP-1 medicines for some people with heart disease or chronic kidney disease.
Evidence Supporting CGMs for Type 2 Diabetes
The EASD/ADA consensus report also recommends consideration of continuous glucose monitoring (CGM) for people with type 2 diabetes, especially those using insulin. There is growing but limited evidence (from small, short trials) that shows modest improvements in blood sugar levels, as well as self-reported improvements in management, supporting the periodic use of CGMs for some people with type 2 diabetes, although equitable access to CGMs and other diabetes technology remains an important consideration and challenge.
The Next Generation of Obesity Medicines at EASD 2026
During the EASD conference in Milan between 28th of September and 2nd of October, several results were presented from clinical trials involving treatments targeting obesity and associated metabolic complications, many reporting substantial weight loss, but also higher rates of treatment discontinuation due to adverse effects.
Phase 3 TRIUMPH-2 Trial
Eli Lilly sponsored a phase 3 trial called TRIUMPH-2, evaluating retatrutide (which is an investigational GIP, GLP-1, and glucagon triple hormone receptor agonist) for efficacy and safety in adults with type 2 diabetes and obesity or overweight. After 80 weeks, participants across all dosage groups showed reductions in HbA1c as well as substantial weight loss, with individuals taking 12 mg retatrutide (the highest dose group) losing an average of 20.8% of their body weight (versus 4% with placebo) and reducing their HbA1c by an average of 1.5% (0.2% with placebo). The reported side effects from the trial included gastrointestinal effects, urinary tract infection, and dysesthesia, which is when an ordinary stimulus can feel unpleasant or painful (for example, burning or tingling skin). Discontinuation rates because of the adverse events varied across the different dose groups, with rates being 3.8% in the 4 mg group, 11.6% in the 9 mg group, and 7.7% in the 12 mg group, compared to 4.9% in the placebo group.
Trial record: NCT05929079
Phase 2 EloraTZP Trial
Eli Lilly also presented results for a phase 2 trial investigating EloraTZP, which is a combination of eloralintide, a selective amylin receptor agonist that activates the same receptors as amylin (a natural hormone released after eating that contributes to satiety and slows gastric emptying) and tirzepatide (the dual GIP GLP-1 receptor agonist in Zepbound and Mounjaro).
In 367 adults with obesity or overweight and type 2 diabetes, when compared to 15 mg tirzepatide at 48 weeks, EloraTZP showed greater weight loss (23.3% of average body weight compared to 14.8% with tirzepatide) and greater HbA1c reduction (average of 2.9% versus 2.4% with tirzepatide). Gastrointestinal adverse events were most frequent within the combination groups and happened mostly during dose escalation. Treatment discontinuations because of adverse events varied according to treatment and dose, ranging from 10.8% to 27% in the EloraTZP group and 0% to 10.8% in the eloralintide group, compared with a lower 2.9% in the tirzepatide-only group, and 16.7% in the placebo group. Larger phase 3 trials would be needed to establish any clinical role for EloraTZP, and Eli Lilly plans to start these phase 3 studies by the end of the year.
Both Novo Nordisk (see CagriSema section below) and Eli Lilly are developing next-generation obesity and type 2 diabetes drugs by pairing an amylin medicine together with an incretin medicine like GLP-1s.
Trial record: NCT06603571
Phase 3 ACHIEVE-4 Trial & Phase 3 ATTAIN-1 Trial
Results from the Phase 3 ACHIEVE-4 and ATTAIN-1 trials were presented at the EASD 2026 meeting, examining Eli Lilly’s oral GLP-1 medicine orforglipron (marketed as Foundayo). The ACHIEVE-4 trial aimed to assess the cardiovascular safety of orforglipron. Although some peptide GLP-1 medicines have been shown to confer cardiovascular benefits, the cardiovascular safety of non-peptide GLP-1 receptor agonists like orforglipron had not previously been studied. ACHIEVE-4 was designed to address this evidence gap by comparing Foundayo with insulin glargine in adults with type 2 diabetes and obesity or overweight who have a higher cardiovascular risk. The trial found that Foundayo showed a non-inferior risk of major adverse cardiovascular events (MACE) such as stroke or heart attack, compared with insulin glargine, meaning that the risk of MACE with Foundayo was not unacceptably worse.
ATTAIN-1 investigated the efficacy and safety of orforglipron in adults with obesity or overweight and weight-related medical conditions. Additional analyses carried out after completion of the trial looked at predicted long-term risk of type 2 diabetes and cardiovascular disease, and showed that orforglipron was associated with significant reductions in both the risk of type 2 diabetes as well as that of cardiovascular disease when compared with placebo. Importantly, these are modeled risk estimates rather than observed reductions in clinical events.
Trial records: NCT05803421, NCT05869903
CagriSema
Novo Nordisk presented further data at the EASD annual meeting on CagriSema, which is an investigational combination of a long-acting amylin analogue, cagrilintide, with semaglutide (a GLP-1 medicine). Findings included results from a 52-week functional brain MRI study of adults with overweight or obesity taking CagriSema, which indicated changes in brain response to high-calorie food. Additional findings were that CagriSema may help reduce ‘food noise’ or persistent thoughts regarding food, which is seen as a challenge for sustainable weight loss.
In the Phase 3 REIMAGINE 1 trial, results in adults with type 2 diabetes showed significant reductions in fat surrounding the abdominal organs (recognized as harmful fat) with CagriSema versus placebo. These results are interesting as the trials are looking at broader questions than how these medicines affect total body weight.
Trial record: NCT06323174
WHO Issues First Global Guidelines on Obesity in Children and Adolescents
In response to the rising prevalence of obesity worldwide, including a substantial increase in children and adolescents, the World Health Organization (WHO) has published its first global guidelines on the integrated management of obesity in children for those aged 29 days to under 10 years, as well as a separate guideline for adolescents aged 10 to 19 years. These were published on the 7th of October 2026.
The guidelines recognize that the consequences of obesity can start at early stages of life and that it can increase the risk of not only diseases, including type 2 diabetes and cardiovascular disease, but also psychosocial consequences like stigma and bullying. The WHO indicates which management is and is not recommended for specific age groups. For example, for children under 10 years, the WHO does not recommend pharmacological treatment for obesity. The reasoning behind this recommendation is that there is a lack of evidence for benefits as well as any potential adverse effects or future consequences, in this age group.
There is trial data currently emerging in this age group, including Novo Nordisk’s reported results from the STEP Young phase 3 trial in children aged 6 to under 12, which showed a greater BMI reduction in the semaglutide group compared to placebo. Importantly, this is emerging evidence, and further studies are needed to look at the safety and consequences of long-term treatment.
The First Treatment Has Been Approved For A Rare Genetic Thyroid Hormone Transport Disorder
On the 28th September 2026, the FDA approved Emcitate (tiratricol), which is a thyroid hormone receptor agonist, for the treatment of peripheral thyrotoxicosis in patients with Allan-Herndon-Dudley syndrome. People with this syndrome (also called MCT8 deficiency) have a genetic mutation that affects the MCT8 thyroid hormone transporter, which carries thyroid hormone to the brain, and this can result in elevated thyroid hormone levels in the blood, but low levels in the brain. It may cause a range of symptoms, including neurological effects like neurodevelopmental delay, or rapid heart rate and raised blood pressure.
Emcitate is designed so that it bypasses the affected MCT8 thyroid hormone transporter and enters the cells independently, reducing the elevated thyroid hormone levels in the blood. It is the first treatment approved for this rare genetic disorder.
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