Commentators Katherine Tuttle (Providence Medical Research Center, Spokane, Washington, USA) and Janani Rangaswami (George Washington University School of Medicine, Washington DC, USA) say that the strengths of these analyses “include large sample sizes and use of different agents, making the case for generalisability across the SGLT2 inhibitor class.”

In a linked commentary, Katherine Tuttle (University of Washington School of Medicine, Seattle, USA) highlights the importance of the eGFR decline analysis, “since the field is moving towards eGFR slope as a potential outcome for clinical trials, especially for interventions at earlier stages of chronic kidney disease, when occurrence of clinical kidney disease events as endpoints is less feasible.”

The results were presented at the virtual ADA 81st Scientific Sessions and simultaneously published in The New England Journal of Medicine , along with an editorial by Katherine Tuttle (University of Washington, Seattle, USA).

These findings support the hypothesis “that metformin use is associated with less cognitive decline,” say Katherine Samaras (Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia) and fellow researchers in Diabetes Care .

Writing in an accompanying commentary, Katherine Tuttle (University of Washington, Seattle, USA) says that taken together, “these results are broadly applicable and impactful,” given that the DAPA-CKD study population “is representative of about 80–90% of patients with CKD.”

Writing in an accompanying comment, Katherine Tuttle (University of Washington, Seattle, USA) said that SONAR “demonstrates a turning point in trial innovation,” and “succeeded in shifting trial design to match patients with treatment on the basis of safety and response assessments during a prerandomisation enrichment period.”

In accompanying commentary, Katherine Tuttle (University of Washington, Spokane, USA) stresses the importance of the finding “that dapagliflozin and saxagliptin can be used together safely for glycaemic control in patients with type 2 diabetes and moderate- to severe chronic kidney disease.”

. © 2019 Springer Healthcare part of the Springer Nature group N Engl J Med 2019; doi:10.1056/NEJMoa1811744 N Engl J Med 2019; doi:10.1056/NEJMe1904740 See also: WATCH | Diabetes expert commentary: The CREDENCE trial LISTEN |  Researcher comment: The CREDENCE trial LISTEN |  Primary care expert commentary: The CREDENCE trial LISTEN |  Nephrologist expert commentary: The CREDENCE trial WATCH | Katherine Tuttle and Jay Shubrook discuss the importance of kidney disease screening in people with diabetes Dapagliflozin–saxagliptin 'attractive' for type 2 diabetes with kidney disease

This was significantly higher than the rate of 4.4% that would be expected by chance alone, report Katherine Sauder (University of Colorado School of Medicine, Aurora, USA) and study co-authors in The Lancet Child & Adolescent Health .

The AWARD-7 trial, conducted by Katherine Tuttle (University of Washington, Spokane, USA) and colleagues, also showed that dulaglutide treatment was associated with a smaller decline in estimated glomerular filtration rate (eGFR), a lower rate of hypoglycemia, and weight loss rather than weight gain compared with insulin glargine.

Much of the problem, Hamer feels, was that the paper was published in an extremely high-profile journal by someone from within the US national healthcare system – lead author Katherine Flegal is based at the Centers for Disease Control and Prevention, “but she didn’t show what people wanted to see.”

Next, Katherine Tuttle (Providence Health Care, Spokane, Washington, USA) recapped the AWARD7 primary findings, originally presented at ADA in June this year.