Endocrinology is the specialty that learned to treat the patient, not the lab result.
In September 1993, the New England Journal of Medicine published a trial in type 1 diabetes. It asked a simple question: does keeping blood sugar close to normal protect the eyes, the kidneys and the nerves? The trial gave 1,441 patients either intensive insulin, with a pump or three or more injections a day, or one or two injections a day. After an average of 6.5 years, intensive insulin cut the risk of eye damage by 76% and of nerve damage by 60%. It also made severe hypoglycaemia two to three times more common. Lower blood sugar had protected the patient, at a price.
Nearly nine years later, in July 2002, hormones had their own reckoning. Decades of observational studies had not settled whether hormone therapy after menopause did more good than harm. The Women’s Health Initiative ran a trial to settle it. The trial gave 16,608 healthy women oestrogen plus progestin or placebo. Its main question was whether the hormones prevented heart disease. The trial stopped after 5.2 years. The hormones did not prevent heart disease. They raised it, with a hazard ratio of 1.29. They also raised stroke (1.41), clots in the lung (2.13) and breast cancer (1.26). They lowered hip fractures and colorectal cancers, but not enough to outweigh the harm. A treatment tested to protect the heart had harmed it.
Six years after that, in June 2008, the field pushed blood sugar lower still. A trial gave 10,251 people with type 2 diabetes and high heart risk one of two targets for glycated haemoglobin, the long-term measure of blood sugar. One group aimed below 6.0%. The other aimed for 7.0 to 7.9%. The low-target group was stopped after an average of 3.5 years, because more people in it were dying: 257 deaths against 203. Heart attacks, strokes and heart deaths had not fallen significantly. The number had gone down. The patients had not done better.
These are three of the thousands of studies that shaped modern endocrinology. The field treats numbers, blood sugar and hormone levels, and it has learned by trial which ones to chase and how far, and each time the answer was in a paper years before it was in a textbook.
It is still happening. Recently, in September 2025, the New England Journal of Medicine published a trial of a GLP-1 drug that comes as a pill rather than an injection. The trial gave 559 adults with early type 2 diabetes, treated with diet and exercise alone, orforglipron or placebo for 40 weeks. Glycated haemoglobin fell by up to 1.48 points on the pill, against 0.41 on placebo. Body weight fell by up to 7.6%, against 1.7%. Nobody had severe hypoglycaemia. The cost was stomach upset, mostly while the dose was being raised, and 4.4 to 7.8% stopped the pill for side effects, against 1.4% on placebo. The injection had become a pill. Practice follows the literature as it goes. It is a good culture. It has exactly one cost.
The literature grows faster than anyone can read it.
Across the medical topics an endocrinologist needs to stay up to date on, from type 2 diabetes and obesity drugs to thyroid disorders and osteoporosis, around 650 full-text papers now arrive every week. That is about 2,800 a month, and more than 30,000 a year. Metabolic syndrome alone is 122 of each week’s 650. Type 2 diabetes treatment is 105. These are not press releases or opinion pieces. They are the same kind of paper as the blood sugar trials and the Women’s Health Initiative, and somewhere in each week’s 650 are the handful that will change a prescription.
It is tempting to believe that experience closes the gap, that twenty years of clinic teach what the papers teach. The evidence points the other way. A systematic review of 62 studies found that in most of them, more years in practice went with lower adherence to current standards of care. Experience is not what keeps an endocrinologist current. Reading is. And reading is the one thing the week does not have room for.
So we built the tool you need to stay up to date.
We summarise the latest research for you and send it directly to your email inbox, every week, or whenever you choose.
A once-daily GLP-1 pill lowered blood sugar and weight in early type 2 diabetes
TakeawayIn 559 adults with early type 2 diabetes, oral orforglipron lowered glycated haemoglobin by up to 1.48 percentage points over 40 weeks, against 0.41 with placebo, with no severe hypoglycaemia.
Orforglipron is a small-molecule GLP-1 receptor agonist taken as a pill rather than an injection. ACHIEVE-1, a phase 3 double-blind trial, randomised 559 adults whose type 2 diabetes was treated with diet and exercise alone to 3 mg, 12 mg or 36 mg once daily, or placebo, for 40 weeks.
- •Glycated haemoglobin at week 40: -1.24 (3 mg), -1.47 (12 mg), -1.48 (36 mg) vs -0.41 percentage points with placebo (P < 0.001 for all).
- •Body weight at week 40: -4.5%, -5.8%, -7.6% vs -1.7%.