Embargoed for release until 5:00 p.m. ET on Monday 13 July 2026
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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine . The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
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1. U.S. study suggests GLP-1 RA drugs are associated with small increase in ischemic optic neuropathy
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00860
URL goes live when the embargo lifts
A target trial emulation found that people with type 2 diabetes who start glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy had a slightly higher risk for ischemic optic neuropathy (ION), a rare condition involving reduced blood flow to the optic nerve that can cause sudden vision loss, compared with those initiating sodium–glucose cotransporter-2 inhibitors (SGLT2is) or dipeptidyl peptidase-4 inhibitors (DPP4is); however, absolute risk was very low. The findings add to limited evidence of a possible association between GLP-1RAs and ION, but they should be interpreted cautiously due to the potential for residual confounding. The study is published in Annals of Internal Medicine .
Researchers from Rutgers University analyzed U.S. insurance claims data of adults aged 18 to 65 years with type 2 diabetes from 2017 to 2022 to compare the risk for ION, a condition that causes sudden vision loss, among initiators of GLP-1 RAs versus SGLT-2is or DPP-4is. Over 18 months, ION occurred in fewer than 1 in 1,000 patients across all groups, though rates were modestly higher among those taking GLP-1RAs. The authors conclude that while an association was observed, the absolute risk was low, and the findings may partly reflect differences in patients’ underlying health rather than a direct effect of the medications.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Chintan V. Dave, PharmD, PhD please email cdave@ifh.rutgers.edu and Nicole Swenarton at nswenarton@ifh.rutgers.edu.
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2. Large Swedish study suggests low overall risk of sudden vision loss with GLP-1 RA use
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-02096
A nationwide cohort study found a slightly higher risk for nonarteritic anterior ischemic optic neuropathy (NAION) among users of glucagon-like peptide-1 receptor agonists (GLP-1RAs) compared with sodium–glucose cotransporter-2 (SGLT-2) inhibitor use. However, absolute risks were small, and differences in risk may be partly due to differences in patients’ underlying health. The study is published in Annals of Internal Medicine .
Researchers from the Karolinska Institutet used nationwide health data of patients aged 35 to 84 years with type 2 diabetes in Sweden between 2013 and 2024 to emulate a pragmatic target trial assessing the effect of GLP-1RA use on risk for NAION, a condition that causes sudden vision loss in one eye. Of 107,518 GLP-1RA initiators and 185,898 SGLT-2 inhibitor initiators, the risk for anterior ischemic optic neuropathy was 0.04% and 0.02% after one year, respectively. While the relative risk was higher in the GLP-1 group, differences were smaller in analyses that accounted more closely for diabetes severity. The authors conclude that there may be an association influenced by other patient factors.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Peter Ueda, MD, PhD please email peter.ueda@ki.se.
3. ACP says underregulated dietary supplements endanger public health
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-01119
Dietary supplements must be more regulated to protect public health, says the American College of Physicians (ACP). In a new paper, “Modernizing the Regulatory Framework for Dietary Supplements: A Position Paper from the American College of Physicians” published in Annals of Internal Medicine , ACP issues recommendations to strengthen and modernize the manufacturing and marketing of dietary supplements.
Over half of adults in the United States consume dietary supplements, but only one quarter consume supplements that have been recommended by a health care professional. Dietary supplements are defined by the Dietary Supplement Health and Education Act of 1994 (DSHEA) as products for ingestion that contain a “dietary ingredient” intended to supplement the diet. Ingredients in supplements include vitamins, minerals, amino acids, and probiotics and range in intended function—from supplementing one’s diet with nutrients to improving athletic performance.
There are as many as 100,000 dietary supplements available, and in 2025, the global dietary supplement market size was estimated to be $209.5 billion. While some dietary supplements, principally vitamins and minerals, are thoroughly tested for safety and efficacy and may aid in ensuring the consumption of essential nutrients, many others are not backed by strong scientific evidence. They may also contain unlisted ingredients, mislabeled dosages or dangerous or illicit substances, and can have harmful interactions with prescription medications.
In the paper, ACP calls on Congress to modernize the DSHEA to require dietary supplements to undergo evidence-based review, registration and premarket approval with the Food and Drug Administration (FDA) and require them to meet quality standards established by the United States Pharmacopeia. ACP says the FDA should receive adequate funding and resources for the oversight and regulation of dietary supplement manufacturing, quality, safety and labeling and recommends bolstering the FDA’s post-market surveillance authority for dietary supplements. Amending the DSHEA to give the FDA the authority to bypass voluntary recall procedures when notified of adverse events or mislabeled products would allow the FDA to more quickly remove compromised or mislabeled supplements from the market.
ACP supports efforts to ensure the Federal Trade Commission has the necessary resources to adequately monitor the marketing and advertising of dietary supplements, particularly those made on social media by paid influencers, and take swift action against violations. There is a need for high-quality, consistent and updated data on dietary supplements that are accessible to the public; ACP urges the FDA to create a national, public, searchable database of dietary supplements that includes information on supplements, their ingredients, and existing scientific research on health impacts and drug interactions. ACP encourages a standardization of language and data sharing to ensure the consistency and safety of products manufactured in a global supply chain. The paper says dietary supplement manufacturers should ensure their products are safe and effective with a secure supply chain, robust clinical research, accurately labeled products, and adherence to Current Good Manufacturing Practices.
ACP urges electronic health record vendors to integrate dietary supplement knowledge databases into their platforms because the lack of standardized supplement documentation procedures leaves patients susceptible to potential adverse events arising from drug interactions with dietary supplements. ACP further supports the education of health care professionals, medical students and patients about the safe use of dietary supplements and urges health care facilities to implement procedures to collect information on patient dietary supplement use parallel to the collection of prescription medication history. Finally, ACP urges Congress to continue funding the National Institutes of Health Office of Dietary Supplements to ensure continued study of the safety of supplements on the market and promote public awareness.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To speak with someone at ACP, please contact Jacquelyn Blaser at jblaser@acponline.org.
4. One in three federally qualified health centers do not offer direct prenatal care
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-00381
An observational study estimated that 1 in 3 federally qualified health centers (FQHCs) did not offer prenatal care directly in 2024, and many of these clinics were located in maternity care deserts and rural areas. The findings may inform workforce, payment, and delivery system policies that enhance the ability of FQHCs to serve vulnerable pregnant populations. The study is published in Annals of Internal Medicine .
Researchers from Harvard Medical School, the Harvard Pilgrim Health Care Institute, and Boston University School of Public Health analyzed data from 1,326 FQHCs providing prenatal care in 2024 and county-level maternity desert data from March of Dimes to describe national rates of onsite versus referral-only prenatal care at FQHCs, FQHC- and area-level characteristics associated with offering onsite prenatal care, and geographic variation in FQHC provision of prenatal care. They found that 67% provided onsite prenatal care and 33% exclusively referred pregnant patients to external providers. FQHCs with onsite prenatal care were more often in urban locations and outside of maternity care deserts. FQHCs with high percentages of patients who were Black, Hispanic, Medicaid-enrolled or had limited English proficiency were most likely to offer prenatal care. Counties in the South and western Midwest were more likely to have no FQHCs or FQHCs without onsite prenatal care. The findings suggest that FQHCs may provide care for populations that otherwise face barriers to accessing quality maternal health care. The findings also highlight opportunities to expand FQHC provision of maternity services in maternity deserts and rural regions to mitigate access-related barriers to care.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Megan B. Cole, PhD, MPH, please email megan_cole_brahim@hphci.harvard.edu.
5. GLP-1 initiation did not improve insulin discontinuation rates among veterans with type 2 diabetes
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-05216
A target trial emulation found that adding glucagon-like peptide-1 receptor agonists (GLP-1RAs) to basal insulin therapy for type 2 diabetes did not increase the likelihood of stopping insulin therapy compared with adding sodium–glucose cotransporter-2 inhibitor (SGLT-2i) or dipeptidyl peptidase-4 inhibitor (DPP-4i) therapy. The findings warrant further research to evaluate whether dual- or triple-incretin agonists, which produce greater glycemic and weight reductions, may have a different impact on insulin discontinuation in routine practice. The study is published in Annals of Internal Medicine .
Researchers from the Veterans Affairs Cooperative Studies Program Clinical Epidemiology Research Center aimed to compare the effects of initiation of GLP-1RAs compared with sodium–glucose cotransporter-2 inhibitors (SGLT-2is) and dipeptidyl peptidase-4 inhibitors (DPP-4is) on the rates of insulin discontinuation over 3 years of follow-up among patients with type 2 diabetes. They used electronic health records from the U.S. Veterans Health Administration between 2020 and 2022 to analyze 8,869 matched sets of GLP-1RA, SGLT-2i, and DPP-4i initiators. 16.7% of GLP-1RA initiators, 17.9% of SGLT-2i initiators, and 17.1% of DPP-4i initiators discontinued insulin therapy after three years of follow-up. The findings suggest that adding a GLP-1RA to basal insulin therapy in routine care may not meaningfully increase the chances of stopping insulin therapy compared with adding an SGLT-2i or DPP-4i first.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Kasia J Lipska, MD, MHS please email kasia.lipska@va.gov.
Also in this issue:
Assessing Front-of-Package Labels: The U.S. Food and Drug Administration’s Proposed Rule in Context
Jacqueline Xu, MD; Joseph T. Kannarkat, MD, MPP; and Diana R.H. Winters, PhD, JD
Ideas and Opinions
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-01632
Obstructive Sleep Apnea
Lucas M. Donovan, MD, MS
In the Clinic
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-02124
Annals of Internal Medicine
News article
People
Glucagon-Like Peptide-1 Receptor Agonists and Risk for Ischemic Optic Neuropathy: A Target Trial Emulation
14-Jul-2026