‘Weekend warriors’ with diabetes have a 33% lower risk of cardiovascular mortality

Embargoed for release until 5:00 p.m. ET on Monday 21 July 2025   

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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. ‘Weekend warriors’ with diabetes have a 33% lower risk of cardiovascular mortality  

All-cause mortality risk lowered when persons with diabetes engage in any amount of physical activity 

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00640

Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-25-02522

URL goes live when the embargo lifts             

A prospective cohort study examined the associations of different physical activity patterns with all-cause, cardiovascular (CV) and cancer mortality among adults with diabetes. The study found that weekend warrior and regular activity patterns meeting current physical activity recommendations were associated with similarly reduced risks for all-cause and cardiovascular mortality compared to physical inactivity, demonstrating the importance of any physical activity for people with diabetes. The results are published in Annals of Internal Medicine.

Researchers from Harvard T.H. Chan School of Public Health, Boston University School of Public Health, Vanderbilt University Medical Center, Capital Medical University, and colleagues studied data from 51,650 adults with self-reported diabetes who participated in the National Health Interview Survey (NHIS) between 1997 and 2018. Current guidelines recommend at least 150 minutes per week of moderate-to-vigorous physical activity (MVPA) distributed across a minimum of three days. Participants were categorized into four activity patterns: inactive (no reported MVPA); insufficiently active (MVPA less than 150 minutes per week); weekend warrior (MVPA 150 or more minutes per week across one to two sessions); and regularly active (MVPA 150 or more minutes per week across at least three sessions). The researchers found that insufficiently active, weekend warrior, and regularly active participants had lower risks for all-cause and cardiovascular mortality compared to inactive participants. Weekend warriors and regularly active participants had a 21% and 17% lower all-cause mortality risk and 33% and 19% lower risks of cardiovascular mortality, respectively, compared with inactive participants. There were fewer differences by cancer mortality compared with physical inactivity. 

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Haibin Li, PhD, please email lihb@mail.ccmu.edu.cn.   

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2. GLP-1 RAs show no clear advantage over DPP4is in dementia risk among older adults with diabetes

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02648

Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-25-02362

URL goes live when the embargo lifts             

A target trial emulation study compared the effect of glucagon-like peptide-1 receptor agonists (GLP-1RAs) versus dipeptidyl peptidase-4 inhibitors (DPP4is) as the second-line therapy for type 2 diabetes on the risk for dementia among older adults. The study found no clear difference in dementia incidence between GLP-1 RA and DPP4is users. Randomized trials with longer follow-up are warranted to better understand the effect of GLP-1 RAs on dementia in adults with diabetes. The study is published in Annals of Internal Medicine. 

Researchers from University of California, Los Angeles and colleagues studied data from 14,295 Medicare fee-for-service beneficiaries aged 66 and older with diabetes who initiated GLP-1RAs or DPP4is between January 2017 and December 2018. Eligible patients had prior use of metformin but no other antidiabetic medication and had no prior diagnosis of dementia. The researchers then matched patients in a 1:2 ratio in the GLP-1RA group with patients in the DPP4i group. The primary outcome was clinical onset of dementia defined as one year before the date of dementia diagnosis. In total, there were 2,418 GLP-1RA initiators and 11,877 DPP4i initiators. Clinical onset of dementia occurred in 4% of the GLP-1RA group and 4.5% of the DPP4i group, and there was no difference in the estimated 30-month risk for dementia diagnosis between both groups. These findings were consistent across several sensitivity analyses. Under conventional statistical criteria, the results were highly compatible with a 39% decrease and a 5% increase in risk for dementia among GLP-1 RA users. Subgroup analyses suggest that GLP-1RAs may have an advantage over DPP4is in adults younger than 75 years. However, the researchers note that additional research is needed to clarify whether the protective effects of GLP-1RAs against dementia vary across different age groups.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Yusuke Tsugawa, MD, PhD, please email Enrique Rivero at ERivero@mednet.ucla.edu.   

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3. Urgent care clinics often inappropriately prescribe antibiotics, glucocorticoids, and opioids

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-04111

URL goes live when the embargo lifts             

A cross-sectional study assessed inappropriate antibiotic, glucocorticoid, and opioid prescribing in urgent care visits in the U.S. The study found that urgent care visits are commonly associated with inappropriate antibiotic, glucocorticoid, and opioid prescribing, revealing the need for multifaceted programs to reduce inappropriate prescribing and mitigate potential harm. The findings are published in Annals of Internal Medicine. 

Researchers from the University of Michigan, Ann Arbor and colleagues used the Merative MarketScan Commercial and Medicare Supplemental databases to study urgent care outpatients of all ages between 1 January 2018 and 31 December 2022. The primary outcome was inappropriate oral antibiotic, glucocorticoids, and opioid prescription fills for the 10 most common Clinical Classifications Software Refined (CCSR) categories. Antibiotic appropriateness was based on established consensus schemes. Glucocorticoid appropriateness was based on literature defining glucocorticoid use as generally inappropriate for upper respiratory infections, sinusitis, acute bronchitis, infectious diseases, and otitis

media. Opioid prescription fills were considered generally inappropriate. Of 10,773,218 patients identified from 22,426,546 urgent care visits, 12.4%, 9.1%, and 1.3% of visits led to antibiotic, glucocorticoid, and opioid prescriptions, respectively. Antibiotics were frequently filled for never-appropriate indications, with 30.66% of prescriptions filled for otitis media. 40.8% of glucocorticoid prescriptions were inappropriately filled to treat acute bronchitis. Opioid prescriptions were commonly inappropriately filled for non-back musculoskeletal pain, abdominal pain and digestive symptoms, and sprains and strains. A subgroup analysis found that COVID-19 related visits led to lower antibiotic prescriptions and higher glucocorticoid prescriptions. The study highlights the need for stewardship programs to reduce inappropriate urgent care prescribing, and future studies should focus on

identifying components for urgent care–tailored stewardship programs.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Shirley Cohen-Mekelburg, MD, MS, please email Jina Sawani at sjina@med.umich.edu.        

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Also new this issue:

New Pneumococcal Vaccine Recommendation for U.S. Adults Aged 50 Years and Older—Promise and Challenges

Miwako Kobayashi, MD, MPH; Jamie Loehr, MD; Virginia A. Caine, MD; Adam L. Cohen, MD, MPH

Ideas and Opinions

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01178