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Obesity and Diabetes Care in Women

Clinical learner guide

Use this guide to revisit the teaching and plan the next clinical conversation. Complete the questions and evaluation in the activity. No patient information is collected by this guide.

Learning objectives

Choose postpartum testing and ongoing diabetes surveillance after gestational diabetes.
Match cardiometabolic treatment to established disease, the trial population and the outcome demonstrated, independently of A1C when appropriate.
Select individualized nutrition and functional support during obesity and diabetes treatment.
Apply product-specific reproductive counseling and coordinate a glycemic treatment transition before planned pregnancy.
Select a follow-up plan with a clinical action, responsible clinician, due date and response to a missed step.

Maya

Case 1 Complete postpartum testing and continuing care

Gestational diabetes and the next prevention step

Maya, age 32 | Fictional patient

Maya is seven weeks postpartum after gestational diabetes. She feels well, but the recommended glucose test has not happened.

Maya | Fictional teaching case illustration

Clinical detail	Case information
Timing	7 weeks postpartum
History	Gestational diabetes
Current concern	Missed glucose test
Practical barrier	Childcare and a fasting visit

Choose the test that answers the question

Neither the obstetric nor primary care office has arranged Maya’s test. Her recent A1C is 5.4%, and she has no hyperglycemic symptoms. What should happen now?

Which plan best evaluates her glucose status at this point?

Choose a response before reviewing the explanation.

Use the recent A1C as the postpartum screen and repeat testing in one year.
Arrange a fasting 75 g two-hour OGTT and agree on a feasible appointment.
Obtain fasting plasma glucose and reserve the OGTT for an abnormal result.
Collect two weeks of home glucose readings and review them instead of an OGTT.

Clinical reasoning

Best answer B. The ADA recommends a 75 g OGTT at 4–12 weeks after a pregnancy with gestational diabetes. The order also needs a workable completion plan.

Confirm fasting instructions, an achievable laboratory appointment and a result reviewer. Ask what would make the visit possible; another order alone will not resolve her childcare barrier.

Turn the order into a completed assessment

Primary care accepts responsibility for the test and result and confirms the handoff with obstetrics.

If the OGTT cannot be completed, document the barrier and arrange clinician review of an alternative pathway.

Teach-back: “This test checks fasting glucose and the response two hours after a glucose drink. How will you prepare, and who will contact you?”

Document which office will act if the appointment is missed.

Sources 1

What happens next

The office books an early appointment and confirms childcare and result communication with Maya.

Explain what a normal result does and does not mean

Maya’s OGTT is normal by nonpregnancy criteria. She asks whether gestational diabetes can now be removed from her history.

What belongs in the ongoing plan?

Choose a response before reviewing the explanation.

Use routine population screening criteria now that the postpartum OGTT is normal.
Repeat screening every three years until two consecutive results remain normal.
Keep the GDM history and arrange lifelong screening every 1–3 years.
Repeat screening before another pregnancy and sooner if hyperglycemic symptoms develop.

Clinical reasoning

Best answer C. Preserve the history and plan lifelong screening at 1–3-year intervals, adjusted to clinical context.

Record the reassuring result, ongoing screening interval and responsible clinician.

Make the result useful to the next clinician

Prediabetes or diabetes results need the appropriate diagnostic and management pathway. New symptoms or pregnancy warrant assessment without waiting for the routine interval.

Record prior GDM separately from current diabetes, including pregnancy year and postpartum result.

Pregnancy history informs prevention; it is not proof of coronary disease.

Review other adverse pregnancy outcomes, blood pressure, smoking, indicated lipid testing and overall cardiovascular health.

Sources 1, 2

What happens next

Maya and her clinician record the next screening date and retain GDM in her history.

Postpartum testing and the next action

Use the two result pathways to connect testing with continued care.

Figure 1. Original teaching summary of ADA Standards of Care 2026, section 15. Source 1. The missed-step workflow is an educational implementation example.

Apply the figure

Identify the result reviewer and missed-appointment response as you read the pathway; no additional written response is required.

Make nutrition support usable

Maya skips breakfast and avoids most carbohydrate because she fears diabetes. She is breastfeeding, has a limited grocery budget and wants enough energy for her day.

Which referral is most useful?

Worked example — no response required. Clinical approach: Refer for nutrition assessment covering lactation, intake, food access and achievable meal routines.

Clinical reasoning

The referral should specify the clinical question and the practical circumstances the RDN needs to address.

Ask what she usually eats, which foods she avoids and why. Build the plan around familiar, affordable foods.

Write a nutrition referral with a clinical question

Send the RDN the lactation context, meal skipping, carbohydrate fear, access concerns and energy goal. Request an adequacy assessment and return of the agreed plan.

If food access limits the plan, identify a usable community resource.

The referring office checks visit completion and follows up if it is missed.

Individualize medical nutrition therapy; this case does not prescribe a universal postpartum diet.

Sources 3, 4

What happens next

The referral includes Maya’s normal OGTT, lactation, nutrition concerns and how recommendations will return to primary care.

Before the handoff

Document the completed postpartum test and interpretation.

Record the ongoing screening interval and responsible clinician.

Send the RDN the specific nutrition question and relevant circumstances.

Confirm how Maya will receive results and what happens after a missed appointment.

Elena

Case 2 Connect cardiovascular benefit with nutrition and function

Cardiovascular protection and nutrition during treatment

Elena, age 54 | Fictional patient

Elena has obesity, type 2 diabetes, and a prior myocardial infarction. Her A1C is at her individualized goal, but the treatment review is not complete.

Elena | Fictional teaching case illustration

Clinical detail	Case information
A1C	6.7%
BMI	33 kg/m²
Current disease	Type 2 diabetes and prior MI
Pregnancy history	Preeclampsia in her 30s

Treat the patient beyond the A1C

Elena takes metformin and secondary-prevention medicines after an MI three years ago. She is postmenopausal and has no acute symptoms. A colleague proposes waiting for A1C to rise before reviewing additional diabetes therapy.

What is the best next treatment discussion?

Choose a response before reviewing the explanation.

Review GLP-1 and/or SGLT2 therapy with demonstrated benefit alongside her current prevention plan.
Optimize metformin and revisit additional treatment when A1C exceeds her individualized target.
Choose obesity treatment by its weight effect and infer cardiovascular protection from that response.
Continue current therapy and reserve cardioprotective diabetes treatment for a later HF diagnosis.

Clinical reasoning

Best answer A. In type 2 diabetes with established ASCVD, cardiovascular benefit can guide treatment independently of the need for additional glucose lowering.

Her MI establishes ASCVD. Review the rest of secondary prevention, kidney status, symptoms and access. Drug choice should follow relevant population and outcome evidence.

Separate the treatment goals

Document the cardiovascular goal so an at-goal A1C is not mistaken for absence of a treatment rationale.

Compare options by disease, outcome, contraindications, tolerability, affordability and preference. HF or CKD may change the choice. [5,11]

Keep nutrition, activity, behavioral support and other appropriate obesity treatments in view. This is not a complete obesity-treatment algorithm. [10]

The trial table separates weight, glycemic and cardiovascular findings. Do not infer superior cardiovascular protection from greater weight loss. [13–15]

Agree which clinician will review metabolic and cardiovascular response.

Sources 5, 11, 13, 14, 15

What happens next

Compare suitable options with Elena and document the treatment goal and follow-up owner.

From trial evidence to a treatment choice

Elena asks whether more weight loss means better heart protection. Check the population, comparator, endpoint, effect and safety findings before answering.

Trial and population	What was demonstrated	Boundary for the decision
SELECT Established CVD, age at least 45, BMI at least 27, no diabetes	Semaglutide 2.4 mg weekly versus placebo reduced first MACE: 6.5% versus 8.0%; HR 0.80, 95% CI 0.72–0.90. [13]	Applies to a defined secondary-prevention population. It does not directly answer Elena’s diabetes question or show benefit after GDM alone.
SURPASS CVOT Type 2 diabetes and established ASCVD	Tirzepatide versus dulaglutide met noninferiority for CV death, MI or stroke: HR 0.92, 95.3% CI 0.83–1.01. Superiority was not established. [14]	An active comparator with established benefit is not placebo. Do not describe greater weight loss as proven superiority for MACE.
SUMMIT Obesity and HFpEF	Tirzepatide improved the composite of CV death or worsening HF versus placebo and health status. [15]	The composite does not establish reduced CV death alone. Confirm HFpEF rather than diagnosing it from BMI and breathlessness.
STEP-HFpEF BMI ≥30; symptomatic HF; LVEF ≥45%; without diabetes	Semaglutide improved symptoms, physical limitations and exercise function. [19]	Patient-reported health status and physical function matter, but are not interchangeable with a mortality endpoint.

These trials cannot be ranked directly across different populations and methods. Discuss benefit with tolerability: SELECT reported adverse-event discontinuation in 16.6% with semaglutide versus 8.2% with placebo. [13]

Choose the branch that matches the disease

Elena’s MI and diabetes guide the evidence choice. If HF or CKD is present, review the relevant SGLT2 evidence and indications; incretin therapy does not replace the rest of cardiac or kidney care. [5,11,21]

FINEARTS-HF provides a separate example: finerenone reduced total worsening-HF events and CV death as a composite in patients with LVEF at least 40%. It is not an obesity medicine; selection requires indication, kidney, potassium, interaction and label review. [20,21]

Disease status determines which evidence applies

Find the relevant disease pathway, then check its trial population and endpoint. More than one pathway may apply.

Figure 2. Original evidence map. Sources 1, 2, 5, 11, 13–15 and 19; see sources 20–21 for the separate HF discussion. It does not rank medicines or replace current prescribing information.

Apply the figure

Compare Elena’s established disease with Maya’s pregnancy history; do not assume their trial evidence is interchangeable.

Interpret a new trial report

In a separate variation, Elena asks whether a report about oral orforglipron has established superior cardiovascular protection in diabetes. What should guide the response?

Worked example — no response required. Clinical approach: Check the indication and distinguish noninferiority from demonstrated cardiovascular event reduction.

Clinical reasoning

The July 2026 Foundayo label lists chronic weight management, not a diabetes-treatment or cardiovascular risk-reduction indication. Route of administration does not establish those outcomes. [16]

ACHIEVE-4’s September 30 sponsor report compared orforglipron with insulin glargine in 2,749 adults with T2D, BMI at least 25 and increased CV risk. MACE-4 HR 0.84 (95% CI 0.59–1.20) met noninferiority, not superiority. Mortality analyses lacked family-wise type I error control; ATTAIN-OUTCOMES was ongoing. [17]

Review the full label for an eligible weight-management patient: GI effects, MTC/MEN2 and hypersensitivity contraindications, dehydration, hypoglycemia with insulin/secretagogues, and CYP3A4/OATP1B and simvastatin interactions. Concomitant use with another GLP-1 receptor agonist is not recommended. [16]

Emerging therapy and the question still unanswered

Retatrutide remained investigational in the September 2026 TRIUMPH-2 sponsor report. Weight and A1C findings do not establish approval, reproductive safety or cardiovascular event reduction. This activity makes no prescribing or enrollment recommendation. [18]

Notice when weight loss hides a new problem

At follow-up, Elena reports weight loss, nausea, small meals, constipation and less energy. She can drink and has no persistent vomiting or severe abdominal pain. A dose increase is approaching.

Which response best addresses the information she has just shared?

Choose a response before reviewing the explanation.

Treat constipation, continue the planned escalation and review intake at the next routine appointment.
Review symptoms, intake, hydration and function with the prescriber and RDN before escalation.
Add a protein supplement, continue escalation and reassess symptoms at the maintenance dose.
Delay escalation and use subsequent weight change to decide whether nutrition review is needed.

Clinical reasoning

Best answer B. Review the whole treatment response, including symptoms and nutrition, before the prescriber decides on dose progression.

Assess what she can eat and drink, symptom-related avoidance and daily function. Nutrition review should accompany treatment, before a problem becomes severe.

Review symptoms before deciding the next dose

Review intake, fluids, bowel habits, activity, dose history and other medicines; consider other causes.

The prescriber decides the medication plan; the RDN assesses intake and communicates concerns.

Persistent vomiting, inability to maintain fluids or severe persistent abdominal pain warrants prompt assessment. These examples are not an exhaustive triage rule. [6,7]

Give Elena a contact route if symptoms worsen.

Sources 6, 7

What happens next

The team reviews symptoms and intake before escalation and explains when to seek prompt assessment.

Protect the ability to live well

After prescriber review, Elena’s symptoms improve. She wants to preserve strength but has knee pain and little resistance-exercise experience. She asks about a protein target seen online.

Which approach best fits her goals?

Worked example — no response required. Clinical approach: Individualize nutrition and suitable resistance activity, with follow-up of a meaningful task.

Clinical reasoning

Nutrition and appropriate strength activity should be planned together, adapted to capability and health status.

Adapt nutrition and resistance activity to capability and health status; consider rehabilitation or physical therapy when needed.

Measure a goal that matters to Elena

Choose a meaningful task, such as rising from a chair, and reassess consistently. Worsening function needs evaluation.

State the limitation and functional goal in a referral.

Reassess intake, symptoms, function, affordability and acceptability. This plan does not guarantee muscle preservation. [6]

Weight loss or a lean-mass estimate alone does not diagnose sarcopenia.

Sources 6

What happens next

Elena chooses a feasible nutrition change and suitable activity, with function included in follow-up.

Before the handoff

State whether the patient has established ASCVD, heart failure, or kidney disease.

Document the treatment goal, relevant outcome evidence, and patient preference.

Connect the nutrition assessment to symptoms and medication decisions.

Choose a follow-up measure that includes how the patient functions.

Nora

Case 3 Plan treatment around reproductive goals

GLP-1 treatment and reproductive decisions

Nora, age 34 | Fictional patient

Nora takes injectable semaglutide for obesity. She would like to try for pregnancy in three months and wants to know what should happen before then.

Nora | Fictional teaching case illustration

Clinical detail	Case information
Medication	Semaglutide injection
Product and reason	Wegovy for obesity
Pregnancy intention	Try in 3 months
Diabetes	Not diagnosed

Make the timing product specific

Nora uses contraception and is not pregnant. She asks which stopping interval applies to her injectable semaglutide.

Which guidance fits the product and indication in this case?

Choose a response before reviewing the explanation.

Arrange preconception review and stop injectable Wegovy one month before trying.
Continue until the first missed period, with prompt medication review at that point.
Use a four-week interval after the last dose based on tirzepatide contraception guidance.
Stop Wegovy at least two months before the planned pregnancy and coordinate preconception care.

Clinical reasoning

Best answer D. The current Wegovy labeling specifies at least two months before planned pregnancy for weight reduction.

Confirm the product, formulation, indication and reproductive goal. Integrate medication timing with nutrition, other medicines and preconception care.

Make the dates understandable

The weekly dosing schedule does not determine the pregnancy stopping interval.

For a January 15 intended conception date, a last dose no later than November 15 illustrates two months. Individual review may support earlier discontinuation.

Use teach-back and discuss changed plans. Do not make reproductive care conditional on an arbitrary weight.

Respect the patient’s contraceptive and pregnancy choices.

Sources 7, 8

What happens next

Nora and her prescriber document the dates and arrange preconception care and nutrition support.

Change the medicine and the counseling changes

Consider a separate variation: Nora is taking tirzepatide as Zepbound, uses an oral hormonal contraceptive, and does not want pregnancy. Her prescriber is increasing the dose. She asks whether taking the pill at a different time is enough.

What counseling is supported by the current Zepbound label?

Worked example — no response required. Clinical approach: Use a non-oral method or add a barrier for four weeks after initiation and each escalation.

Clinical reasoning

Discuss a patient-chosen non-oral method or an added barrier method for the specified four-week periods.

Explain the product-specific issue, discuss feasible options and confirm understanding without prescribing a particular contraceptive choice.

Give a usable contraception instruction

This is a separate Zepbound variation, not a recommended switch. Confirm the contraception route.

An October 20 escalation starts a four-week precaution through November 17. Each further escalation starts another period.

Record the dates and chosen method in the dose-review plan.

Oral formulations differ. Oral Wegovy requires morning dosing fasting, with no more than 4 ounces of plain water and a 30-minute wait before food, drinks or other oral medicines. Foundayo permits food and uses a 30-day contraceptive precaution after initiation and each escalation. Verify the exact label. [7,16]

Separating tablet and injection times does not replace Zepbound’s precaution. [9]

Sources 9, 7, 16

What happens next

The next escalation review includes the documented contraception plan.

Stopping treatment is not the whole plan

In another variation, Nora has type 2 diabetes controlled with a GLP-1 receptor agonist. She plans pregnancy and proposes stopping treatment until her first prenatal visit.

Which plan best addresses this change?

Choose a response before reviewing the explanation.

Stop the GLP-1 medicine before trying and review glucose treatment at the first prenatal visit.
Coordinate discontinuation, alternative glycemic treatment and monitoring before conception.
Stop before trying and arrange treatment review only if home readings move outside target.
Continue the current regimen while arranging pregnancy care and stop after pregnancy is confirmed.

Clinical reasoning

Best answer B. The plan must address both medication discontinuation before conception and ongoing glucose management.

Plan time to select and titrate pregnancy-appropriate treatment and establish monitoring. Include nutrition support and a named contact.

Coordinate the transition before conception

The Endocrine Society/ESE guideline suggests discontinuation before conception. Evidence certainty is very low; individualize timing with active glycemic management. [8]

Send the regimen, glucose information and reproductive goal. Document alternative treatment, monitoring, prescriber and contact for changing readings.

Unexpected pregnancy needs prompt exposure and maternal review; Zepbound labeling calls for discontinuation. Limited safety evidence does not predict an individual fetal outcome. [1,8,9]

Coordinate endocrinology, pregnancy care and nutrition. Assess lactation separately using current product and formulation information.

Sources 1, 8, 9

What happens next

Write the transition, monitoring plan, accepting clinician and review date, including what to do if pregnancy occurs sooner.

An oral option still needs reproductive counseling

In a separate variation, Nora starts Foundayo for obesity while using oral hormonal contraception. She assumes an oral medicine needs no contraceptive precaution.

Which instruction matches the July 2026 label?

Worked example — no response required. Clinical approach: Use a non-oral method or add a barrier for 30 days after initiation and every escalation.

Clinical reasoning

Use the label’s 30 days after initiation and each escalation. Discuss a feasible non-oral or added-barrier method and record the dates. [16]

Product in the teaching case	Specific reproductive teaching point
Injectable Wegovy for obesity	Discontinue at least two months before planned pregnancy. Coordinate preconception care and ongoing treatment needs. [7]
Zepbound	For oral hormonal contraception: non-oral method or added barrier for four weeks after initiation and each escalation. [9]
Foundayo	For oral hormonal contraception: non-oral method or added barrier for 30 days after initiation and each escalation. Discontinue when pregnancy is recognized. The July 2026 label does not recommend use in nursing women. [16]

Planned-pregnancy stopping intervals and temporary contraception precautions answer different questions. Diabetes requires ongoing glycemic care; lactation needs a separate label review. [1,7–9,16]

Teach-back: “Which method will you use, and which dates does the precaution cover?”

Use the correct reproductive timing

Check product, formulation, indication and reproductive goal before assigning dates.

Figure 3. Original product-specific teaching timelines, not to a shared scale. Sources 7, 9 and 16, reviewed October 14 2026. Example calendar dates are illustrative. Pregnancy and lactation require separate review of the exact label.

Apply the figure

Use the timeline to check the dates. In the diabetes variation, confirm who will arrange treatment and monitoring before discontinuation.

Before the handoff

Record the exact product, formulation, indication, and reproductive goal.

Specify product-dependent timing and contraceptive counseling.

Plan ongoing glycemic treatment when diabetes is present.

Name the next clinician, the review date, and the action if plans change.

References

Clinical source review October 14 2026. Recheck current labeling and guidelines before publication and clinical use. Bracketed numbers refer to this list. Brand names identify product-specific guidance and do not imply endorsement.

1. ADA 2026 Diabetes in pregnancy. Postpartum testing, ongoing surveillance, and interprofessional preconception care.

https://diabetesjournals.org/care/article/49/Supplement_1/S321/163918/15-Management-of-Diabetes-in-Pregnancy-Standards

2. AHA 2024 Postpartum cardiovascular prevention. Cardiovascular prevention following adverse pregnancy outcomes.

https://www.ahajournals.org/doi/10.1161/CIR.0000000000001212

3. ADA 2026 Health behaviors and well-being. Individualized medical nutrition therapy and referral to an RDN.

https://diabetesjournals.org/care/article/49/Supplement_1/S89/163932/5-Facilitating-Positive-Health-Behaviors-and-Well

4. ADA Nutrition and wellness. Nutrition patterns tailored to needs, preferences, culture, and access.

https://professional.diabetes.org/clinical-support/nutrition-wellness

5. ADA 2026 Cardiovascular disease and risk management. Outcome-guided therapy for type 2 diabetes and cardiovascular disease.

https://diabetesjournals.org/care/article/49/Supplement_1/S216/163933/10-Cardiovascular-Disease-and-Risk-Management

6. Joint advisory 2025 Nutrition during GLP-1 therapy. Nutrition assessment, symptoms, adequate intake, muscle, and function. Read with the 2026 correction listed as reference 12.

https://doi.org/10.1016/j.ajcnut.2025.04.023

7. Wegovy US prescribing information. Product-specific reproductive guidance and adverse-effect review. Retrieved October 14 2026; revision June 2026.

https://www.novo-pi.com/wegovy.pdf

8. Endocrine Society and ESE 2025 Preexisting diabetes and pregnancy. Preconception GLP-1 discontinuation, individualized timing, and glycemic transition.

https://www.endocrine.org/clinical-practice-guidelines/preexisting-diabetes-in-pregnancy

9. Zepbound US prescribing information. Oral contraceptive precautions and pregnancy guidance. Retrieved October 14 2026; revision August 2026.

https://pi.lilly.com/us/zepbound-uspi.pdf

10. ADA 2026 Obesity and weight management. Standards of Care in Diabetes 2026 section 8. doi:10.2337/dc26-S008. Individualized obesity care and monitoring nutritional intake.

https://pmc.ncbi.nlm.nih.gov/articles/PMC12690172/

11. ADA 2026 Pharmacologic approaches. Standards of Care in Diabetes 2026 section 9. doi:10.2337/dc26-S009. Person-specific treatment selection.

https://pmc.ncbi.nlm.nih.gov/articles/PMC12690185/

12. Nutrition advisory correction 2026. Mozaffarian et al. Am J Clin Nutr. 2026;123:101303. doi:10.1016/j.ajcnut.2026.101303. Corrects one study description; reviewed October 14 2026. No outcome estimate from that study is used in this activity.

https://pmc.ncbi.nlm.nih.gov/articles/PMC13639435/

13. Lincoff AM et al. SELECT. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023. doi:10.1056/NEJMoa2307563.

https://www.nejm.org/doi/full/10.1056/NEJMoa2307563

14. Nicholls SJ et al. SURPASS-CVOT. Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes. N Engl J Med. 2025;393:2409–2420.

https://www.nejm.org/doi/full/10.1056/NEJMoa2505928

15. Packer M et al. SUMMIT. Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med. 2025. doi:10.1056/NEJMoa2410027.

https://www.nejm.org/doi/full/10.1056/NEJMoa2410027

16. FDA. Foundayo orforglipron US prescribing information. Revised July 2026. Indication, interactions, reproductive counseling and lactation.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/220934s003lbl.pdf

Manufacturer prescribing information: https://pi.lilly.com/us/foundayo-uspi.pdf

17. Klein KR, et al. Cardiovascular safety of orforglipron versus insulin glargine in adults with type 2 diabetes at increased cardiovascular risk (ACHIEVE-4). Lancet. Published September 30, 2026. doi:10.1016/S0140-6736(26)01865-9. Primary publication; accompanying sponsor report also informed the teaching summary.

https://doi.org/10.1016/S0140-6736(26)01865-9 ; Sponsor report: https://investor.lilly.com/news-releases/news-release-details/lillys-oral-glp-1-foundayo-orforglipron-demonstrated

18. Lilly. TRIUMPH-2 detailed results. September 29, 2026. Sponsor report; retatrutide is described as investigational.

https://investor.lilly.com/node/54981

Report title: Lilly’s triple agonist retatrutide delivered substantial weight loss; https://investor.lilly.com/news-releases/news-release-details/lillys-triple-agonist-retatrutide-delivered-substantial-weight

19. Kosiborod MN et al. STEP-HFpEF. Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med. 2023. doi:10.1056/NEJMoa2306963.

https://www.nejm.org/doi/full/10.1056/NEJMoa2306963

20. Solomon SD et al. FINEARTS-HF. Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. N Engl J Med. 2024. doi:10.1056/NEJMoa2407107.

https://www.nejm.org/doi/full/10.1056/NEJMoa2407107

21. American College of Cardiology. Management of Heart Failure With Preserved Ejection Fraction. 2026 Expert Consensus Decision Pathway. doi:10.1016/j.jacc.2026.06.018.

https://www.jacc.org/doi/full/10.1016/j.jacc.2026.06.018

22. REDEFINE 4: Novo Nordisk announcement, February 23 2026. Manufacturer report: primary noninferiority endpoint not met. CagriSema remains investigational.

https://www.globenewswire.com/news-release/2026/02/23/3242381/0/en/novo-nordisk-a-s-cagrisema-demonstrated-23-weight-loss-in-an-open-label-head-to-head-redefine-4-trial-in-people-with-obesity-the-primary-endpoint-was-not-achieved.html

23. REIMAGINE 5: Novo Nordisk topline announcement, September 21 2026. Manufacturer-reported topline results; CagriSema 1.0/1.0 mg versus tirzepatide 5 mg in type 2 diabetes.

https://www.novonordisk.com/news-and-media/news-and-ir-materials/news-details.html?id=916774

Completion

Three baseline questions, three cases with two required decisions each, six posttest questions and a short evaluation. Passing score: 65% (at least four of six correct). Review feedback and retry when needed. Video, audio and transcripts are equivalent optional learning supports.