John B. Buse
Chapel Hill
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Articles by John B. Buse
Addressing the Lingering Challenge of Hypoglycemia in T1D, With John Buse, MD, PhD
Despite advancements in diabetes technology in recent years, hypoglycemia is still among the most substantial dangers faced by patients with type 1 diabetes (T1D).
Weight Loss Intervention Promoting an Adapted Mediterranean-Style Dietary Pattern : The DELISH Randomized Clinical Trial
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Weight Loss Intervention Promoting an Adapted Mediterranean-Style Dietary Pattern: The DELISH Randomized Clinical Trial Supplement 1. Trial Protocol and Statistical Analysis Plan Supplement 2. eAppendix 1. Overview of Enrollment eAppendix 2. Complete Listing of Inclusion Criteria eAppendix 3. Complete Listing of Exclusion Criteria eAppendix 4. Detailed Instructions Provided to Primary Care Clinicians (PCPs) on How to Make a Referral to the Study eAppendix 5.
By Thomas C Keyserling, Qiang Wu, Alice S. Ammerman, Seth A. Berkowitz, John B. Buse, David J. Couper, Kelly R. Evenson, Daniela Sotres-Alvarez, Veeral Saraiya, Harlyn G. Skinner, Caroline Nelson, Lauren Kruse, Teresa T Fung, Stephanie Pitts Verified, Eric Finkelstein, Carmen D Samuel-Hodge, Steven D. Hursting, Kiira Lyons, Candice L. Alick, Alison N. Mathers
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JAMA Network
Verified
Effect of semaglutide on kidney outcomes in the SELECT, FLOW, and SOUL trials: a prespecified pooled analysis
Get full text access Log in, subscribe or purchase for full access. References 1. Bikbov, B ∙ Purcell, CA ∙ Levey, AS ∙ et al., the GBD Chronic Kidney Disease Collaboration Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 Lancet. 2020; 395:709-733 2.
Cortisol and Type 2 Diabetes: Solutions and Practical Takeaways
Health Resources Hub / Endocrine Health / Type 2 Diabetes Concluding the series, John Buse, M.D., Ph.D., details how cortisol directly promotes visceral belly fat distribution and appetite surges, while leaving patients with an empowering reminder that a stubborn A1C is a clinical puzzle to solve rather than a personal failure.
Cortisol and Type 2 Diabetes: Managing Cortisol
| Published on July 6, 2026 3 min read In the fifth episode of our insights series, Cortisol and Type 2 Diabetes: What Patients Need to Know, John Buse, M.D., Ph.D., addresses the practicalities of treating cortisol issues when they contribute to poor glucose control. Buse begins by clarifying that "lowering cortisol" is not exactly the right terminology.
Cortisol and Type 2 Diabetes: Testing and Talking to Your Doctor
| Published on June 29, 2026 3 min read In the fourth episode of our insights series, Cortisol and Type 2 Diabetes: What Patients Need to Know, John Buse, M.D., Ph.D., maps out the diagnostic landscape for patients and providers who suspect that cortisol is sabotaging their metabolic health. Buse establishes that the gold standard for initial screening is the overnight dexamethasone suppression test.
Cortisol and Type 2 Diabetes: Recognizing the Signs
Health Resources Hub / Endocrine Health / Type 2 Diabetes John Buse, M.D., Ph.D., explains that unlike classic Cushing's syndrome, diabetes-related hypercortisolism rarely presents with obvious physical signs, meaning the primary warning flag for patients is a body that simply refuses to respond to standard blood pressure medications or advanced A1C therapies.
ADA leader apologizes to members removed from meeting, broader diabetes community
Key takeaways: Five attendees at the American Diabetes Association Scientific Sessions were removed from the meeting after distributing copies of an editorial. ADA’s CEO issued a video statement and apology on June 10. The American Diabetes Association issued a video statement and apology from the CEO on June 10, after five attendees were removed from its annual Scientific Sessions. On June 5, the first day of the annual meeting, five ADA members were escorted out of the New Orleans Ernest N.
The Cortisol–Diabetes Connection | The Educated Patient
| Published on June 15, 2026 3 min read In the second episode of our insights series, Cortisol and Type 2 Diabetes: What Patients Need to Know, John Buse, M.D., Ph.D., addresses the complex question of whether cortisol is a direct cause of type 2 diabetes or a contributing factor.
Understanding the Basics | The Educated Patient
| Published on June 15, 2026 3 min read In the inaugural episode of our insights series, Cortisol and Type 2 Diabetes: What Patients Need to Know, expert John Buse, M.D., Ph.D., demystifies the biological realities of cortisol. While popular culture frequently labels cortisol strictly as a "stress hormone," Buse explains that it is actually a vital, life-sustaining steroid hormone produced by the adrenal glands.
Understanding the Basics
Cortisol and Type 2 Diabetes: What Patients Need to Know - Episode 1 Published on: John Buse, M.D., Ph.D., demystifies the baseline role of cortisol as an essential life hormone and introduces the striking clinical reality that autonomous cortisol hypersecretion silently drives treatment resistance in one-quarter of patients with difficult-to-control type 2 diabetes.
What Comes Next for Berobenatide? VESPER-3 and Phase 3 Expectations, With John Buse, MD, PhD
With VESPER-3's 28-week interim results showing placebo-adjusted weight loss of up to 12.3% with once-monthly berobenatide dosing, attention is now turning to what the 64-week final analysis will add and how phase 2b findings should inform expectations for the upcoming phase 3 program.¹ In an interview at the 2026 Scientific Sessions of the American Diabetes Association (ADA), John Buse, MD, PhD, offered his perspective on how clinicians and researchers should contextualize the current data.
Berobenatide Monthly Dosing Shows Weight Loss Efficacy in VESPER Trials, With John Buse, MD, PhD
VESPER-1 and VESPER-3 findings highlight the potential of berobenatide, an investigational ultra-long-acting GLP-1 RA, for overweight or obesity with or without type 2 diabetes.
Towards intelligent and miniaturized drug delivery devices
Abstract Advances at the intersection of biotechnology, artificial intelligence, electronics and materials science are reshaping how drugs can be delivered inside the body. Intelligent and miniaturized drug delivery devices (IMDDDs) leverage these technologies to achieve precise pharmacokinetics, targeted distribution and programmable release while minimizing toxicity and improving patient adherence.
The Next Generation of Probiotics
Founded by PhD doctors and scientists from Johns Hopkins, Harvard, Berkeley, and Stanford Created Glucose Control, the only medical probiotic on the market clinically shown to improve A1C in type 2 diabetes Featuring strains you can't get anywhere else, including live Akkermansia, a keystone strain that's been in 3,000+ scientific publications We continue to drive microbiome research forward through our own rigorous research and partnerships in clinical trials Next-generation anaerobic...
Doctors: NC made the wrong decision about weight loss medication coverage | Opinion Original
Quick “fixes” for the cost of healthcare can create serious barriers to good health. Right now, there is intense pressure on our healthcare system, and our leaders in North Carolina have tough decisions to make. Health care costs are partly fueled by an obesity epidemic affecting 34% of adults in our state. Obesity drives risk for more than 200 diseases and medical conditions.
Rybelsus becomes first oral GLP-1 approved for CVD prevention in adults with diabetes
Rybelsus becomes first oral GLP-1 approved for CVD prevention in adults with diabetes • The FDA approved oral semaglutide for primary and secondary prevention of CV events in high-risk adults with diabetes. • Rybelsus is the first oral GLP-1 with a CV prevention indication in those with diabetes. Novo Nordisk announced its oral GLP-1 has been approved by the FDA to reduce risk for major adverse cardiovascular events in high-risk adults with type 2 diabetes.
Once-weekly semaglutide 7·2 mg in adults with obesity and type 2 diabetes (STEP UP T2D): a randomised, controlled, phase 3b trial
Get full text access Log in, subscribe or purchase for full access. References 1. Garvey, WT ∙ Mechanick, JI ∙ Brett, EM ∙ et al., the Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity Endocr Pract. 2016; 22:1-203 2. Ruze, R ∙ Liu, T ∙ Zou, X ∙ et al.
Once-weekly semaglutide 7·2 mg in adults with obesity and type 2 diabetes (STEP UP T2D): a randomised, controlled, phase 3b trial
Introduction Obesity contributes to the development and progression of type 2 diabetes, while also increasing the risk of dyslipidaemia, hypertension, and cardiovascular disease.1,2 GLP-1 receptor agonists have shown efficacy in lowering HbA1c and reducing bodyweight in adults with type 2 diabetes.2–4 In many countries, including the USA and EU countries, once-weekly subcutaneous semaglutide 2·4 mg is approved for bodyweight management in adults with obesity or with overweight in the presence...
HCPLive Five at ADA Scientific Sessions 2025
The 2025 American Diabetes Association (ADA) Scientific Sessions, held June 20–23 in Chicago, reflected a shifting paradigm in diabetes care prioritizing comprehensive approaches to glucose management, cardiometabolic health, and patient-centered outcomes. This year’s meeting featured a diverse slate of groundbreaking research spanning automated insulin delivery, weekly insulin alternatives, and novel interventions tackling unique drivers of glycemic dysregulation.
Trump attacks on the environment aren’t new. But why are Democrats helping?
In just 100 days, President Trump has waged an open war on the environment, with a cruel plan to sell off our public lands and sacrifice our air, water and wildlife. The attack is frightening, although not surprising, considering Trump ran a scorched earth campaign for his second term. What’s alarming is that many California Democrats aren’t just standing by—they’re aiding and abetting the environmental destruction.
Effect of Hypercortisolism on Cardiovascular and Diabetes Care
Practical Strategies for Identifying and Screening for Hypercortisolism - Episode 9 Published on: , , , , Experts discuss how hypercortisolism contributes to treatment-resistant hypertension and other cardiovascular diseases, the impact of treating hypercortisolism on cardiovascular risks, when cardiologists should suspect hypercortisolism as a contributing factor to cardiovascular disease, the role of hypercortisolism in type 2 diabetes, how it complicates the management of type 2 diabetes...
Dexamethasone Suppression to Identify Hypercortisolism
Practical Strategies for Identifying and Screening for Hypercortisolism - Episode 8 Dexamethasone Suppression to Identify Hypercortisolism Published on: April 30, 2025 Pamela Kushner, MD, FAAFP , John Anderson, MD, John Buse, MD, PhD , Stephen Greene, MD, FACC, FHFSA , Davida Kruger, MSN, APN-C, BC-ADM Experts discuss risk factors and laboratory abnormalities that might raise clinical suspicion for hypercortisolism and who should be screened for hypercortisolism.
Who to Screen for Hypercortisolism
Practical Strategies for Identifying and Screening for Hypercortisolism - Episode 7 Who to Screen for Hypercortisolism Published on: April 23, 2025 Pamela Kushner, MD, FAAFP , John Anderson, MD, John Buse, MD, PhD , Stephen Greene, MD, FACC, FHFSA , Davida Kruger, MSN, APN-C, BC-ADM Experts discuss risk factors and laboratory abnormalities that might raise clinical suspicion for hypercortisolism and who should be screened for hypercortisolism Video content above is prompted by the following:...
Importance of Primary Care in Identification and Screening for Hypercortisolism
Practical Strategies for Identifying and Screening for Hypercortisolism - Episode 6 Published on: , , , , Experts discuss how the clinical presentation of hypercortisolism differs in the primary care vs specialist setting, highlighting earlier signs/symptoms vs overt disease, and review recent data on the prevalence of hypercortisolism, including its higher occurrence in patients with difficult-to-control diabetes, difficult-to-control hypertension, and cardiovascular disease.
Overcoming Inertia in Hypercortisolism Identification
Practical Strategies for Identifying and Screening for Hypercortisolism - Episode 5 Published on: , , , , Experts discuss how hypercortisolism affects health care utilization and costs for patients, comparing it with patients with other chronic diseases, and how our understanding of the clinical presentation of hypercortisolism has evolved, distinguishing overt hallmark symptoms from nonspecific features overlapping with chronic disease.
Key Learnings From the CATALYST Study on Hypercortisolism Prevalence
Practical Strategies for Identifying and Screening for Hypercortisolism - Episode 4 Published on: , , , , Experts discuss the challenges of identifying and diagnosing hypercortisolism, the reasons behind its often-delayed diagnosis, the impact of a wide spectrum of clinical signs and symptoms on clinicians’ ability to diagnose the condition, and recent data on the prevalence of hypercortisolism in at-risk populations, including those with difficult-to-control diabetes, hypertension, and...
Defining Hypercortisolism and Its Impact on Physical and Mental Health
Practical Strategies for Identifying and Screening for Hypercortisolism - Episode 2 Published on: , , , , Experts discuss the physical impact of hypercortisolism on a patient, how the condition affects overall health, and the long-term risks that remain even after remission, including incomplete resolution of comorbidities, reduced quality of life, and increased mortality risk. Video content above is prompted by the following: Can you describe the physical impact of hypercortisolism on a patient?
Characteristics and Delivery of Diabetes Shared Medical Appointments in North Carolina
By Connor Drake, Julienne K. Kirk, John B. Buse, David Edelman, Christopher M. Shea, Susan Spratt, Laura A. Young, Anna R. Kahkoska Drake, Connor, Julienne K. Kirk, John B. Buse, David Edelman, Christopher M. Shea, Susan Spratt, Laura A. Young, and Anna R. Kahkoska. 2019. "Characteristics and Delivery of Diabetes Shared Medical Appointments in North Carolina." North Carolina Medical Journal 80 (5): 261-68. https://doi.org/10.18043/ncm.80.5.261.
Practical Strategies for Identifying and Screening for Hypercortisolism
Practical Strategies for Identifying and Screening for Hypercortisolism - Episode 1 Practical Strategies for Identifying and Screening for Hypercortisolism Published on: March 17, 2025 Pamela Kushner, MD, FAAFP , John Anderson, MD, John Buse, MD, PhD , Stephen Greene, MD, FACC, FHFSA , Davida Kruger, MSN, APN-C, BC-ADM Experts discuss practical strategies for identifying and screening for hypercortisolism.
A bioinspired polymeric membrane-enclosed insulin crystal achieves long-term, self-regulated drug release for type 1 diabetes therapy - Nature Nanotechnology
Abstract The nuclear envelope serves as a highly regulated gateway for macromolecule exchange between the nucleus and cytoplasm in eukaryotes. Here we have developed a cell nucleus-mimicking polymeric membrane-enclosed system for long and self-regulated therapy. A polymeric nano-membrane with nanopores is conformally synthesized in situ on the surface of each insulin crystal, ensuring sustained, adjustable and zero-order drug release kinetics.
Hypercortisolism prevalent among 24% of adults with difficult-to-control type 2 diabetes
You've successfully added to your alerts. You will receive an email when new content is published. Click Here to Manage Email Alerts We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Key takeaways: The percentage of adults with hypercortisolism and difficult-to-control type 2 diabetes was higher than researchers expected. Adults using more antihypertensive medications had higher odds for hypercortisolism.
Adaptive selection at G6PD and disparities in diabetes complications - Nature Medicine
Abstract Diabetes complications occur at higher rates in individuals of African ancestry. Glucose-6-phosphate dehydrogenase deficiency (G6PDdef), common in some African populations, confers malaria resistance, and reduces hemoglobin A1c (HbA1c) levels by shortening erythrocyte lifespan.
Hypercortisolism prevalent among 24% of adults with difficult-to-control type 2 diabetes
Read more You've successfully added to your alerts. You will receive an email when new content is published. Click Here to Manage Email Alerts We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Key takeaways: The percentage of adults with hypercortisolism and difficult-to-control type 2 diabetes was higher than researchers expected.
Outpatient treatment of COVID-19 and incidence of post-COVID-19 condition over 10 months (COVID-OUT): a multicentre, randomised, quadruple-blind, parallel-group, phase 3 trial
Summary Background Post-COVID-19 condition (also known as long COVID) is an emerging chronic illness potentially affecting millions of people. We aimed to evaluate whether outpatient COVID-19 treatment with metformin, ivermectin, or fluvoxamine soon after SARS-CoV-2 infection could reduce the risk of long COVID. Methods We conducted a decentralised, randomised, quadruple-blind, parallel-group, phase 3 trial (COVID-OUT) at six sites in the USA.
Outpatient treatment of COVID-19 and incidence of post-COVID-19 condition over 10 months (COVID-OUT): a multicentre, randomised, quadruple-blind, parallel-group, phase 3 trial
Summary Post-COVID-19 condition (also known as long COVID) is an emerging chronic illness potentially affecting millions of people. We aimed to evaluate whether outpatient COVID-19 treatment with metformin, ivermectin, or fluvoxamine soon after SARS-CoV-2 infection could reduce the risk of long COVID. We conducted a decentralised, randomised, quadruple-blind, parallel-group, phase 3 trial (COVID-OUT) at six sites in the USA.
Study design and baseline profile for adults with type 2 diabetes in the once-weekly subcutaneous SEmaglutide randomized PRAgmatic (SEPRA) trial
PRECIS-2 assessment The trial design was retrospectively assessed using the PRECIS-2 tool27 by the study steering group in December 2018. The allocated scores were plotted in a PRECIS-2 wheel (which is similar to a radar or spider chart) showing that the study was scored 4–5 in all nine domains (1=very explanatory and 5=very pragmatic) (online supplemental figure 1; online supplemental table 4).
Outpatient treatment of Covid-19 with metformin, ivermectin, and fluvoxamine and the development of Long Covid over 10-month follow-up.
Abstract Background Long Covid is an emerging chronic illness potentially affecting millions, sometimes preventing the ability to work or participate in normal daily activities. COVID-OUT was an investigator-initiated, multi-site, phase 3, randomized, quadruple-blinded placebo-controlled clinical trial (NCT04510194).
Navigating Therapeutic Boundaries in GLP-1RA Use
Content for healthcare professionals only Home CVD and Type 2 Diabetes: Navigating Therapeutic Boundaries in GLP-1RA Use Don't have time to view the video?
More Holistic Approach Needed for Hyperglycemia Management
This transcript has been edited for clarity. In the 2022 Management of Hyperglycemia consensus statement from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), the focus has shifted. Regarding the management of hyperglycemia, we feel a more holistic approach is needed.
A new class of drug in the diabetes toolbox - Nature Medicine
The DAWN and SEED trials demonstrate the potential of glucokinase activators for the treatment of type 2 diabetes, but how they fit in the overall treatment algorithm remains to be determined. For nearly three decades, scientists have searched for an orally active small-molecule activator of glucokinase (GK) for the treatment of diabetes, because of its central role in glucose homeostasis in the pancreas and the liver1.
Opinion: CEQA attacks come as our warming planet most needs the law
If the recent attacks on California’s landmark environmental law sound tired, that’s because they are. Ever since the California Environmental Quality Act went into effect in 1970, there have been calls to tweak, reform or completely throw it out. The regulations stifle the economy, developers say. The environmental review is too cumbersome, politicians argue. As a longtime environmental attorney, I’ve heard them all.
Opinion: CEQA attacks come as our warming planet most needs the law
If the recent attacks on California’s landmark environmental law sound tired, that’s because they are. Ever since the California Environmental Quality Act went into effect in 1970, there have been calls to tweak, reform or completely throw it out. The regulations stifle the economy, developers say. The environmental review is too cumbersome, politicians argue. As a longtime environmental attorney, I’ve heard them all.
Effect of the Glucagon-like Peptide-1 Receptor Agonists Semaglutide and Liraglutide on Kidney Outcomes in Patients With Type 2 Diabetes: a Pooled Analysis of SUSTAIN 6 and LEADER Trials
Abstract Background: We assessed the effect of once-weekly semaglutide and once-daily liraglutide on kidney outcomes in type 2 diabetes (T2D). Methods: Pooled (N=12,637) and by-trial data from SUSTAIN 6 (N=3297) and LEADER (N=9340) were assessed for albuminuria change, annual slope of estimated glomerular filtration rate (eGFR) change, and time to persistent eGFR reduction (30%, 40%, 50%, and 57%) from baseline.
Further RISE’ing to the Challenge of Type 2 Diabetes in Youth
The RISE Study—More Insights into T2D in Youth and Adults Klara R. Klein and John B. Buse⇑ Division of Endocrinology and Metabolism, University of North Carolina School of Medicine, Chapel Hill, NC Corresponding author: John B. Buse, john_buse{at}med.unc.edu Despite three decades of increasing prevalence of type 2 diabetes (T2D) in adolescents (1), the diabetes community continues to grapple with the pathophysiology of youth-onset T2D.
100 years on: the impact of the discovery of insulin on clinical outcomes
Clinical care/Education/Nutrition 100 years on: the impact of the discovery of insulin on clinical outcomes http://orcid.org/0000-0002-9723-3876John B Buse1, Melanie J Davies2, Brian M Frier3, Athena Philis-Tsimikas4 1Medicine/Endocrinology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA 2Diabetes Research Centre, University of Leicester, Leicester, UK 3The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK...
New FDA Guidance on T2D Trial Design Provides Flexibility
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Log out Cancel Perspective > Medscape Diabetes & Endocrinology > ADA 2021 COMMENTARY This transcript has been edited for clarity. The story of cardiovascular outcomes in diabetes is a fascinating one. There were new developments in the regulatory landscape that really drove the past 10 years of history.
Potential kidney protection with liraglutide and semaglutide - exploratory mediation analysis
ORIGINAL ARTICLE Johannes F. E. Mann MD, Corresponding Author prof.j.mann@gmail.com orcid.org/0000-0002-3154-5332 Dept. of Nephrology, Friedrich Alexander University of Erlangen, Erlangen, and KfH Kidney Center, Munich, Germany Correspondence Johannes F.E. Mann, MD, KfH Kidney Center, 15, Isoldenstrasse, München, 80804, Germany. Tel: +49 89 307990. Email: prof.j.mann@gmail.com Search for more papers by this author John B.
Prototype of an evidence‐based tool to aid individualized treatment for type 2 diabetes
1 INTRODUCTION Current standards of medical care for type 2 diabetes (T2D) promote individualized treatment according to co-morbidities, individual preferences and treatment goals.1-3 The American Diabetes Association (ADA) Standards of Care guidelines offer examples of important considerations for selecting a T2D therapy for any particular individual, including: the estimated reduction in HbA1c; adverse-event profile; risk of hypoglycaemia; impact on body weight; ease and frequency of...
Comparison of Protocols to Reduce Diabetic Ketoacidosis in Patients With Type 1 Diabetes Prescribed a Sodium-Glucose Cotransporter 2 Inhibitor
Feature Articles Abstract OBJECTIVE | Sodium–glucose cotransporter 2 (SGLT2) inhibitors are approved for type 1 diabetes in Europe and Japan, with off-label use in type 1 diabetes in the United States. Although there were no consistent approaches to risk mitigation in clinical trials of these agents, protocols have been developed to try to reduce the risk of diabetic ketoacidosis (DKA). However, a validated risk mitigation strategy does not exist.
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