bio europe: EASD 2026 GLP-1 & Metabolic Therapy Insights

EASD 2026 Preview: In the Wake of the GLP-1 Boom, the Field of Metabolic Disease Treatment Is Seeking Longer-Acting Solutions

 1. Why EASD 2026 Shouldn’t Be Viewed Merely as a Conference for New GLP-1 Data Releases, a Topic Also Discussed at bio europe

 EASD 2026 offers far more than just the next set of weight-loss or blood-glucose-lowering data, a theme already surfacing at bio europe.The 62nd Annual Meeting of the European Association for the Study of Diabetes (EASD) will be held in Milan, Italy, from September 28 to October 2, 2026. The official conference website is https://www.easd.org/. Looking back at the official figures from the 2025 Vienna meeting, a total of 14,027 registered delegates from 127 countries attended.This figure underscores the EASD’s standing in global diabetes and metabolic research. What attendees need to bring to the conference most of all is a more specific question: Now that GLP-1 receptor agonists have become the dominant force in metabolic therapy, will the next phase—where products truly differentiate themselves—be driven by dosing frequency, long-term adherence, combination strategies, and the ability to sustain benefits in the real world?

 Over the past two years, GLP-1 agonists have moved from being prescribed exclusively by diabetes specialists into the public eye, with news of their weight-loss effects spreading far more rapidly than that of any previous metabolic drug. However, popularity alone does not constitute a product barrier. When multiple companies’ pipelines target similar mechanisms, similar dosing regimens, and similar clinical endpoints, the true value of the conference data lies in revealing which differences can underpin long-term product competitiveness and which are merely one-time numerical advantages.EASD 2026 offers a window of opportunity: it allows the industry, on a sufficiently large academic platform, to simultaneously examine whether the balance between efficacy, safety, adherence, and commercialization pathways can be redefined.

 Table 1: Comparison of Basic Information for EASD Annual Meetings

Event	2025 Vienna Annual Meeting (Held)	2026 Milan Annual Meeting (Upcoming)
Edition	61st	62nd
Date	2025	September 28–October 2, 2026
Location	Vienna, Austria	Milan, Italy
Registered Delegates	14,027	To be announced after the conference
Countries of Origin	127	To be announced
Key Topics	Diabetes and Metabolic Research	GLP-1, Peptides, Metabolism and Obesity, Innovative Macromolecular/Small-Molecule Drugs, and Combination Therapies

 Among the information listed in the table above, the “Topics” column is particularly noteworthy. The fact that GLP-1, peptides, metabolism and obesity, innovative macromolecular and small-molecule drugs, and combination therapies all appear among the conference’s core topics indicates that the scope of EASD’s discussions has long extended beyond a single glycemic indicator.With 14,027 registered delegates from 127 countries, the conference’s data and policy discussions have an impact on clinical practice and healthcare policy decisions across the vast majority of the world. For product teams, EASD requires attendees to simultaneously assess clinical pathways, regulatory trends, and competitive landscapes, making it a multidimensional decision-making arena.

 1.1 From a Conference on Blood Glucose Control to a Decision-Making Arena for the Long-Term Management of Metabolic Diseases

 Judging by the structure of topics extracted from conference materials, innovative macromolecular and small-molecule drugs—including GLP-1 agonists, peptides, and treatments for metabolic disorders and obesity—as well as combination therapies form the core content of EASD 2026. Taken together, these topics send a clear signal: the focus of diabetes conferences has shifted from “how to lower blood glucose” to “how to manage the full burden of metabolic diseases over a longer timeframe.”

 Weight management is the most tangible manifestation of this shift. The weight-loss effects of GLP-1 agonists have elevated obesity from a “risk factor” for diabetes to a “chronic disease requiring independent management.” This means that treatment plans must simultaneously consider the extent and rate of weight loss, the ability to maintain weight loss, and the long-term effects on muscle mass and bone density. Reports on changes in body composition presented at the conference often provide more valuable insights than mere weight figures.

 Cardiovascular risk management is another key theme. The performance of GLP-1 agonists in cardiovascular outcome trials has altered the evaluation criteria for diabetes medications—glycemic control is no longer the sole endpoint, and cardiovascular safety has shifted from “demonstrating no increased risk” to “whether it can reduce risk.” This shift directly impacts regulatory agencies’ review frameworks and health insurance payers’ coverage decisions.Any new data on cardiovascular outcomes presented at EASD 2026 must be interpreted within this revised framework.

 Comorbidities in chronic diseases are an inescapable reality in metabolic therapy. Patients with type 2 diabetes often face multiple conditions simultaneously, including cardiovascular disease, chronic kidney disease, fatty liver, and retinopathy. This is precisely where the value of combination therapy lies: it addresses the needs of multiple organs within a single treatment regimen, covering issues that monotherapy cannot adequately address. Discussions at the conference regarding combination therapy strategies should focus on the independent contributions of each component as well as the cumulative safety effects of the combination.

 The long-term burden of treatment is a factor that is easily overlooked in data but is decisive in determining whether patients will adhere to their regimen. Daily injections, weekly injections, oral formulations, dose-escalation regimens, and adverse event management—these details may be obscured by strict research protocols in clinical trials, but in the real world, they directly impact treatment persistence. If EASD 2026 presents data on the relationship between dosing frequency and adherence, such information may be more valuable to product strategy than the results of a single weight-loss percentage study.

 When viewed collectively, the scope of discussions at EASD has long extended beyond a single glycemic indicator. This conference, a key European biopharma partnering fixture, simultaneously influences clinicians’ prescribing decisions, R&D teams’ pipeline prioritization, BD teams’ asset evaluations, and product teams’ market positioning judgments. Different roles extract entirely different insights from the same conference, which is precisely why it is essential to clarify the specific questions you aim to answer before attending.

 Specifically, clinicians focus on whether new data can change prescribing habits—for example, whether a longer-acting formulation can provide sustained benefits even to patients with poor adherence.R&D teams focus on whether the molecular designs or drug delivery technologies disclosed at the conference hint at new platform capabilities. BD teams engaged in life sciences deal-making focus on which assets garnered attention at the conference and whether that attention translates into signals of potential collaborations or deals. Product teams, meanwhile, need to assess, based on all this information, whether their product’s position in the competitive landscape has shifted. The value of EASD lies in its ability to present these signals from different levels simultaneously on a single platform; attendees must come prepared with their own questions to filter through the information, rather than passively absorbing everything.

 1.2 The Most Important Preparation Before Attending Is Not a List of Hot Topics, but a Set of Comparative Criteria

 Rather than walking into the conference with a list of hot topics, it’s better to first establish a set of comparison criteria that runs throughout the entire analysis. When evaluating GLP-1, peptides, small molecules, and small nucleic acids later in this article, we will refer back to the following four dimensions. These four dimensions form a progressive screening logic; if a candidate fails to meet the criteria in an earlier dimension, the significance of the subsequent dimension is diminished.

 Table 2: Framework of Four Comparative Dimensions

Comparison Dimensions	Core Question	Signs of Failure
Is efficacy sustainable?	Are treatment effects maintained over a longer follow-up period, and do they rebound after discontinuation?	Short-term data look promising but lack long-term follow-up, or the effects fade rapidly after discontinuation
Does safety support long-term use?	Are adverse reactions manageable, and is there a cumulative risk associated with prolonged use?	The incidence of serious adverse events increases over time, or new safety signals emerge
Can the burden of administration be truly reduced?	Do the reduced frequency, route of administration, and management complexity lower barriers to patient adherence?	Reduced frequency but increased management complexity, or limited improvement in convenience
Can the product be integrated into existing treatment pathways?	In real-world clinical settings, can the product be integrated into existing clinical workflows and reimbursement systems?	Implementation requires an entirely new clinical infrastructure or entails significant additional costs

 The first dimension is whether efficacy is sustainable.The treatment cycle for chronic metabolic diseases is measured in years; the fundamental question is whether the results of a 12-week or 68-week trial can be extrapolated to 3 or 5 years of real-world use. The weight rebound observed after discontinuation of GLP-1 agonists demonstrates that short-term efficacy does not equate to long-term benefits. Similarly, the ultra-long-acting gene silencing effects claimed for small nucleic acid drugs must be validated for sustainability and reversibility through longer-term follow-up.

 The second dimension is whether safety supports long-term use. Acute adverse reactions can be managed through dose escalation, but long-term safety requires attention to cumulative exposure, rare events, and performance in special populations. Patients with chronic metabolic diseases may require lifelong medication, and the width of the safety margin directly determines a product’s scope of application. Signals related to the gallbladder, pancreas, cardiovascular system, liver, kidneys, and nutrition must be tracked separately during long-term metabolic therapy.

 The third dimension is whether the burden of administration can be genuinely reduced. Moving from daily to weekly injections, and from weekly to quarterly injections, intuitively reduces the number of injections. However, the burden of administration is not limited to frequency; it also includes the complexity of dose escalation, storage conditions, the ease of use of administration devices, and the difficulty of managing adverse reactions. A product that requires a quarterly injection but involves complex dose adjustments and intensive monitoring may, in practice, impose a burden no less than that of a weekly injection.

 The fourth dimension is whether the product can be integrated into existing treatment pathways. If an innovative therapy requires entirely new diagnostic infrastructure, specialized administration training, or high monitoring costs, its real-world accessibility will be limited. Whether a product can be integrated into existing clinical and diagnostic workflows and reimbursement systems determines how far it is from translating trial data into population-level benefits.

 This four-dimensional framework will recur throughout the remainder of this article. When evaluating the next generation of weekly peptide formulations, refer back to these four dimensions; when evaluating oral small-molecule GLP-1 agonists, refer back to these four dimensions; and when evaluating ultra-long-acting small-nucleic-acid formulations, refer back to these four dimensions as well. The key to avoiding an article that becomes a mere list of technical terms lies in applying the same yardstick to measure different technological pathways.

 Action recommendation for this section: Before attending the conference, write down these four dimensions on a piece of paper and establish a criterion for each—defining what constitutes “meeting the standard.” When you hear any data presented at the conference, first quickly filter it through these four dimensions before deciding whether to take detailed notes. For any product that clearly fails to meet the standard in any of the four dimensions, remain cautious and do not alter your judgment based solely on a single weight-loss figure or the magnitude of glycemic control.

 2. The buzz around GLP-1 is no longer rare; what is rare is sustainable product differentiation at bio europe

 GLP-1 receptor agonists will remain a key area of focus at EASD 2026. However, the focus of analysis has shifted from “who has the higher weight loss numbers” to product capabilities beyond efficacy.The following questions are more meaningful than a single glycemic reduction figure: Does weight rebound after discontinuation? Can gastrointestinal tolerability be managed? Have any long-term safety signals emerged? Are there differences in benefits across different patient populations? Can manufacturing capacity and accessibility support real-world use? And can patients adhere to treatment after leaving the clinical trial setting?

 We do not assume that EASD 2026 will necessarily announce any specific results. The following discussion uses these open questions to guide the analysis; specific data will need to be supplemented based on the official agenda and on-site reports. Competition in the GLP-1 space has entered its second phase: the first phase focused on efficacy metrics, while the second phase centers on who can translate that efficacy into a sustainable, manageable, and affordable long-term treatment regimen.

 2.1 The Next Round of Peptide Competition Must Address Three Key Challenges: Dosage Frequency, Tolerability, and Combination Therapy

 This analysis of peptide drugs does not delve into mechanism encyclopedias. The focus is on what clinical challenges weekly formulations, potentially longer-acting formulations, and combination therapies respectively address. Dosage frequency, tolerability, and combination therapy are three questions that must be answered simultaneously; leaving any one of them unaddressed will limit a product’s competitiveness.

 Table 3: The Three Key Challenges in Peptide Drug Competition

Competitive Dimensions	Current Status	Unresolved Issues
Dosage Frequency	Weekly formulations have become the mainstream	Are there longer-acting (e.g., monthly) peptide regimens available, and what are their exposure stability and dosing flexibility?
Gastrointestinal Tolerability	Nausea, vomiting, and diarrhea are the main limiting factors	Can the dose-escalation regimen be further optimized, and can the discontinuation rate due to adverse reactions be reduced?
Combination Strategies	Exploration of combination therapy with basal insulin, SGLT2 inhibitors, and other agents	Can the added benefits of combination regimens offset the costs associated with more complex dosing regimens and manufacturing?

 In terms of frequency, weekly formulations have already reduced the number of injections from 365 per day to approximately 52 per year, representing a significant improvement in adherence. However, patients and physicians continue to anticipate even longer-acting regimens.If peptide drugs can achieve monthly dosing or even lower-frequency administration while maintaining stable exposure and flexibility in dose adjustment, this would further lower the barrier to treatment. However, longer-acting peptide formulations must address issues such as controlled sustained release, the risk of sudden drug release, and inter-individual variations in exposure. If relevant early-stage data are presented at the conference, attention should be paid to whether the exposure-effect curve is smooth.

 In terms of tolerability, gastrointestinal reactions are the most common adverse effects of GLP-1 agonists and one of the primary reasons for discontinuation. The design of dose-escalation regimens directly impacts tolerability—a slower escalation may reduce adverse reactions but could also delay reaching the therapeutic dose.If comparative data on different dose-escalation regimens are presented at the conference, key metrics to compare include the proportion of patients reaching the therapeutic dose, the time to reach it, and the discontinuation rate throughout the process. Changes in lean body mass are also a metric worth examining: loss of muscle mass during weight loss may affect long-term metabolic health and functional status, which is clinically more significant than mere numerical weight loss.

 Regarding combination therapy, the combination of peptides with other mechanisms must address a core question: What issues does the combination regimen resolve that monotherapy fails to address? If the limitation of monotherapy is insufficient weight loss, the goal of combination therapy is to increase the magnitude of weight loss; if the limitation is tolerability, the goal of combination therapy may be to reduce the monotherapy dose while maintaining efficacy. Combination regimens with different objectives require entirely different evaluation criteria.When presenting combination regimens at conferences, it is essential to inquire about the actual contributions of each component, the rationale for dose design, performance in subgroups, and long-term follow-up plans.

Another question that needs to be explored at the conference is whether the efficacy can be replicated in a broader patient population. Clinical trials are typically conducted in a screened population, where patient compliance, management of comorbidities, and follow-up support are superior to those in the real world. When a product is introduced to a broader population, the extent to which efficacy may be reduced—if at all—is information that may not appear in conference abstracts but can be inferred from subgroup analyses and preliminary signals from real-world studies.

 2.2 The Value of Big-Molecule and Small-Molecule Drugs Cannot Be Determined Solely by Ease of Administration

 Compare innovative large-molecule and small-molecule drugs presented in conference materials within the same decision-making framework. Oral or more convenient routes of administration are attractive, but ease of administration is only one component of a product’s value. The following factors also require examination:

 Table 4: Comparison of Decision-Making Frameworks for Big-Molecule and Small-Molecule Innovative Drugs

Evaluation Dimensions	Big Molecules (Injectable Peptides/Proteins)	Small Molecules (Oral)
Convenience of Administration	Requires injection; weekly formulations have significantly reduced the frequency	Oral administration; highly convenient with good patient acceptance
Exposure Stability	Exposure is relatively predictable with injections	Oral absorption is influenced by food, gastrointestinal pH, and individual variability
Selectivity	Target selectivity is generally high	Off-target effects and drug interactions require attention
Long-term safety	There is extensive real-world experience with these drugs	Limited long-term safety data available; ongoing monitoring is required
Target Population	Suitable for patients requiring high-intensity treatment	May be suitable for patients in the early stages or with mild disease, or as a component of combination therapy

 The key takeaway from the table above is that different administration routes may serve different patient populations, rather than simply being interchangeable alternatives. Oral small-molecule GLP-1 agonists have a natural advantage in terms of convenience, but exposure stability, food effects, and drug interactions remain technical challenges that require ongoing attention. If data on the coefficient of variation in exposure or food effects for oral small-molecule GLP-1 agonists are presented at the conference, this information is essential for assessing the product’s performance in the real world.

 The advantage of injectable macromolecules lies in the predictability of exposure and target selectivity. After years of use, these drugs have accumulated a wealth of real-world safety data. However, the injection itself remains a barrier for some patients, even though the frequency has been reduced to once a week. Product selection should not simply conclude that “small molecules will replace peptides” or that “injectables will remain dominant in the long term,” but rather should match the most appropriate administration route based on the target population, stage of treatment, and combination therapy needs.

 One technical challenge that warrants separate discussion is the control of exposure for oral small molecules. Following oral administration, the drug must undergo gastrointestinal absorption, first-pass metabolism, and hepatic distribution—a process influenced by multiple factors. If inter-individual variability in exposure is too great, some patients may fail to achieve therapeutic concentrations, while others may experience excessively high exposure leading to adverse reactions.If data on the coefficient of variation (CV) of exposure for oral small molecules are presented at the conference, this figure would be more informative than the average exposure level.

 Drug interactions are a particular concern for small-molecule drugs. Patients with chronic metabolic conditions often take multiple medications concurrently, including antidiabetics, antihypertensives, lipid-lowering agents, and antiplatelet drugs. If an oral small molecule is metabolized by CYP enzymes, it may interact with other drugs metabolized by the same enzymes. Information on this may be insufficient in early-phase clinical trials, so attention must be paid to drug interaction studies and real-world data in subsequent trials.

 Oral bioavailability is another technical metric that warrants separate discussion. The challenges of oral administration for peptide drugs include high molecular weight, susceptibility to enzymatic degradation in the gastrointestinal tract, and limited ability to penetrate the intestinal epithelial barrier. Currently, oral semaglutide has been made possible through the use of the absorption enhancer SNAC; however, its bioavailability remains significantly lower than that of the injectable formulation, and it requires specific dosing conditions, such as taking the medication on an empty stomach and waiting before eating.If bioavailability data for novel oral peptides or small molecules are presented at the conference, attention should be paid to their coefficient of variation and dosing restrictions—these two metrics are better predictors of real-world performance than average bioavailability. Dosing restrictions can be strictly controlled in clinical trials but are often overlooked in the real world, leading to insufficient or fluctuating exposure, which ultimately affects the predictability of efficacy and safety.

 2.3 The Key to Combination Therapy Is Not Adding a Target, but Addressing Issues Left Unresolved by Monotherapy

 Combination therapy should be framed as a clinically driven choice rather than a race to accumulate more targets. It is important to distinguish whether a combination regimen aims to increase weight loss, improve glycemic control, protect cardiovascular, hepatic, and renal outcomes, or enhance tolerability and sustain efficacy. Combination regimens with different objectives follow entirely different design logics and evaluation criteria.

 Table 5: Classification of Four Clinical Objectives for Combination Therapy

Combination Objective	Issues Addressed	Evaluation Focus	Potential Risks
Increasing Weight Loss	Insufficient weight loss with monotherapy	Increase in weight loss and changes in body composition following combination therapy	Cumulative adverse reactions, reduced tolerability
Improved glycemic control	Monotherapy fails to achieve glycemic control targets	Changes in HbA1c and risk of hypoglycemia	Increased risk of hypoglycemia, weight gain
Cardiovascular, hepatic, and renal protection	Persistent Progression of Metabolic Organ Damage	Cardiovascular and renal outcomes, changes in biomarkers	Significant need for long-term follow-up; time is required for endpoint events to accumulate
Improved tolerability and sustained efficacy	Poor tolerability or waning efficacy with monotherapy	Discontinuation rates, tolerability scores, and duration of efficacy	Combination regimens that are overly complex may impair adherence

 The value of the table above lies in highlighting that the evaluation of combination regimens must be grounded in the clinical problems they aim to address. If the goal of a combination regimen is to increase weight loss, the focus should be on whether the incremental weight loss achieved by the combination is clinically meaningful—rather than simply concluding that “the combination is superior to monotherapy.” If the clinical significance of the increment is minimal, the reduced tolerability and increased costs associated with adding an additional component may not be worth the effort.

 When validating combination regimens in clinical practice, the following items must be verified one by one: The true contribution of each component: Does each component in the combination regimen have independent therapeutic value, or is a particular component merely a “free rider”? Basis for dose design: How were the doses for each component in the combination regimen determined—were they based on dose-finding studies, or were they simply set at the recommended monotherapy doses?Discontinuation rate: Is the tolerability of the combination regimen acceptable, and is the discontinuation rate higher than that of monotherapy? Subgroup performance: Does the combination regimen consistently demonstrate benefits across patients with different baseline characteristics? Long-term follow-up: Are there accumulated data on the long-term safety and sustained efficacy of the combination regimen?

 Don’t focus solely on the most eye-catching average change figures from early-phase trials. The weight loss achieved with a combination regimen in a Phase II trial may be impressive, but if the sample size is small, follow-up is short, and subgroup analyses are inadequate, the generalizability of this figure is very limited. The true value of a combination regimen needs to be confirmed in larger, longer-term Phase III trials.

 Action recommendations for this section: When hearing data on combination regimens at a conference, first ask three questions: What is the goal of the combination? Is the contribution of each component clear? Is tolerability acceptable? If there is no clear answer to any of these three questions, label the data as “early signal, to be validated” and do not use it as a basis for adjusting product strategy. Exercise extra caution regarding the dose design of each component in a combination regimen if it lacks support from dose-finding studies.

 3. With small nucleic acids entering the chronic disease market, the focus in metabolic therapy at bio europe has shifted to how long a single injection can last

 The industry views 2026 as the “breakout year” for small nucleic acid drugs. The liver-targeted siRNA drug developed by Sanofi in collaboration with Arrowhead was approved for the treatment of familial chylomicronemia (FCS), with an administration frequency of one injection every three months.GSK’s ASO therapy, Bepirovirsen, has made progress in a Phase III clinical trial for chronic hepatitis B (the B-Well study), aiming for a “functional cure.” Meanwhile, siRNA technology has begun to expand into the areas of cardiovascular lipid-lowering and weight loss.

 When these developments are considered within the context of cardiovascular, metabolic, and obesity research at the EASD, they raise a new competitive question: future competitive metrics may shift from “how many times per week” to whether low-frequency dosing can deliver reliable, reversible, and manageable long-term benefits. Viewed within the framework of chronic metabolic diseases, industry advancements in siRNA and ASO represent a product logic that redefines “treatment frequency,” with implications extending beyond the scope of any single drug class.

 Table 6: Overview of Recent Advances in Small Nucleic Acid Drugs

Project	Type	Target Indication	Dosage Frequency	Development Status
Sanofi/Arrowhead siRNA	Liver-targeted siRNA	Familial Chylomicronemia (FCS)	Injection once every 3 months	Approved for marketing (2026)
GSK Bepirovirsen	ASO (antisense oligonucleotide)	Chronic hepatitis B	Periodic subcutaneous injection	Phase III clinical trial (B-Well study) in progress
siRNA for lipid-lowering applications	siRNA	Cardiovascular Lipid-Lowering	Low-frequency dosing (specific frequency to be determined)	Early exploratory phase
siRNA for Weight Loss	siRNA	Obesity/Weight Management	To be confirmed	Early exploratory phase

The table above requires the following note: When specific approval statuses and trial conclusions are involved, regulatory agency announcements, official company announcements, or official meeting materials should be double-checked prior to publication of the main text. Small nucleic acid drugs are advancing rapidly, and the statuses listed in the table may be updated over time. The purpose of listing these projects here is to illustrate the trend of small nucleic acids expanding from rare diseases to a broader range of chronic conditions, rather than to provide the latest information on approval and clinical statuses.

 From FCS to chronic hepatitis B, and on to cardiovascular lipid-lowering and weight loss, the path of indication expansion for small nucleic acids follows a clear logic: first, safety and dosing rationale are validated in rare diseases with small target populations and high unmet medical needs, then the approach extends to chronic disease areas with larger patient populations. The maturation of liver-targeted delivery systems such as GalNAc has improved the developability of liver-targeted small nucleic acids, providing the technological foundation for this expansion.

 3.1 GalNAc Solves Some Delivery Challenges, but Does Not Address All Product-Related Issues

 GalNAc (N-acetylgalactosamine) conjugation technology enables the directed delivery of small nucleic acid drugs to the liver by binding to the asialoglycoprotein receptor (ASGPR) on the surface of liver cells. This technology enhances the developability of liver-targeted small nucleic acids, allowing siRNA drugs to achieve sufficient concentrations in liver tissue to produce gene silencing effects.

 However, “improving developability” and “completely solving delivery challenges” are two different matters. GalNAc addresses the issue of “getting the drug there,” but it does not answer questions regarding “whether there is enough of it, whether it is stable, and whether it is effective.” The following points require separate consideration:

 Is the target primarily located in the liver? GalNAc-delivered small nucleic acids can only act on target mRNAs in liver tissue. If the therapeutic target is located in extrahepatic tissues (such as adipose tissue, muscle, the pancreas, or the central nervous system), GalNAc delivery cannot directly reach them. This means that the scope of small nucleic acid applications in metabolic diseases is limited by the tissue distribution of the target.If there are presentations at the conference regarding extrahepatic delivery technologies, pay close attention to their delivery efficiency, specificity, and safety data.

 Is the depth and duration of gene silencing consistent across different patients? The efficacy of gene silencing is influenced by various factors, including dosage, the turnover rate of the target mRNA, individual metabolic differences, and liver function status. The depth and duration of silencing produced by the same dose may vary significantly among different patients. If variability is too great, a fixed-dose, low-frequency dosing regimen may result in insufficient efficacy in some patients and excessive silencing in others.

 What is the safety profile following repeated dosing? Low-frequency dosing implies that each dose may be relatively high to maintain effective concentrations for a sufficiently long duration. Long-term follow-up data are needed to determine whether there is a risk of cumulative toxicity, immunogenicity, or liver damage following repeated dosing. The approval of FCS drugs provides preliminary safety data; however, these results are based on a small patient population, and caution is required when extrapolating them to a broader population of patients with chronic diseases.

 Is extrahepatic delivery still a limitation to expanding indications? Metabolic diseases involve the coordinated function of multiple organs and tissues. If small nucleic acids can only target hepatic sites, their scope of application in metabolic diseases will be limited. Advances in extrahepatic delivery technologies are a prerequisite for determining whether small nucleic acids can play a greater role in indications such as obesity and diabetes.

 3.2 The advantages of ultra-long-acting formulations must be weighed against manageability, not merely against duration

 When comparing daily oral administration, weekly injections, and quarterly or less frequent dosing, one cannot focus solely on the frequency figures. While a longer duration of action may offer greater patient convenience, dose adjustments, the decline in effect following discontinuation, the management of adverse reactions, and the care of special patient populations may also become more complex.

 Table 7: Comparative Analysis of Manageability Across Different Dosage Frequencies

Dosage Regimen	Convenience	Flexibility in Dose Adjustment	Post-Discontinuation Decline in Effect	Management of Adverse Reactions
Daily oral administration	Requires daily dosing; moderate convenience	Dose can be adjusted or treatment discontinued quickly	Effects subside within a few days after discontinuation	Adverse reactions may resolve relatively quickly after discontinuation
Weekly injection	Once a week; relatively convenient	It takes 1–2 weeks for dose adjustments to take effect	The effect begins to wear off approximately 1–2 weeks after discontinuation	Adverse reactions subside within a few weeks after discontinuation
Quarterly injections	Once every 3 months; highly convenient	It takes several months for dose adjustments to take effect	The effects may persist for several weeks to several months after discontinuation	Adverse reactions may persist for a relatively long time after discontinuation
Less frequent dosing	Once every six months or once a year, offering exceptional convenience	Long dose adjustment cycles, low flexibility	Post-discontinuation effects may persist for several months	Adverse reactions are difficult to manage and may require additional intervention

 The key message conveyed by the table above is that long-acting formulations are not inherently superior to short-acting ones. While reduced dosing frequency enhances convenience, it also increases management complexity. For a product administered quarterly, if a patient experiences adverse reactions, the drug’s effects may persist for weeks or even months after discontinuation, making the management of adverse reactions during this period far more complex than with daily oral formulations.

 Flexibility in dose adjustment is another factor that must be weighed. With daily oral medications, doses can be rapidly adjusted based on the patient’s response, allowing an appropriate maintenance dose to be determined within one or two weeks. However, with quarterly injectable products, it takes several months to assess the effect of each dose adjustment, meaning the process of finding the appropriate dose may take a year or longer. For treatment regimens requiring individualized adjustments, the lack of flexibility associated with ultra-long-acting formulations may offset their advantage in administration frequency.

 Management of special patient populations must also be factored into the comparison. Elderly patients, those with impaired liver or kidney function, and patients with multiple comorbidities may require dosing and monitoring strategies that differ from standard regimens. Experience with ultra-long-acting products in these populations is typically limited, and the risks associated with dose adjustments are higher. This leads to a nuanced assessment: long-acting formulations place higher demands on target specificity, dose predictability, and safety margins.Only when the target is clearly defined, the dose-response relationship is predictable, and the safety margins are sufficiently wide can the convenience advantages of ultra-long-acting dosing be fully realized.

 Post-discontinuation management is an often-overlooked yet critically important issue in clinical practice. Patients may need to discontinue treatment due to surgery, pregnancy, severe adverse reactions, or financial reasons. For ultra-long-acting products, the persistence of drug effects after discontinuation means that the interruption of the treatment plan is not immediate; rather, it requires a “washout period.” The duration of this washout period and the corresponding management strategies must be clearly defined prior to the product’s market launch.

 Management of special populations requires particular caution with ultra-long-acting formulations. Older adults may experience reduced liver and kidney function as well as polypharmacy, all of which can affect the metabolism and clearance of small nucleic acid drugs. Patients with impaired liver function may require dose adjustments; however, because the dose adjustment cycle for ultra-long-acting products is lengthy, determining the appropriate dose is more complex than with short-acting products.Pregnant women and women planning to become pregnant require special consideration—the persistent effects of ultra-long-acting products after discontinuation mean a longer washout period prior to pregnancy, which may impact family planning. Experience with these special populations is typically accumulated gradually after product launch, as they are often excluded from early-phase trials. When planning trials, product teams need to consider whether to include sufficient subgroups of these special populations to support widespread post-marketing use.

 3.3 Small Nucleic Acids and GLP-1 Are More Likely to Form Tiered and Combination Therapies Rather Than Simply Replacing Each Other

 When viewed within the context of real-world treatment pathways, GLP-1 agonists are likely to continue playing a role in managing body weight and multiple metabolic parameters, while small nucleic acids may demonstrate value as low-frequency interventions for well-defined targets, specific lipid abnormalities, or high-risk populations. The relationship between these two classes of therapies is more likely to involve stratification and combination rather than simple substitution.

 Table 8: Comparison of the Roles of Small Nucleic Acids and GLP-1 in Metabolic Therapy

Dimension	GLP-1 Class (Peptides/Small Molecules)	Small Nucleic Acids (siRNA/ASO)
Primary Target Tissues	Systemic (via receptor distribution)	Liver (GalNAc delivery)
Dosage Frequency	Daily oral administration to weekly injections	Injections every quarter or less frequently
Reversibility of therapeutic effect	Effects subside relatively quickly after discontinuation	Effects may persist for several weeks to several months after discontinuation
Current Indications	Diabetes, obesity	FCS, chronic hepatitis B; expanding to lipid-lowering and weight loss
Role in metabolic therapy	Management of body weight and multiple metabolic parameters	Low-frequency interventions targeting specific pathways
Combination Potential	Can Be Combined with Various Mechanisms	Can be used in combination with GLP-1 or other metabolic drugs

 The table above illustrates that the two technologies complement rather than compete with each other across multiple dimensions. The advantage of GLP-1 lies in systemic metabolic regulation and weight management, while the advantage of small nucleic acids lies in low-frequency silencing of specific targets. In practical treatment pathways, GLP-1 may serve as the foundation of the treatment regimen, while small nucleic acids may function as a supplementary intervention targeting specific lipid abnormalities or high-risk factors.

 The following considerations must be addressed when using these therapies in combination. Patient selection: Which patients are suitable for combination therapy, and should selection be based on genotype, baseline lipid levels, or cardiovascular risk stratification? Endpoint selection: Is the primary endpoint of the combination regimen weight loss, lipid reduction, or cardiovascular outcomes? Trial designs and follow-up periods vary significantly depending on the endpoint.Alignment of Duration of Action: How should the dosing schedules—weekly for GLP-1 and quarterly for small nucleic acids—be coordinated, and is it necessary to administer both during the same clinic visit? Long-Term Safety: Are there cumulative risks or unexpected interactions associated with the long-term combined use of these two classes of drugs? Reimbursement Logic: Can the incremental costs of the combination regimen be offset by incremental benefits, and are health insurance payers willing to cover the premium for the combination regimen?

 Avoid making alternative assertions that lack clinical evidence. Most applications of small nucleic acids in metabolic diseases are still in the early exploratory stages, and positioning them as “replacements” for GLP-1 lacks evidentiary support. A more reasonable assessment is that small nucleic acids provide a new tool for metabolic therapy, expanding treatment options, but they will not replace existing GLP-1 and peptide regimens in the short term.

 Action recommendations for this section: When following small nucleic acid-related presentations at EASD 2026, focus on documenting three key pieces of information—whether the target is located in the liver, the duration and coefficient of variation of the silencing effect, and safety data from repeated dosing.For any claim positioning small nucleic acids as GLP-1 alternatives, demand direct comparative clinical evidence; do not accept conclusions of equivalence based solely on mechanistic speculation. If early data on the combination of small nucleic acids and GLP-1 are presented at the conference, pay close attention to patient selection criteria and the duration-of-action matching regimen.

 4. At EASD and bio europe, the most valuable aspect to verify is the long-term quality behind impressive endpoints

 This section shifts the focus from trend analysis to data interpretation methods. When reviewing the same results figure, clinicians, R&D personnel, and BD teams should ask entirely different questions. Do not merely focus on percentage weight loss or a single statistically significant result; the following dimensions determine the true value of the data: trial duration, control design, baseline differences, handling of missing data, discontinuation rates, rescue therapy, subgroup consistency, and changes following discontinuation.

 4.1 Efficacy Data Must Be Interpreted in Conjunction with Trial Design

 A 15% weight loss result can have entirely different implications depending on the trial design. The following factors determine whether efficacy figures can be trusted and to what extent they can be extrapolated:

 Table 9: Checklist for Interpreting Efficacy Data

Trial Design Elements	Items to Check	Impact on the Conclusions
Trial Duration	Was the follow-up period long enough to assess sustained efficacy?	Data from a 12-week trial cannot be extrapolated to annual efficacy
Control Design	Placebo-controlled or active-controlled; is rescue therapy permitted?	In placebo-controlled trials, the observed effect may overestimate the true difference
Baseline differences	Are baseline characteristics balanced across groups?	Baseline imbalance may lead to bias
Handling of missing data	Methods for imputing missing data (e.g., LOCF, MMRM, tipping point)	Different imputation methods may lead to different conclusions
Estimation objectives	Estimation of treatment strategies versus estimation of treatment adherence	The former reflects real-world strategies, while the latter reflects the drug’s intrinsic efficacy
Sample Size	Is the sample size sufficient to support subgroup analyses and long-term conclusions?	When sample size is insufficient, subgroup analyses are for reference only

 The most easily overlooked yet most impactful factor in the table above is the choice of estimand. The ICH E9(R1) Supplementary Guidance introduced the concept of the estimand, distinguishing between the “treatment policy estimand” (which includes patients in the analysis regardless of treatment adherence) and the “while-on-treatment estimand” (which analyzes only data from the period during which patients adhered to treatment).

 The treatment policy estimand answers the question, “What effect can be expected if this drug is prescribed to patients?” and is closer to real-world treatment strategies. The while-on-treatment estimand answers the question, “What effect can the drug itself achieve when patients adhere to treatment?” and is closer to the drug’s intrinsic efficacy. Using different estimands in the same trial may yield significantly different results. When reading conference reports, it is necessary to confirm which estimand strategy was used for the primary endpoint.

 If trial designs differ across projects, it is meaningless to directly compare their efficacy figures. Clearly state the limitations of such comparisons and avoid creating rankings that disregard the study designs. A 15% weight loss in a 12-week placebo-controlled trial may be less clinically valuable than a 12% weight loss in a 68-week active-controlled trial, as the latter has a longer follow-up period, stricter controls, and more closely resembles a real-world treatment setting.

 4.2 Safety and Discontinuation Data Determine Whether a Product Can Move Beyond the Clinical Trial Setting

 Review common adverse reactions, serious adverse events, dose interruptions, and permanent discontinuations separately. “Overall good tolerability” is a non-informative conclusion that cannot replace specific data. The following signals require separate monitoring in long-term metabolic therapy:

 Table 10: Safety Signals Requiring Monitoring in Long-Term Metabolic Therapy

Safety Signal Category	Key Indicators	Special Significance in Long-Term Metabolic Therapy
Gallbladder-Related	Incidence of Cholecystitis and Gallstones	Rapid weight loss increases the risk of gallstones; monitoring is required during long-term medication use
Pancreas-Related	Incidence of Pancreatitis and Changes in Pancreatic Enzymes	The pancreatic safety of GLP-1 agonists has long been a concern
Cardiovascular	Changes in heart rate, arrhythmias, cardiovascular events	Some GLP-1 agonists may increase heart rate
Liver and Kidneys	Changes in liver enzymes and renal function markers	Cumulative effects of long-term metabolic medication on liver and kidney function
Nutrition-Related	Vitamin and mineral deficiencies, changes in muscle mass	Sustained weight loss may lead to malnutrition and loss of lean body mass
Gastrointestinal	Incidence and severity of nausea, vomiting, and diarrhea	The most common adverse reactions, which directly affect adherence

 The signal categories listed in the table above must be evaluated in conjunction with the specific mechanism of action of each product.Due to their mechanism of action, gastrointestinal reactions are the most anticipated adverse reactions for GLP-1 agonists. However, signals related to the gallbladder and pancreas require long-term monitoring, as the incidence of these events is low and may not be sufficient to detect statistical differences in short-term trials. When writing, do not exaggerate individual events—a single case of pancreatitis is not meaningful without a comparison to the background incidence rate—nor should you substitute “generally well tolerated” for specific data.

 Discontinuation rates must be interpreted in a stratified manner. Discontinuation due to adverse events, lack of efficacy, loss to follow-up, and other reasons carry entirely different implications. A high discontinuation rate due to adverse events indicates that tolerability is a bottleneck for the product; a high rate due to lack of efficacy suggests that the treatment fails to meet patient expectations; and a high loss-to-follow-up rate may indicate issues with trial conduct or patient compliance.If a conference presentation reports only the overall discontinuation rate without stratification, the information value of that figure is significantly diminished.

 Dose interruption is an intermediate state—patients temporarily stop taking the drug or reduce the dose, after which they may resume treatment or permanently discontinue it. The frequency and causes of dose interruption reflect the difficulty of managing the product in routine use. If data on dose interruption are reported at a conference, pay attention to the proportion of patients who resume treatment after an interruption and the time taken to resume.

 Interpreting safety signals requires consideration of the background incidence rate. If three cases of an adverse event occur in the treatment group, the information provided by these three cases is very limited without the background incidence rate of the control group as a reference. If one case occurs in the control group, the difference between the three cases in the treatment group may suggest a signal but is insufficient to confirm an association. If there are zero cases in the control group and three in the treatment group, this signal warrants greater caution.If a conference presentation only provides the adverse event incidence rate for the treatment group without data from the control group, one should request the control group data—safety figures without a control group have no diagnostic value. Additionally, detecting rare events requires a larger sample size and a longer duration. The sample size of a Phase III trial may be insufficient to detect events with an incidence rate lower than one per thousand; such signals may only be revealed through post-marketing surveillance.When conducting safety assessments, product teams must not only examine whether a specific event occurred during the Phase III trial but also evaluate the expected background incidence rate of that event and the trial’s detection power.

 4.3 Real-world issues must be examined separately from registrational results

 Systematic differences exist between the population enrolled in registrational clinical trials and patients in routine clinical practice. Trial participants are typically rigorously screened, have well-controlled comorbidities, demonstrate good compliance, and receive adequate follow-up support. Patients in routine clinical practice may be older, have more comorbidities, a more complex treatment history, and a wider range of socioeconomic backgrounds.

 Table 11: Differences Between Registrational Trials and Real-World Patients

Dimension	Regulatory Trial Population	Real-World Patients	Impact of Differences
Age Range	Typically subject to strict age restrictions	Covers a broader age range	Safety and efficacy may differ in elderly patients
Comorbidities	Severe comorbidities are typically excluded	Often have multiple comorbidities	Drug interactions and safety profiles may differ
Prior Treatment	Previous medication use is usually limited	Past treatment histories are complex and varied	Baseline efficacy and drug resistance may vary
Follow-up support	Study nurses conduct regular follow-ups, resulting in high adherence	Reliance on patient self-management	Decreased adherence may affect treatment efficacy
Socioeconomic conditions	There is typically a certain barrier to entry	Vary widely	Variations in drug accessibility and ability to maintain treatment

 The differences listed in the table above imply that whether the efficacy observed in clinical trials translates into population-level benefits depends on drug availability, patient education, long-term follow-up, and post-treatment management. A product that achieves 15% weight loss in a clinical trial may perform far worse in the real world than the trial data suggest if it requires strict dietary control, frequent dose adjustments, and intensive monitoring for adverse reactions.

 Drug accessibility encompasses price, health insurance coverage, supply stability, and convenience of administration. A product with excellent efficacy but a high price or unstable supply will see its population-level benefits significantly diminished. While pricing and supply issues are not typically discussed at conferences, product teams must factor these considerations into their strategic decisions.

 Patient education and long-term follow-up are key mediating factors for real-world efficacy. Patients must fully understand and cooperate with the dose-escalation regimens, adverse event management, and lifestyle interventions associated with GLP-1 agonists. If the healthcare system cannot provide sufficient educational and follow-up support, patient adherence will decline, and efficacy will decrease accordingly.If real-world study data are presented at the conference, pay close attention to the descriptions of the level of follow-up support and patient education programs—this information determines whether the real-world data can represent the expected performance of the target population.

 Action recommendations for this section: When recording any efficacy data presented at the conference, simultaneously document the trial design details—including the intended endpoints, follow-up period, type of control group, and methods for handling missing data. For safety data, request to see stratified discontinuation rates rather than the overall discontinuation rate. If a conference presentation does not provide real-world data, label the trial data as “registration results; real-world performance to be validated” and do not use it directly for product strategy decisions.

 5. Different Attendees Should Not Approach EASD 2026 and bio europe in the Same Way

 Avoid providing a generic list of suitable attendees. Different roles require extracting entirely different information from the same session. Below are on-site tasks tailored for three teams—Clinical and Medical Affairs, R&D and Translational Research, and BD and Strategy—ensuring this article serves both professional readers and helps first-time EASD attendees establish an effective conference itinerary.

 Table 12: Conference Priorities by Role

Attendee Role	Core Task	Information Screening Priorities
Clinical and Medical Affairs Team	Seeking Evidence to Change Patient Pathways	Subgroup Benefits and Risks > Treatment Continuity > Comorbidity Outcomes > Medication Management
Research and Translation Team	Unraveling the Sources of Differences	Targets and Molecular Design > Administration Routes and Dosage > Combination Mechanisms > Biomarkers
BD and Strategy Team	Translating Scientific Highlights into Development Risks	Clarity of Target Population > Sustainability of Differentiation > Trial Scale and Manufacturing Burden > Value Allocation in Combination Regimens

 5.1 Clinical and Medical Affairs Teams Must Seek Evidence That Can Change Patient Pathways

 The clinical team’s top priority at EASD is to identify data capable of altering the patient pathway. The patient pathway encompasses the entire process, including diagnosis, initiation of treatment, dose adjustment, efficacy assessment, adverse event management, and long-term follow-up. Evidence that alters the pathway consists of data capable of changing the choice of initial treatment, dose adjustment strategies, or long-term management regimens. Even if weight loss figures are impressive, they do not constitute a pathway change unless they alter these decision points.

 Prioritize documenting the following information: Benefits and risks across different patient subgroups—whether efficacy and safety are consistent or show significant differences across subgroups such as age, gender, baseline BMI, duration of diabetes, and presence of comorbidities. Treatment persistence—how many patients adhere to treatment during longer-term follow-up, and what are the primary reasons for discontinuation.Comorbidity outcomes—the impact of treatment on comorbidities such as cardiovascular disease, chronic kidney disease, and fatty liver disease. Feasibility of medication management—whether dose-escalation regimens, adverse reaction management protocols, and patient education materials are feasible in real-world practice.

 Any claim intended to change clinical practice must be verified against four key pieces of information. Study phase—whether it is a Phase I exploratory, Phase II proof-of-concept, or Phase III confirmatory trial. Follow-up duration—whether the treatment period covered by the data is sufficient to support long-term use recommendations. Guideline status—whether the data has been incorporated into any clinical guidelines or remains solely at the research stage. Maturity of evidence—whether there is independent validation, real-world data support, or evidence from meta-analyses.

 Do not treat conference abstracts as established treatment standards. Conference abstracts typically report only preliminary results that have not yet undergone a full peer-reviewed review. When using abstract data for clinical decision-making, wait for the publication of the full paper, guideline updates, or regulatory approval to determine its clinical status. When hearing compelling data at a conference, first record the facts, then assess whether the evidence is mature enough to change clinical practice.

 5.2 R&D and Translational Teams Must Break Down the Sources of Differentiation

 The R&D team’s task is to drill down layer by layer along the dimensions of targets, molecular design, administration routes, dosing, combination mechanisms, and biomarkers. The goal is to distinguish true platform capabilities from one-off early-stage data advantages.

 Table 13: Dimensions for Analyzing R&D Differentiation

Dimensions for Analysis	In-Depth Analysis of Ultra-Long-Acting Small Nucleic Acids	In-Depth Analysis of Peptides and Metabolic Drugs
Target	Is the target located in the liver, and are the physiological consequences of silencing this target controllable?	How selective is the target, and are there any off-target effects?
Molecular Design	What are the sequence design, modification strategies, and stability like?	Does the molecular structure support longer-acting or oral administration?
Route of Administration	Is GalNAc delivery sufficiently efficient, and is extrahepatic delivery feasible?	What is the availability and stability of injection devices or oral formulations?
Dosage	Is the dose-response curve predictable, and what is the interindividual variability?	Is the dose-escalation protocol optimized, and is the exposure-effect relationship clear?
Mechanism of Combination	Is there a mechanistic basis for combination with other metabolized drugs?	Is the contribution of each component in the combination regimen clear?
Biomarkers	Are there monitorable biomarkers of silencing effects?	Are there biomarkers that can predict therapeutic efficacy or adverse reactions?

 The value of the table above lies in breaking down the vague concept of “differentiation” into an actionable checklist of questions. For ultra-long-acting small nucleic acids, it is particularly important to examine delivery range, reversibility of drug effects, and the safety of repeated dosing. Delivery range determines the product’s applicable targets and indications; reversibility of drug effects determines the difficulty of post-discontinuation management; and the safety of repeated dosing determines whether the product can be used for chronic diseases requiring treatment over many years.

 For peptides and other metabolic drugs, exposure, tolerability, body composition, and long-term endpoints should be evaluated. Stability of exposure—is the variability in exposure among patients controllable, and do food effects or differences in injection sites affect exposure?Tolerability—whether the dose-escalation regimen has been systematically optimized, and whether the incidence and severity of adverse reactions follow a predictable pattern with dose changes. Body composition—whether the ratio of changes in fat mass to lean body mass during weight loss is reasonable, and whether muscle mass loss remains within acceptable limits. Long-term endpoints—whether data on cardiovascular, renal, or other organ outcomes are available, or if results are limited to intermediate metabolic markers.

 The distinction between platform capability and the advantages of one-off data lies in reproducibility and scalability. A platform that can consistently produce effective and safe molecules across different targets and indications is far more valuable than a project that achieves good results by chance for a single target. If there are multiple reports at a conference regarding the same platform across different indications, pay attention to the consistency and reproducibility of these results.

 Another perspective for evaluating platform capability is the transferability of technical parameters. Can a delivery technology validated in small-scale studies maintain consistent quality during scaled-up production? Does the optimization of sequence design rely on manual screening, or is there a systematic set of design rules? The answers to these questions determine the speed and cost of the platform’s production of new molecules.Conferences typically showcase only success stories, with few reports of failed attempts. However, R&D teams can indirectly assess a platform’s robustness by examining the consistency of reports from the same team across different time periods and targets. If similar issues—such as exposure variability, delivery efficiency, or safety concerns—recur across different projects using the same platform, these recurring patterns provide a more accurate reflection of the platform’s true capability limits than a single success.R&D teams should also assess whether the platform has clearly defined limits—specifically, for which targets or indications it is unsuitable. This self-awareness is, in itself, a sign of the platform’s maturity.

 5.3 BD and Strategy Teams Must Translate Scientific Highlights into Development Risks

 The BD team’s task at EASD is to translate scientific highlights into development risk assessments. Impressive scientific data does not equate to a developable product, much less a commercializable asset. In addition to efficacy, the following factors must be evaluated:

 Table 14: Factors for Translating Scientific Highlights into Development Risks

Risk Assessment Dimensions	Questions to Be Answered	Risk Indicators
Clarity of Target Population	Is the product’s target patient population sufficiently well-defined and identifiable?	Vague definition of the target population, or an insufficient number of identifiable patients
Sustainability of Differentiation	Can the product’s competitive advantage withstand competition once similar projects are launched?	Advantages are based on a single data point and lack barriers at the platform or mechanism level
Trial Scale and Manufacturing Burden	Are the scale, duration, and costs of follow-up trials reasonable?	The need for ultra-large-scale trials or specialized manufacturing processes leads to excessively high costs
Commercialization Burden	What infrastructure is required after the product is launched to support sales?	Does the product require a completely new drug delivery system, special storage conditions, or intensive monitoring?
Value Allocation in Combination Therapies	How is value allocated among the parties in a combination therapy?	Unclear contributions by one party in a combination therapy lead to disputes over value allocation

 The first question that needs to be answered is whether the target population is sufficiently well-defined. A product definition such as “for metabolic diseases” is too broad to support development decisions. It must be clearly specified: for which specific disease, at which disease stage, for which patient subgroup, and at what point in the existing treatment sequence the product is intended. If a product presented at a conference cannot even clearly define its target population, its development risks are very high.

 Whether differentiation can withstand the progress of comparable projects determines the product’s competitive lifespan. If a product’s advantage is based solely on an earlier start date for clinical trials, that advantage may disappear as comparable projects advance. True differentiation should stem from barriers at the level of mechanism of action, molecular design, or drug delivery technology—barriers that are not easily replicated quickly.

 The feasibility of a product’s development in biotech deal-making Europe and its commercial returns depend on whether the scale of subsequent trials and the manufacturing and commercialization burdens are reasonable. Production costs for small nucleic acid drugs currently remain higher than those for traditional small molecules and peptides; if the patient population for the target indication is small, manufacturing costs may become a bottleneck for commercialization. Cost and manufacturing issues are not typically discussed at conferences, but the business development (BD) team needs to supplement this information outside of the conference.

 Exercise caution regarding collaboration announcements, common at any pharma licensing conference, and early-stage assets. Collaboration announcements or news of asset transactions between companies may surface during EASD. The signal value of these announcements is limited—transaction activity does not equate to product viability. Do not substitute transaction activity for an assessment of product viability. Collaboration announcements can serve as a trigger to focus on a particular direction, but investment decisions must be based on a technical evaluation and risk analysis of the product itself.

 Action Recommendations for This Section: Before attending the conference, each team should develop its own agenda based on the priorities outlined above. The clinical team should list 3–5 specific questions that “could change the patient journey”; the R&D team should list the key evaluation criteria for each technical pathway; and the BD team should prepare a risk-to-revenue conversion assessment table. Record information according to these checklists during the conference, and conduct role-specific debriefings afterward to ensure that different roles do not apply the same criteria when filtering information.

 6. Maintain a separate evaluation form for before, during, and after bio europe to transform information into conclusions.

Implement the practical approach to meetings in three phases. Before the meeting, establish a technical roadmap and a list of key items; during the meeting, use a standardized issue-tracking system to record data; and after the meeting, conduct a debriefing based on the maturity of the evidence and items requiring verification.

 6.1 Pre-meeting Preparation: First, Identify Known Facts and Items to Be Verified

 The core of pre-meeting preparation is to distinguish between known and unknown information. Known items can be included in the document, while items requiring verification must be flagged.

 Table 15: Pre-Meeting Preparation Checklist

Preparation Items	Known Facts (Can Be Included in the Paper)	Items to Be Verified (Must Be Flagged)
Basic Conference Information	62nd EASD Annual Meeting, September 28–October 2, 2026, Milan, Italy	Detailed Agenda, Presentation Times, and Venue
Official Website	https://www.easd.org/	Are there any program updates or venue changes?
Attendance figures	Vienna 2025: 14,027 attendees from 127 countries	Final attendance figures for Milan 2026
Key Topics	GLP-1, Peptides, Metabolism and Obesity, Innovative Macromolecular/Small-Molecule Drugs, and Combination Therapies	Specific Presentation Titles and Abstract Content
Advances in the Small Nucleic Acid Industry	Sanofi/Arrowhead siRNA Receives FCS Approval; GSK’s Bepirovirsen in Phase III Trials	Are there any related presentations at EASD? Latest approval and trial statuses

 The purpose of the table above is to categorize information into two groups for processing. Established facts can be included directly as background information in the article, but must be cross-checked against official websites one final time before publication to ensure no changes have occurred. Items pending verification must be clearly marked in the article as “to be confirmed as of the time of writing” to avoid presenting uncertain information as established facts.

 Identify no more than five key questions for each therapeutic approach to prevent being sidetracked by trending topics during the session. Key questions for GLP-1: weight rebound data after discontinuation, long-term safety signals, differences in benefits across subpopulations, exposure stability of oral formulations, and the contribution of each component in combination regimens. Key questions for peptides: exposure variability in longer-acting formulations, optimization of dose-escalation protocols, changes in lean body mass, consistency across subgroups, and the cost-effectiveness of combination regimens.Key issues for small molecules: variability in oral bioavailability, food effects, drug interactions, long-term safety, and target population definition. Key issues for combination therapies: clarity of the combination’s objectives, contributions of each component, rationale for dose design, discontinuation rates, and long-term follow-up. Key issues for small nucleic acids: tissue distribution of the target, variability in silencing depth, safety of repeated dosing, reversibility management, and progress in extrahepatic delivery.

 6.2 Meeting Records: Each Data Point Addresses Clinical and Product Value

 Meeting records use a standardized template to ensure that information across different reports is comparable. After each data point is recorded, a single sentence should explain which patient problem it addresses and whether it constitutes a sustainable product differentiation.

 Table 16: Meeting Record Template

Recording Item	Record Content	Remarks
Study Population	Age, BMI, duration of diabetes, comorbidities, prior treatment	Consistency with the target population
Control	Placebo/active control; whether rescue therapy is permitted	Interpretation of Effect Size
Primary endpoint	Endpoint Definition and Estimation of Target Strategy	Estimation of Treatment Strategy vs. Compliance-Based Estimation
Magnitude of Effect	Effect size and 95% confidence interval for the primary endpoint	Not just point estimates; consider the width of the interval
Duration	Duration of follow-up and maintenance of efficacy	Short-term vs. Long-term
Safety	Incidence of adverse reactions, serious adverse events, and specific signals	Stratified discontinuation rates
Discontinuation Rate	Overall Discontinuation Rate and Reasons by Subgroup	Due to adverse reactions/insufficient efficacy/loss to follow-up
Next Steps	Whether to proceed to the next phase of the trial; anticipated timeline	Assessment of Development Progress
Clinical Value	In a nutshell: What patient problem does it solve?
Product Differentiation	In a nutshell: Does this constitute a sustainable product differentiation?

 The final row of the template above—the assessment of product differentiation—is the entry most easily overlooked yet holds the greatest strategic value. During meetings, it is easy to be drawn to efficacy figures, but these figures alone do not constitute product differentiation. Product differentiation requires answering the following question: Does this product’s advantage stem from repeatable technical capabilities, or from a one-time trial design or selection of a specific patient population?

 When information is insufficient, leave the question open; do not fill in the gaps with speculation. If a presentation does not provide stratified discontinuation rates, subgroup analyses, or estimated target data, note “Insufficient Information” in your record; do not extrapolate the full picture based on partial data. These notes will become items requiring follow-up and verification during post-meeting debriefing.

 Recording information during meetings presents several practical challenges. Presentations typically last only 10 to 15 minutes, feature a high density of data, and involve rapid slide transitions. Completing all items on the template within the limited time requires advance preparation—you can print the recording template in advance, fill in only keywords while listening to the presentation, and complete the entry after the meeting based on your memory and the official abstract. Another challenge is the inconsistency in data presentation. Different research teams may use different chart formats, different measures of effect, and different statistical methods to present their results.A standardized recording template can help overcome this inconsistency by converting data from different sources into a comparable format. If complete statistical parameters—such as confidence intervals, p-values, or effect sizes—are not provided during the presentation, you can consult the official abstract or contact the researchers after the meeting to obtain supplementary information. Data mentioned in the oral presentation but not shown in the slides should also be verified after the meeting.

 6.3 Post-Conference Review: Let the Excitement Settle Before Determining What Truly Changed the Landscape

 The core principle of post-conference review is to let the excitement of the conference subside and use a more objective standard to reassess which data truly changed the game. Categorize all recorded data into three groups: data that may change practice, data worth continuing to track, and data with insufficient evidence.

 Table 17: Post-Conference Evidence Classification Criteria

Evidence Classification	Evaluation Criteria	Follow-Up Actions
Likely to Change Practice	Phase III confirmatory data with statistical and clinical significance; safety is acceptable; data has been or will be submitted to regulatory authorities	Include in the main text of the article, noting the study phase and duration of follow-up
Warrants further monitoring	Phase II proof-of-concept data or Phase III data that are promising but lack sufficient sample size or follow-up duration	Mentioned in the article but labeled as “to be validated”; establish a follow-up plan
Insufficient evidence	Phase I data, case reports, or speculative mechanisms	Not cited as a conclusion in the main text; mentioned only in trend analysis

 The classification criteria in the table above ensure that conclusions in the article are supported by corresponding evidence. Categorizing results into three groups and specifying the basis for judgment helps avoid treating all conference data as equally valid. No matter how impressive Phase II proof-of-concept data may be, it should not be cited at the same level of confidence as Phase III confirmatory data.

 When updating the main text, include links to the official abstract, paper, or company’s original materials. At the same time, retain the initial publication date and update date to ensure both the timeliness and traceability of the content. The value of a pre-conference article lies in its ability to be continuously updated—publishing preliminary assessments before the conference, updating with on-site data during the conference, and supplementing with post-conference analysis and conclusions afterward.

 Action recommendations for this section: Before the conference, complete the information compilation and definition of core questions in Table 15. During the conference, record data item by item using the template in Table 16, completing the “clinical value” and “product differentiation” assessments for each data point. After the conference, classify the data according to the criteria in Table 17: update data labeled “may change practice” into the main text of the article; include data labeled “worth further tracking” in the follow-up plan; and archive data labeled “insufficient evidence” without citing it as a conclusion.When updating the article, record the date of the revision and a summary of the changes.

 7. Conclusion: The Next Distinguishing Factor in Metabolic Chronic Diseases at bio europe Is Whether Efficacy Can Be Sustained Long-Term with a Low Burden

 Returning to the question posed at the beginning of this article: Now that GLP-1 has become the dominant approach in metabolic therapy, what will truly set the next phase apart? Based on the analysis in the previous six chapters, we can offer a measured conclusion.

 Table 18: Summary of the Positioning of Various Therapeutic Approaches in Metabolic Chronic Diseases

Therapeutic Approach	Role at EASD 2026	Tests to Be Undertaken
GLP-1 and Peptides	Central theme of the conference; remains the most important window for observation	Efficacy durability, long-term safety, adherence, and real-world performance
Innovative macromolecular and small-molecule drugs	Key Directions for Diversifying Administration Methods	Exposure stability, selectivity, long-term safety, and suitability for the target population
Combination therapy	The Path from Monotherapy Competition to Regimen Competition	Clarity of component contributions, tolerability, cost-effectiveness, and long-term follow-up
Small Nucleic Acids (siRNA/ASO)	External signals that drive long-term competition to a new temporal scale	Target specificity, reversibility management, safety of repeated dosing, and extrahepatic delivery

 GLP-1 and peptides remain key focal points at EASD 2026. This assessment is based on two facts: the conference’s core agenda explicitly includes GLP-1 and peptides, and these two classes of technologies have accumulated the most clinical evidence and real-world usage experience. In the short term, no other technological approach can replace them in terms of the breadth and depth of metabolic therapy.

 The significance of small nucleic acids lies in pushing the competition for long-acting formulations to a new temporal scale.From weekly to quarterly injections, and potentially even lower dosing frequencies, small nucleic acids offer a different solution to the adherence challenges associated with chronic metabolic diseases. However, this solution is currently limited by hepatic delivery, target selection, and reversibility management. There is a lack of evidence to support viewing small nucleic acids as the “next-generation replacement” for GLP-1; it is more reasonable to regard them as new tools for expanding treatment options.

 Products with a genuine opportunity to enter long-term chronic disease management must pass four tests simultaneously: sustained efficacy, safety, patient adherence, and alignment with treatment pathways. These four tests correspond to the four comparative dimensions proposed in Chapter 1. Any product that fails to meet the standards in even one of these areas—regardless of how impressive its individual data may be—will struggle to establish a foothold in long-term chronic disease management.

 A final note: This article is based on publicly available information and industry trend analysis as of the time of writing. Specific conference data, approval statuses, and trial conclusions are subject to the official EASD 2026 agenda, regulatory announcements, and companies’ original materials. The article will be continuously updated before and after the conference to include on-site data and post-event analysis. Readers planning to attend the conference are advised to establish their own information screening system by referring to the three-stage evaluation table in Chapter 6.

 From a longer-term perspective, competition in the treatment of metabolic chronic diseases is shifting from “whose efficacy numbers are higher” to “who can translate efficacy into a sustainable long-term management plan.” This shift has far-reaching implications for R&D priorities, commercial strategies, and payer decisions.R&D teams need to reassess which differentiating factors are truly meaningful in the long-term competitive landscape—reduced dosing frequency, expanded safety margins, and tailored treatment pathways—as these factors may determine a product’s long-term competitiveness more than short-term efficacy metrics. Commercial teams need to consider how to position products in a market dominated by long-term management and adherence. Payers need to evaluate a product’s long-term benefits and cost-effectiveness at the population level, rather than just short-term results from clinical trials.EASD 2026 offers a window into how these shifts are playing out in real-world product competition.

 8. EASD 2026 and bio europe Frequently Asked Questions

 8.1 When and Where Will EASD 2026 Take Place?

 EASD 2026 (the 62nd Annual Meeting of the European Association for the Study of Diabetes) will be held in Milan, Italy, from September 28 to October 2, 2026. The official conference website is https://www.easd.org/. Please check the official website again before publication to confirm whether there have been any changes to the schedule or venue arrangements.Based on data from the 2025 Vienna Annual Meeting, which saw 14,027 registered delegates from 127 countries, the Milan Annual Meeting is expected to be of a similar scale.

 8.2 Which Areas of Metabolic Therapy Deserve the Most Attention at EASD 2026?

 According to conference materials, core topics include GLP-1, peptides, and innovative macromolecular and small-molecule drugs as well as combination therapies in the fields of metabolism and obesity. These areas cover major therapeutic pathways ranging from injectable peptides to oral small molecules, and from monotherapies to combination regimens.Small nucleic acids (siRNA/ASO), as an external trend expanding into cardiovascular and metabolic chronic diseases, warrant separate attention; they should not be mistakenly listed as a confirmed EASD priority agenda item. Attendees can identify specific presentations worth noting by evaluating them across four dimensions: sustained efficacy, long-term safety, administration burden, and suitability for treatment pathways.

 8.3 Why siRNA and ASO Influence Assessments in the Fields of Diabetes and Obesity

 The core characteristics of siRNA and ASO are low-frequency dosing and long-acting gene silencing. Taking Sanofi/Arrowhead’s liver-targeted siRNA as an example, the dosing frequency of one injection every three months is far lower than existing weekly injection regimens. If this low-frequency dosing model can be replicated in metabolic diseases, it may alter the evaluation criteria for chronic disease adherence and the design logic of combination therapy.

 At the same time, it is essential to maintain clear boundaries in technical assessments. Extrahepatic delivery, long-term safety, reversibility of effects, and indication selection still require validation. GalNAc-mediated delivery currently primarily targets the liver; the coordinated multi-organ functions involved in metabolic diseases cannot be fully achieved through hepatic silencing alone. Directly extrapolating the progress of small nucleic acids in FCS and chronic hepatitis B to diabetes and obesity requires further clinical evidence.

 From the perspective of combination therapy, GLP-1 agonists may continue to play a central role in managing body weight and multiple metabolic parameters, while small nucleic acids may serve as low-frequency supplemental interventions for specific lipid abnormalities (such as elevated Lp(a) or PCSK9-related hypercholesterolemia) or in high-risk cardiovascular populations.Coordinating the dosing schedules of these two classes of therapies—weekly GLP-1 administration versus quarterly small nucleic acid administration—requires the design of a reasonable follow-up plan. Whether such a tiered combination can be implemented in clinical practice depends on the safety of the combination regimen, patient selection criteria, and payers’ coverage policies. If relevant early-stage data are presented during the conference, attention should be paid to the patient selection strategies and the alignment of treatment duration between the two therapies.

 8.4 How to Screen Information at Your First EASD Conference

 It is recommended to prioritize reviewing official abstracts and original studies, screening information according to the following criteria:

 Step 1: Confirm the study phase. Phase I data are used to explore safety and pharmacokinetics; Phase II data are used for proof of concept; and Phase III data are used for confirmatory evaluation. Only Phase III data (or real-world data of equivalent scale) are sufficient to support conclusions that change clinical practice.

 Step 2: Examine the trial design. Pay attention to whether the follow-up period is sufficient, the type of control group, how missing data are handled, and the strategy for estimating the primary endpoint. Results from trials with different designs cannot be directly compared across studies.

 Step 3: Evaluate the durability of efficacy and safety. Determine whether efficacy is maintained during longer follow-up periods and whether there is a rebound effect after discontinuation. Regarding safety, focus on stratified discontinuation rates rather than the overall discontinuation rate, as well as signals related to the gallbladder, pancreas, cardiovascular system, liver, kidneys, and nutrition that require monitoring during long-term metabolic therapy.

 Do not rely on secondhand headlines or simple numerical comparisons across trials. Headlines in the media and on social media during the conference typically highlight only the most eye-catching figures, taken out of context from the trial design and safety data. Readers new to the EASD are advised to obtain official abstracts from the official website and form their own independent judgments by combining them with the data interpretation methods outlined in Chapter 4 of this article.

 For readers who wish to continue following EASD content, we recommend monitoring the official abstracts published on the EASD website and the full-text papers subsequently published in academic journals such as *Diabetologia*. These primary sources are more reliable than news reports during the conference and are better suited for long-term reference. After the conference concludes, the full data for some reports may not be available until the papers are published; during this period, definitive conclusions should not be drawn based on fragmentary information from oral presentations.The advantage of blog posts is that they can be continuously updated—publishing preview analyses before the conference, supplementing them with on-site data during the conference, and consolidating and reviewing conclusions afterward.

 Table 19: EASD 2026 Quick Q&A

Question	Short Answer
EASD 2026 Date and Location	September 28–October 2, 2026, Milan, Italy
EASD Official Website	https://www.easd.org/
2025 Attendance	14,027 attendees from 127 countries
Key Topics	GLP-1, Peptides, Metabolism and Obesity, Innovative Macromolecular/Small-Molecule Drugs, and Combination Therapies
Small Nucleic Acid Trends	siRNA/ASO applications are expanding into cardiovascular and metabolic chronic diseases, but it remains to be confirmed whether EASD will feature a dedicated session on this topic