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Article History

Accepted: 6 August 2026

First Online: 4 September 2026

Ethics

Competing interests: K.R.T has received investigator-initiated grant support from Benaroya Research Institute, Breakthrough T1D (formerly the Juvenile Diabetes Research Foundation), the Doris Duke Charitable Foundation, Travere, Bayer, and Otsuka; consultancy fees from Alnylam, AstraZeneca, Boehringer Ingelheim, Bayer, Glaxo Smith Kline, Lilly, Novo Nordisk, Otsuka, ProKidney and Roche; and speaker fees from Astra Zeneca, Novo Nordisk, Boehringer Ingelheim, Bayer and Travere. K.R.T. is also chair of the data safety monitoring boards for the National Institute of Diabetes and Digestive and Kidney Disease, and George Clinical Institute, and a member of the data safety monitoring board for AstraZeneca. R.Z.A. has received research support from Benaroya Research Institute, Breakthrough T1D (formerly the Juvenile Diabetes Research Foundation), the Doris Duke Charitable Foundation, Travere, Bayer, Otsuka, Novartis, Boehringer Ingelheim, AstraZeneca, Novo Nordisk, The George Institute for Global Health, CareDx and KBP BioSciences; and personal fees from Boehringer Ingelheim, Bayer Pharmaceuticals and Eli Lilly. J.J.C. reports funding unrelated to this work to Karolinska Institutet from AstraZeneca, Boehringer Ingelheim, Vifor Pharma, NovoNordisk and MSD, as well as personal fees from Fresenius Kabi and Laboratorios Columbia. A.M.N. has received honoraria for consulting from Amgen, Arrowhead, AstraZeneca, Bayer, Eli Lilly, Esperion, Janssen, Merck, New Amsterdam, Novartis, Novo Nordisk, Pfizer, Roche, Silence Therapeutics and research support to her institution from Amgen and Esperion. B.L.N. has received consulting fees from AstraZeneca, Alexion, Bayer, Boehringer Ingelheim, Medscape, Cambridge Healthcare Research; speaking honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, the Limbic, Cornerstone Medical Education and Travere Therapeutics; travel support from Bayer, Boehringer Ingelheim and Novo Nordisk (with all payments made to The George Institute for Global Health). V.P. has received honoraria for steering committee, data monitoring committee or advisory board roles or for scientific presentations from AstraZeneca, Bayer, Boehringer Ingelheim, Chinook, GlaxoSmithKline, Janssen, Novo Nordisk, Novartis, Otsuka, Travere, Tricida and UptoDate; and is a Board Director for George Clinical, St. Vincents Health Australia and several independent medical research institutes. P.R. has received institutional research grant support from Novarti, Novo Nordisk, Kowa, Amarin, Pfizer, Bristol Myers Squibb and Esperion; has served as a consultant to Novartis, Novo Nordisk, Agepha, Ardelyx, CSL Behring, Tourmaline Bio, Nodthera, Cardio Therapeutics, Bio Age, AstraZeneca, Civi Biopharm, Glaxo Smith Kline, SOCAR, Eli Lilly, New Amsterdam, HeartFlow, Caristo, Boehringer-Ingelheim and Cardiol Therapeutics; has minority shareholder equity positions in Uppton, Bitteroot Bio and Angiowave; and receives compensation for service on the Leducq Foundation Advisory Board, Paris, France. N.M. has given lectures for Bayer, Boehringer Ingelheim, Sanofi-Aventis, MSD, BMS, AstraZeneca, Lilly and Novo Nordisk; has received unrestricted research grants from Boehringer Ingelheim; has served as an adviser for Bayer, Boehringer Ingelheim, Sanofi-Aventis, MSD, BMS, AstraZeneca, Novo Nordisk; and served in a trial leadership capacity for Boehringer Ingelheim and Novo Nordisk. N.M. declines all personal compensation from pharma or device companies. P.M.R. has received institutional research grant support from Kowa, Novartis, Amarin, Pfizer, Esperion and Novo Nordisk; during the past 5 years has served as a consultant to Novartis, Flame, Agepha, Ardelyx, Arrowhead, AstraZeneca, CSL Behring, Janssen, Civi Biopharm, Glaxo Smith Kline, SOCAR, Novo Nordisk, Health Outlook, Montai Health, Eli Lilly, New Amsterdam, Boehringer-Ingelheim, RTI, Zomagen, Cytokinetics, Horizon Therapeutics and Cardio Therapeutics; has minority shareholder equity positions in Uppton, Bitteroot Bio and Angiowave; and receives compensation for service on the Peter Munk Advisory Board (University of Toronto), the Leducq Foundation, Paris, France, and the Baim Institute (Boston, MA, USA). The other authors declare no competing interests.