The edition · Diabetes & Endocrinology
Below-knee amputation in diabetes: 23.5% dead at one year, and no better than 2012
A 25-year England population study puts hard numbers on what a major amputation means. Plus a Class II recall of compounded semaglutide, and a three-society consensus on moving young people to adult services.
The edition in brief
Today's diabetology desk leads with a 25-year England population study of 25,176 people with diabetes undergoing below-knee amputation. All-cause mortality was 23.5% at one year, 60.0% at five years and 82.3% at ten, with no improvement since 2012. Older age, female sex and greater comorbidity burden marked out those at highest risk, and 6.43% had lost the other leg within five years. The figures are worth carrying into the consent conversation and into how aggressively a threatened foot is escalated. On the regulatory side, the FDA sweep carries an ongoing Class II recall of multiple strengths of compounded semaglutide multi-dose vials from one outsourcing facility, for particulate matter identified as nylon/polyamide and silk/proteinaceous material. A separate ongoing Class II recall covers a ready-to-use human insulin infusion bag for manufacturing deviations. Neither is a finding about the molecules; both are about what is in the vial. A cluster-randomised trial protocol from 88 early-years sites will test whether pressuring, rushing and food-as-reward can be removed from preschool mealtimes. It is a protocol with no results, listed because the question matters for childhood obesity, not because it has answered anything yet. The edition closes with a joint ISPAD/EASD/ADA consensus report on transition from paediatric to adult diabetes care: 31 statements across pre-transfer, transfer and post-transfer. Transition is where young adults are lost, and the report gives a structure to audit a local pathway against.
One year after a below-knee amputation, a quarter of patients are dead
Quote real survival figures at consent, and push escalation of the threatened foot earlier, because outcomes after the amputation have not moved in over a decade.
Class II recall of compounded semaglutide vials for particulate matter
Establish whether a patient's GLP-1 comes from a licensed pen or a compounded vial, and inspect compounded product before use.
A trial that will test whether preschool mealtime habits can be unlearned
Nothing to act on yet, but start asking where and how a child eats outside the home, because that is where most of their meals are.
The 90 days after an amputation are a cardiac window, not a surgical one
Treat the first post-amputation diabetes review as a cardiovascular review, and ask about breathlessness rather than chest pain.
Thirty-one consensus statements on getting young people through transition
Write a named post-transfer check into your local pathway, and confirm the young person actually attended the adult clinic rather than assuming the referral did the work.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for diabetes & endocrinology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free