The edition · Diabetes & Endocrinology
Below-knee amputation carries a 23.5% one-year mortality that has not moved since 2012
An England population study of 25,176 people with diabetes reframes what a major amputation means, a new insulin aspart product reaches the US market, and three societies agree how young adults should be handed over.
The edition in brief
Today's diabetology desk opens with a 25-year England population study of 25,176 people with diabetes undergoing below-knee amputation. Mortality was 23.5% at one year, 60.0% at five years and 82.3% at ten, with no improvement since 2012 — figures that put a major amputation closer to an advanced cancer than to an orthopaedic procedure, and that should change how the operation is discussed beforehand. Contralateral amputation reached 6.43% at five years, so the surviving limb is a standing item, not a footnote. On the regulatory side, the FDA approved GARZULYS (insulin aspart-fsan) under BLA 761497 on 15 September 2026, from Emerge Bioscience. The public record is an application entry rather than a trial readout: it confirms a further rapid-acting insulin aspart product entering the US market and says nothing about Indian availability, which remains unknown. A 12-week randomised trial in 102 men with overweight or obesity and hyperuricaemia compared calorie-restricted DASH, carbohydrate-restricted and low-purine diets. Mean weight loss was 8.47 kg with no difference between arms, and urate fell by 0.50 to 0.89 mg/dL with no significant separation. What mattered was a transient rise in urate in week 1 that coincided with the peak in gout flares — a warning to anyone starting a structured weight-loss programme in a patient with hyperuricaemia. ISPAD, EASD and the ADA reached consensus on 31 statements covering the pre-transfer, transfer and post-transfer stages of moving young people with diabetes into adult services. The edition closes on the first practical international position statement for continuous glucose monitoring, insulin pumps and automated insulin delivery in hospital — covering who keeps their device, insulin titration, alarm settings, imaging and discharge.
One year after a below-knee amputation, one in four patients has died
Quote 23.5% one-year mortality when consenting for below-knee amputation, and plan cardiovascular follow-up and contralateral foot surveillance before the patient leaves.
FDA approves GARZULYS, an insulin aspart product, under BLA 761497
Another insulin aspart product is licensed in the US; nothing changes in how you prescribe aspart, and its Indian status is unknown.
Three weight-loss diets, the same urate fall — and a gout flare peak in week one
Counsel every patient with hyperuricaemia starting a weight-loss diet about a first-week flare and give them a plan for it before they need one.
ISPAD, EASD and the ADA agree 31 statements on handing young people to adult services
Treat transfer to adult services as a process with named steps before and after the date, and confirm the young adult arrived.
The foot you are not looking at
At every post-amputation review, take the sock off the remaining foot and examine it properly.
There is now an international position statement on keeping CGM, pumps and AID running in hospital
Use this to write your ward's standing policy on inpatient CGM, pumps and automated insulin delivery — including imaging and who may change settings — before the next admission raises it.
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