A Charcot foot diagnosis carries a one-in-three five-year mortality

The edition in brief

Charcot neuro-osteoarthropathy (CNO) in diabetes behaved like a systemic illness in a Scottish registry cohort of 140 patients: 88% had an emergency admission, 31% an amputation and 38% died over a median 4.6 years, with 5-year amputation-free survival of only 44%. Advanced CKD and high foot-risk status marked the worst outcomes. In a prespecified analysis of the open-label SMART-CHOICE 3 trial, 2,089 people with diabetes who had completed dual antiplatelet therapy after PCI had fewer deaths, MIs and strokes on clopidogrel than on aspirin monotherapy (4.5% vs 9.1%; HR 0.57), with no difference in bleeding; the interaction with diabetes was not significant, so the finding supports clopidogrel for everyone rather than for diabetes specifically. In 1,356 Framingham participants without diabetes, time above 140 mg/dL on blinded CGM tracked with higher PREVENT risk and more hypertension and dyslipidaemia after adjusting for fasting glucose, though the design was cross-sectional. A Diabetes Care commentary argues that current automated insulin delivery systems are not built for pregnancy targets and that pregnant women with type 1 diabetes have been left out of the trials. And a review from Chennai sets out how generic competition and price regulation cut SGLT2 inhibitor and GLP-1 agonist prices in India by about 60–90%.