One in three adults with a diabetic HbA1c is not coded, treated or both

The edition in brief

A retrospective US claims cohort of 27,650 adults with laboratory-confirmed diabetes found only 66.6% had both a diagnosis code and drug treatment within a year; 9.6% had neither. Patients with HbA1c just over 6.5% and those with heavier comorbidity were least likely to be coded or treated. In the PDN-Sensory trial (91 patients), 10-kHz spinal cord stimulation added to medical management gave at least 50% pain relief in 27 of 34 implanted patients versus 2 of 50 on medical management alone, with blinded sensory scores and nerve fibre density also improving at six months. Seven OGTT-based national surveys in Mauritius show type 2 diabetes prevalence peaking at 23.3% in 2009 and falling to 19.9% in 2021, with intermediate hyperglycaemia falling from 24.9% to 15.6%. A 21-patient open-label pilot found empagliflozin raised urinary sodium excretion and roughly halved daily paracentesis volume over 10 days in diabetic patients with refractory cirrhotic ascites. A meta-analysis of 11 trials suggests education and behavioural programmes may reduce fear of hypoglycaemia in type 2 diabetes, but certainty is very low and heterogeneity extreme. The pearl covers when HbA1c misleads.