Placental grafts raise 12-week foot ulcer closure, and screening for silent ischaemia still lacks outcome benefit

The edition in brief

A meta-analysis of nine randomised comparisons (944 participants) found that adding a placental-derived product to standard care raised complete closure of diabetic foot ulcers at 12 weeks from about 36% to 59% (RR 1.70, 95% CI 1.31 to 2.20), with moderate certainty; the prediction interval crossed 1, so not every product or setting will match the average. A 134-patient randomised trial from China found a structured self-management programme improved HbA1c, eGFR, systolic pressure and LDL cholesterol in people with type 2 diabetes at high risk of kidney disease, but not albuminuria, over 24 weeks. A 66-child trial reported faster resolution of ketoacidosis with subcutaneous insulin infusion than with intravenous insulin; it is small, single-centre and not a reason to change protocols. A cluster trial showed an electronic prompt raised referral to diabetes education from about 1% to 13%, though absolute referral stayed low. A systematic review of five trials (3,315 adults) found no significant reduction in cardiovascular events from screening asymptomatic people with diabetes for silent ischaemia (pooled HR/RR 0.76, 95% CI 0.48 to 1.19). The review was not prospectively registered. The pearl covers sick-day advice for people on SGLT2 inhibitors.