SGLT2 ketoacidosis risk does not fade after the first months

The edition in brief

Today's diabetology edition closes on a Scandinavian cohort and nested case-control study of 322,597 SGLT2 inhibitor treatment episodes: ketoacidosis ran at 2.43 per 1000 person-years, was highest soon after starting but persisted throughout follow-up, and clustered in people with very high HbA1c, malnutrition, low BMI, previous ketoacidosis or recent hypoglycaemia, with infection the commonest co-occurring event. An England population study of 25,176 people with diabetes undergoing below-knee amputation found mortality of 23.5% at one year and 82.3% at ten, with no improvement since 2012. A Swedish register study linked each later year of type 1 diabetes onset with lower mortality, and onset before age ten with about three times the all-cause mortality of matched controls. A single-arm 13-week trial of an automated insulin delivery system in insulin-treated type 2 diabetes reported HbA1c falling 0.7 percentage points and time in range rising 16 points. The FDA lists a class II recall of a compounded tirzepatide vial for lack of sterility assurance. The pearl covers sick-day guidance for SGLT2 inhibitors.