At last year’s DFCon, Professor Tony Keech of Sydney offered us some tantalizing evidence that fenofibrate had a net protective effect on preventing low-level amputations. While the rationale behind this was not entirely clear, further information at DFCon11– and further data– seems to suggest the answer may lie in its potential microvascular benefits. Our long-time friend Prof. Rayaz Malik of the University of Manchester spelled out compelling data from a series of studies that treatment of triglycerides (and maybe lipids) may provide more benefit than putting someone in a euglycemic state. He took us on an elegant tour from works by Solomon Tesfaye to very recent data from the DISTANCE study that seem to suggest that higher triglycerides = higher amputations. Perhaps this is due to reduced sensation and the commensurate pathway to limb loss. We’ve been discussing this for some time. It looks like there might be some real potential here. Stay tuned!