Diabetic kidney disease (DKD) is a common and serious complication of diabetic mellitus (DM). More sensitive methods for early DKD prediction are urgently needed. This study aimed to set up DKD risk prediction models based on machine learning algorithms (MLAs) in patients with type 2 DM (T2DM).

The electronic health records of 12,190 T2DM patients with 3-year follow-ups were extracted, and the dataset was divided into a training and testing dataset in a 4:1 ratio. The risk variables for DKD development were ranked and selected to establish forecasting models. The performance of models was further evaluated by the indexes of sensitivity, specificity, positive predictive value, negative predictive value, accuracy, as well as F1 score, using the testing dataset. The value of accuracy was used to select the optimal model.

Using the importance ranking in the random forest package, the variables of age, urinary albumin-to-creatinine ratio, serum cystatin C, estimated glomerular filtration rate, and neutrophil percentage were selected as the predictors for DKD onset. Among the seven forecasting models constructed by MLAs, the accuracy of the Light Gradient Boosting Machine (LightGBM) model was the highest, indicated that the LightGBM algorithms might perform the best for predicting 3-year risk of DKD onset.

Our study could provide powerful tools for early DKD risk prediction, which might help optimize intervention strategies and improve the renal prognosis in T2DM patients.

The shape of the oral glucose tolerance test (OGTT) curve is an early predictor of metabolic disturbances. In this study, we analyzed which parameters are associated with different OGTT-curve shapes (CS) in healthy middle-aged and older adults.

In the cross-sectional Enable Study, 354 participants were comprehensively phenotyped. Based on a 2-hour OGTT, CS was classified according to the presence (polyphasic) or absence (monophasic, mp) of a rise in plasma glucose of more than 4.5 mg/dL after the first decline of the plasma glucose level. Associations between CS and age, sex, anthropometric, metabolic, and inflammatory parameters were analyzed by binomial logistic regression.

Curve shape was mp in 77.4% of the participants without age group difference, but a higher frequency was observed in men (89.3%) compared to women (65.5%, P < .001). The odds of mp CS increased with higher fasting GLP-1 (odds ratio [OR], 1.066; 95% CI, 1.006-1.133; P < .05) and 1-hour plasma glucose (OR, 1.054; 95% CI, 1.037-1.072; P < .001) and lower 2-hour plasma glucose (OR, 0.975; 95% CI, 0.959-0.992; P < .01).

In healthy adults, mp CS was widespread and associated with more unfavorable metabolic parameters. A higher fasting GLP-1 level was associated with an mp CS.

Insulin resistance (IR) and dysglycemia can induce cardiac remodeling in adulthood, but little evidence exists with respect to cardiac remodeling in youth with and without evidence of new-onset glucose metabolic alterations. This study investigated whether changes in metabolic status from adolescence to young adulthood are associated with the risk of progressive cardiac remodeling and examined potential mechanistic pathways.

From the Avon Longitudinal Study of Parents and Children (ALSPAC), U.K. cohort, 1,595 adolescents, mean (SD) age 17.7 (0.4) years, who had data on fasting plasma glucose and insulin levels, and echocardiography left ventricular (LV) mass indexed for height raised to the power of 2.7 (LVMI2.7) and in whom these factors repeatedly were measured at a clinic visit when they were aged 24 years were included. HOMA-IR was computed, hyperglycemia was defined as glucose concentration of ≥5.6 mmol/L and ≥6.1 mmol/L, and LV hypertrophy was defined as LVMI2.7 ≥51g/m2.7.

The prevalence of LV hypertrophy increased from 2.4% at baseline to 7.1% at follow-up. Each unit increase of glucose (β = 0.37 g/m2.7 [95% CI 0.23-0.52]; P < 0.001) and HOMA-IR (1.10 g/m2.7 [0.63-1.57]; P < 0.001) was independently associated with increased LVMI2.7 over 7 years. Persistent hyperglycemia of 5.6 mmol/L and 6.1 mmol/L was associated with higher odds (odds ratio [OR] 1.46 [95% CI 1.35-1.47], P < 0.001; and 3.10 [95% CI 1.19-8.08], P = 0.021, respectively) of worsening LV hypertrophy over 7 years. Increased fat mass (62% mediation) significantly mediated the association of increased HOMA-IR with increased LVMI2.7.

Persistent adolescent hyperglycemia and worsening IR were associated with the risk of worsening structural and functional cardiac damage, and these were largely explained by increased fat mass.

The triglyceride-glucose (TyG) index has emerged as a surrogate marker for insulin resistance and is associated with the incidence and progression of chronic kidney disease (CKD) in patients with type 2 diabetes.

Data from the ACCORD trial were used. The Cox proportional hazards model was employed to calculate hazard ratios (HRs), while generalized additive mixed models were used to capture the non-linear eGFR slope in each group. The primary outcome was CKD.

9360 participants were included in this study, divided into tertiles based on their TyG index, with 3 119, 3 121, and 3 120 individuals in T1 (low), T2 (medium), and T3 (high), respectively. After a median follow-up of 4 years, 1 229 cases of CKD (13.30 %) occurred. Among women rather than men, CKD risk increased across ascending TyG index groups (adjusted HR for T3, Model 3, 1.46 [95 % CI, 1.13-1.88]) (p for interaction = 0.03). Additionally, longitudinal analysis revealed a rapid eGFR decline in women in the T3 group (-4.79 mL/min/1.73 m2) than the T1 group (-3.07 mL/min/1.73 m2, p < 0.05), but not in men.

A higher TyG index was associated with elevated CKD risk and accelerated eGFR decline, particularly in women.

Type 2 diabetes mellitus (DM2) is one of the main public health threats of the 21st century. Half of the people with DM2 worldwide are not diagnosed. The high prevalence, underdiagnosis and complications of diabetes highlight the need for identifying people at risk. Sedentary behaviour (SB) or prolonged sitting is a major predisposing risk factor for the increasing prevalence of DM2. Incorporating SB measures into clinical practice systems for identifying individuals more likely to have DM2 should be considered.

To develop a mathematical model for clinical practice that allows early identification of office employees at risk of DM2 based on objective data on SB.

A cross-sectional study with a cross-validation procedure was conducted. Anthropometric variables (sex, age and body mass index, BMI), sleep time (hours; measured by ActivPAL3M devices), and SB patterns (sedentary breaks and time spent in sedentary bouts of four different lengths; measured by ActivPAL3M devices) of two groups of office employees (adults with and without diabetes) were compared. Eighty-one participants had DM2 and 132 had normal glucose metabolism (NGM). The risk of having DM2 was modelled using generalized linear models (GLM), particularly a logistic regression model.

Five non-invasive clinical variables that were significantly correlated to DM2 with no collinearity were included in the mathematical model: sex, age, BMI, sleep time (hours) and sedentary breaks < 20 minutes (number/day). The validated model correctly classified 94.58 % of the participants with DM2 and 97.99 % of participants with NGM. The sensitivity was 94.58 % and the specificity 97.99 %. Additionally, the model allowed the design of a preventive tool to recommend changes in the SB pattern based on the participant's anthropometric profile, aiming to reduce the risk of developing DM2 in office employees.

This study highlights the importance of incorporating SB measures in primary care clinical practice. Our mathematical model suggests that including SB could enhance the early identification of adults at risk of DM2. Further research is needed to validate these findings and assess the practical application of the mathematical model in clinical practice.

To identify subgroups of patients with diabetic neuropathic pain according to their phenotypic characteristics and factors associated with belonging to each of these groups.

A multicenter cross-sectional study carried out in patients with DM-type2 and diabetic neuropathy. We recorded sociodemographic and clinical data, intensity of pain, pain phenotypes, mood disorders, sleep quality, social support, and health-related quality of life. A hierarchical cluster analysis was carried out to find groups according to their phenotype. The factors associated with belonging to these groups were assessed with a multinomial logistic regression model.

Four phenotypic groups were found: G1 with longer pain duration, predominance of pain provoked by brushing or pressure, and sensation of pins/needles and tingling; G2 characterized by stabbing, pins and needles, and electric shocks; G3 with lower scores in all the NPSI items; and G4 with low-moderate scores in almost all the items, but showing some level of pins and needles and tingling. Intensity and duration of pain, and level of anxiety were the factors associated with belonging to G1, G2, and G4 with respect to G3, although the magnitude of the risk was slightly different among them.

Specific treatment strategies should be developed for the different profiles found, with special attention to those with more pain and anxiety levels, including cognitive-behavioral therapies or mindfulness-based interventions.

No study has reported about the prevalence and factors associated with dynapenic abdominal obesity in patients with pre-dialysis chronic kidney disease (CKD).

Evaluation of the prevalence of dynapenic abdominal obesity and its relationship with sociodemographic, lifestyle, clinical, and nutritional variables in patients with CKD not dependent on dialysis.

A cross-sectional study was conducted at the Nutrition and Nephropathy Outpatient Clinic (public service) in Bahia, Brazil.

This cross-sectional study was conducted on 102 patients of both sexes, aged ≥ 20 years. Dynapenic abdominal obesity (DAO) was defined as the simultaneous presence of dynapenia (handgrip strength less than the first tertile of the sample itself, according to sex and age) and increased waist circumference. Differences between groups with and without DAO were assessed using the Student's Mann-Whitney t-test, Pearson's chi-square test, or Fisher's exact test. Associations were tested using bivariate and multivariate models with Poisson regression to calculate the prevalence ratio and 95% confidence intervals (PR; 95% CI).

The mean age of the patients was 58.7 (standard deviation = 11.69); 50.5% were male, 51.6% were elderly, 41.8% had diabetes, 5.5% were smokers, 58.2% were abdominally obese, and 38.5% were dynapenic. DAO was identified in 18.7% of participants and was associated with diabetes mellitus (PR = 2.8; 95% CI = 1.12-6.99) and smoking (PR = 3.22; 95% CI = 1.16-8.96).

Non-dialysis dependent patients with CKD showed a significant prevalence of DAO associated with smoking and diabetes mellitus.

Gestational diabetes mellitus (GDM) is a common complication of pregnancy. Implementation of Value-Based Healthcare (VBHC) to GDM care is worthwhile as traditional GDM care is fragmented and fails to meet the needs of women with GDM. Value of care can be improved through optimization and redesign of the care pathway and implementation of an outcome-based payment model. This study was conducted to perform a value-based evaluation of GDM care pathway redesign by using cost- and outcome data.

This study was designed as a single center, prospective, observational cohort study. In January 2022, GDM care was redesigned by substituting GDM care activities from an Internal Medicine Department (IMD) to an Integrated Maternity Care Organization (IMCO) in the Netherlands. Women diagnosed with GDM in 2021 were assigned to a pre-intervention cohort (N = 264) and those diagnosed in 2022 to a post-intervention cohort (N = 407). The impact of the intervention on value of care for women with GDM was evaluated by comparing clinical outcomes, patient-reported experience measures (GDM Responsiveness questionnaire), and costs (Time-Driven Activity-Based Costing) between the cohorts.

Referrals to the IMD for GDM decreased by 84.8% (pre-intervention: 100%, post-intervention: 15.2%, p <.001), patient-reported experiences significantly improved (Mean responsiveness pre-intervention: 3.46, post-intervention: 3.63, p: 0.00). Initiation of insulin treatment decreased by 46.8% (pre-intervention: 25.0%, post-intervention: 13.3%, p <.001). Maternal- and neonatal clinical outcomes were not different after redesign. Weighted average costs per GDM treatment were 9.7% lower post-intervention (pre-intervention: €168,37, post-intervention: €151,97).

The redesign of GDM care positively impacted value through decreased referrals and improved patient-reported experiences while clinical outcomes remained constant. By de-fragmenting GDM care, cost savings were realized. This study contributes to the improvement of care delivery, particularly in pregnancy and childbirth, by promoting the adoption of comprehensive, value-based evaluations of redesign initiatives and supports the further uptake of VBHC in maternity care.

Epidemiological studies have discovered an inverse correlation between serum Mg2+ concentration and the risk of developing heart failure (HF) as well as atrial fibrillation (AF) in patients with type 2 diabetes mellitus (T2DM). The prognostic relevance of serum Mg2+ concentration in patients with HF and T2DM remains unclear.

To assess the association of serum Mg2+ concentration with cardiovascular event rates in a retrospective cohort of patients with HF and T2DM.

This study included patients diagnosed with HF and T2DM in First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, from July 2018 to December 2021. The primary endpoint was cardiovascular death or rehospitalization for HF.

This study included 216 patients with HF and T2DM. Patients were divided into three groups (T1 [serum Mg2+ level ≤ 0.8 mmol/L], T2 [0.8 < serum Mg2+ level ≤ 0.89 mmol/L], T3 [serum Mg2+ level ≥ 0.9 mmol/L]) based on serum Mg2+ level. The Kaplan-Meier analysis revealed that the incidence rate of primary endpoint was significantly increased among three groups (P < 0.001). In multivariate Cox regression model, elevated serum Mg2+ level was considered as a protective factor in the coexistence of T2DM and HF with poor prognosis.

Our results indicated that increased serum Mg2+ concentration may improve long-term prognosis of patients with HF and T2DM.

Theabrownin has demonstrated metabolic-modulating effects, but the doses used in previous studies are difficult to achieve through regular tea consumption. This study reassesses its hypoglycemic effects at physiologically relevant doses in the db/db mouse model of type 2 diabetes mellitus (T2DM), with a focus on intestinal microbiota and metabolic pathways. The findings show that theabrownin delays glucose absorption by inhibiting α-glucosidase in the duodenum. It also reduces lipopolysaccharide (LPS)-producing bacteria, increases Akkermansia muciniphila abundance, lowers serum LPS levels, and alleviates β-cell dysfunction due to oxidative stress. Additionally, theabrownin promotes the microbial indole pathway of tryptophan metabolism, enhancing glucagon-like peptide-1 (GLP-1) secretion, which helps mitigate β-cell dysfunction. In conclusion, theabrownin shows potential as a dietary supplement for T2DM treatment, primarily regulating LPS/GLP-1 levels and restoring pancreatic islet function. These findings highlight the potential role of fermented tea in glucose metabolism regulation.

Background: Diabetes mellitus is a heterogeneous metabolic disorder that poses substantial challenges in the management of patients with diabetes. Emerging research underscores the potential of unsupervised cluster analysis as a promising methodological approach for unraveling the complex heterogeneity of diabetes mellitus. This systematic review evaluated the effectiveness of unsupervised cluster analysis in identifying diabetes phenotypes, elucidating the risks of diabetes-related complications, and distinguishing treatment responses. Methods: We searched MEDLINE Complete, PubMed, and Web of Science and reviewed forty-one relevant studies. Additionally, we conducted a cross-sectional study using K-means cluster analysis of real-world clinical data from 558 patients with diabetes. Results: A key finding was the consistent reproducibility of the five clusters across diverse populations, encompassing various patient origins and ethnic backgrounds. MOD and MARD were the most prevalent clusters, while SAID was the least prevalent. Subgroup analysis stratified by ethnic group indicated a higher prevalence of SIDD among individuals of Asian descent than among other ethnic groups. These clusters shared similar phenotypic traits and risk profiles for complications, with some variations in their distribution and key clinical variables. Notably, the SIRD subtype was associated with a wide spectrum of kidney-related clinical presentations. Alternative clustering techniques may reveal additional clinically relevant diabetes subtypes. Our cross-sectional study identified five subgroups, each with distinct profiles of glycemic control, lipid metabolism, blood pressure, and renal function. Conclusions: Overall, the results suggest that unsupervised cluster analysis holds promise for revealing clinically meaningful subgroups with distinct characteristics, complication risks, and treatment responses that may remain undetected using conventional approaches.

Diabetes mellitus (DM) is a growing public health concern globally, particularly in Saudi Arabia, where increasing prevalence is associated with significant morbidity. This study aimed to assess the prevalence of diabetes-related complications among patients in Riyadh and examine the impact of sociodemographic factors, comorbidities, and lifestyle habits on these complications. A cross-sectional study was conducted with 980 diabetic patients attending health centers in Riyadh from March to April 2023. Data were collected via a validated bilingual questionnaire that captured sociodemographic information, diabetes-related variables, comorbid conditions, lifestyle habits, and complications. Statistical analyses, including descriptive statistics, chi-square tests, and binary regression, were performed via SPSS to identify significant associations. A p-value less than 0.05 was considered significant for all comparisons. Among the participants (980), 38% (378) reported diabetes-related complications, primarily neuropathy (30%), retinopathy (25%), and cardiovascular diseases (20%). Complications were significantly associated with older age (p < 0.001) and longer diabetes duration (more than 5 years; p < 0.001). Individuals with hypertension, hyperlipidemia, heart disease, kidney disease, and obesity had significantly higher complication rates than those without these conditions (p < 0.05). The most pronounced association was observed in participants with heart disease (85% vs. 15%; RR = 1.506), highlighting the need for better management of these comorbidities. Consuming fruits and vegetables, milk, and regular exercise were inversely associated with the risk of complications (p < 0.05). Conversely, sugary drinks, white bread, sheesha/vaping, and inadequate sleep were linked to increased risk (p < 0.05), highlighting the protective role of healthy dietary and lifestyle habits. This study highlights the impact of sociodemographic factors and lifestyle choices-such as age, education, family history, comorbidities, and poor diet-on diabetes complications. While early detection and lifestyle interventions are vital, a cautious approach is needed when applying these findings to other regions, given differences in socioeconomic circumstances.

Obesity and type 2 diabetes mellitus (T2DM) are global health crises, with bariatric surgery emerging as a key intervention. However, the comparative efficacy of Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (SG) in achieving diabetes remission remains debated.

This PRISMA-compliant meta-analysis included three randomized controlled trials (RCTs, n = 613 patients) comparing RYGB and SG in adults with severe obesity (BMI ≥30 kg/m²) and T2DM.

diabetes remission (HbA1c 6.0%). Risk of bias was assessed via Cochrane RoB-2 tool; statistical analysis used fixed-effect models (I²=0%).

RYGB demonstrated superior diabetes remission rates vs. SG (OR 2.77, 95% CI 1.83-4.20, p0.001), with no heterogeneity. Subgroup analyses confirmed consistency across studies. Mean follow-up was ≤5 years; baseline demographics were comparable (mean age 46.2 years, 53.4% male).

RYGB significantly outperforms SG in achieving T2DM remission, likely due to its combined restrictivemalabsorptive mechanisms and metabolic hormonal effects. These findings support RYGB as the preferred surgical option for obese patients with T2DM, though long-term studies are needed to assess durability.

As the primary anthropometric measure in metabolic dysfunction-associated steatotic liver disease (MASLD), waist circumference (WC) may more accurately reflect the visceral fat distribution than body mass index (BMI). This study aimed to compare the prognostic value of BMI, WC and WC-related indices including waist-hip ratio (WHR), body shape index (BSI) and weight-adjusted-waist index (WWI) in individuals with MASLD.

The study population was derived from four large-scale cohorts: the National Health and Nutrition Examination Survey (NHANES 2017-2020 and NHANES III), the Kailuan Cohort and the UK Biobank Cohort. We evaluated the mortality risk across these measures using multivariate Cox proportional hazards regression and restrictive cubic spline.

The Pearson correlation coefficient of WC with hepatic steatosis and fibrosis was better than that of BMI. WC [Quartile 4 vs. Quartile 1: HR (hazard ratio) = 1.48 (95% confidence interval (CI) 1.13-1.93)] and WC-related indices [Quartile 4 vs. Quartile 1: WHR HR = 3.21 (95% CI 2.36-4.37); BSI HR = 3.22 (95% CI 2.48-4.17); WWI HR = 4.72 (95% CI 3.36-6.62)], but not BMI [obesity vs. lean: HR = 0.90 (95% CI 0.72-1.12)], indicated a significant mortality risk gradient among individuals with MASLD. The finding was consistent across sex and racial/ethnic subgroups, with external validation supporting the WC-related indices. MASLD and fibrosis prevalence showed a dose-dependent pattern across WC-related index quartiles. Notably, low BMI and high WC-related indices portended the highest mortality risk.

WC and WC-related indices are better parameters in prognosticating MASLD than BMI. The BMI-related 'obesity paradox' may be a misnomer resulting from the use of an incorrect metric. WC should be measured more routinely among individuals with MASLD.

Type 2 diabetes mellitus (T2DM) remaina significant global health challenge, with its increasing prevalence and associated complications contributing to high morbidity and economic burden. Genetic factors play a crucial role in T2DM susceptibility, yet individual responses to dietary interventions vary widely, emphasizing the importance of gene-diet (G × D) interactions. This review synthesizes the current literature on the genetic basis of T2DM and the role of G × D interactions in shaping individual responses to diet. We examine the genetics implication in T2DM risk and modulation by dietary factors, with a focus on the potential of Nutrigenetics in guiding personalized nutrition (PN) strategies. Moreover, the clinical implications of these interactions for the personalized prevention and management of T2DM are explored, highlighting the promise of tailoring dietary recommendations based on genetic profiles. Critical research gaps, including the need for diverse and longitudinal studies, the integration of multi-omic data, and the inclusion of digital health technologies in PN are discussed. Finally, future directions for the field are outlined, advocating for more inclusive, large-scale studies to optimize PN approaches for diverse populations and improve the efficacy of T2DM prevention and management. This review underscores the potential of an individualized, genetically informed dietary approach in modulating the global burden of T2DM.

Diabetic foot ulcers (DFU) represent one of the most severe complications of diabetes mellitus and are closely associated with persistent hyperglycemia. Endoplasmic reticulum stress response proteins play critical roles in the development and progression of DFU, highlighting the urgent need for further research to identify novel biomarkers and therapeutic strategies.

This study utilized DFU datasets from the GEO database and employed bioinformatics approaches to identify differentially expressed genes encoding endoplasmic reticulum stress (ERS) response proteins. Key regulatory proteins NCCRP1, KDELR3, BOK, and YOD1 were screened using WGCNA, machine learning algorithms, and molecular docking techniques, followed by an evaluation of their correlation with the immune microenvironment. Additionally, single-cell RNA sequencing and Mendelian randomization analysis were applied to investigate the structural and functional characteristics of these proteins in DFU pathogenesis. The expression levels of key protein biomarkers were validated using qRT-PCR.

A total of 32 differentially expressed endoplasmic reticulum stress-related proteins associated with DFU were identified. Machine learning algorithms confirmed that NCCRP1, KDELR3, BOK, and YOD1 proteins demonstrated significant diagnostic potential as biomarkers. Immune analysis revealed associations between these stress-response proteins and immune cell infiltration, while molecular docking identified metronidazole as a promising therapeutic candidate targeting the KDELR3 and YOD1 protein structures. Experimental validation confirmed the differential expression of KDELR3 and YOD1 proteins in DFU tissues, and Mendelian randomization analysis suggested that BOK protein may be a potential causal factor in DFU development due to its structural interactions with ERS pathways.

Our study characterized specific ERS response proteins with significant diagnostic potential for DFU. These findings enhance the understanding of protein-mediated DFU pathogenesis and lay the foundation for improving diagnostic and therapeutic strategies targeting these biological macromolecules.

To explore the relationship between the systemic immune-inflammation index (SII) and the severity of depression.

This retrospective study included 750 patients who were hospitalized at Xiamen Xianyue Hospital and diagnosed with depression from January 2022 to December 2023. The SII was defined as the platelet count × neutrophil count/lymphocyte count. The participants were divided into a mild to moderate depression group (299 patients) and a major depression group (451 patients). Univariate and multivariate Logistic regression analysis, subgroup analysis, sensitivity analysis, and receiver operating characteristic (ROC) curve analysis were used to explore the correlation between the SII and the severity of depression.

According to the multivariate Logistic regression analysis, the SII was independently associated with the risk of major depression (P < 0.05). For every 1- unit and 1-standard-deviation increase in the SII, the risk of major depression increased by 0.1% and 25.3%, respectively (OR: 1.001, 95% CI: 1.000-1.001, P = 0.008; OR: 1.253, 95% CI: 1.061-1.480, P = 0.008), and each 1-unit increase in the Log10SII was associated with a 124.8% increased risk of major depression (OR: 2.248, 95% CI: 1.231-4.106, P = 0.008). Subgroup analysis and sensitivity analysis revealed significant associations between the SII and the risk of major depression was significant in multiple specific populations (P < 0.05). ROC curve analysis revealed that the area under the curve (AUC) value for using the SII to predict the risk of major depression was 0.585 (95% CI: 0.507-0.591, P = 0.024).

Higher SII values are strongly associated with a greater risk of major depression.

Serum uric acid (SUA) has been suggested to be associated with obesity, dyslipidaemia, diabetes, and hypertension. However, whether uric acid is independently associated with the risk of myocardial infarction (MI), a major type of cardiovascular disease (CVD), remains debatable, especially across different populations. This study aims to examine the relationship between SUA levels and MI in an adult population group in Bangladesh.

The study included 392 participants: 188 with a history of MI in the CVD group and 204 healthy individuals without CVD in the control group. Anthropometric, blood pressure, SUA, and other biochemical parameters were measured. A multivariate regression model was used to assess the relationship between elevated SUA levels and the risk of CVD.

The mean level of SUA was significantly higher in the CVD group (7.6 ± 4.5 mg/dL) compared to the non-CVD group (5.3 ± 1.8 mg/dL) (p < 0.001). The prevalence of hyperuricemia was also observed to be higher in the CVD group (46.3%) compared to the non-CVD group (18.2%) (p < 0.001). A significant difference was observed in the levels of blood glucose and lipid profile between the CVD and non-CVD groups (p < 0.001 for all cases). No significant differences were observed in the mean level of SUA or the prevalence of hyperuricemia between the gender groups. When SUA was divided into four quartiles, a significant difference was observed for systolic blood pressure across the quartile groups. After adjusting for potential confounders in the regression models, SUA was found to have a significant association with CVD.

Elevated levels of SUA were associated with increased odds of CVD among the study participants. Managing SUA levels and implementing intervention strategies could be effective in preventing and controlling cardiovascular events.

Type 2 diabetes (T2D) is a persistent illness that has a high incidence rate. Still, there is no conclusive evidence on effectively improving blood sugar levels in patients through physical therapy. This study examined the regulatory effects of different intensities of low-intensity pulsed ultrasound (LIPUS) on T2D by stimulating brown adipose tissue (BAT). Eight-week-old C57BL/6J mice were divided into six groups (n = 10 per group): Control sham (C-Sham), Control-LIPUS (C-LIPUS), T2D-sham (T2D-Sham), T2D groups treated with LIPUS at spatial average-temporal-average intensity (Isata) of 60mW/cm² (T2D-L-60), 80mW/cm² (T2D-L-80), and 100mW/cm² (T2D-L-100). T2D models were induced by intraperitoneal injection of 40 mg/kg streptozotocin (STZ) three times after 12 wks of high-fat diet (HFD). The T2D-LIPUS group received LIPUS stimulation for 20 minutes per day for 6 weeks. The LIPUS stimulation had a duty cycle of 20%, a frequency of 1 MHz, and Isata of 60mW/cm², 80mW/cm², 100mW/cm². Subsequently, glucose tolerance tests (GTT) and insulin tolerance tests (ITT) were performed, and body fat content in mice was analyzed using nuclear magnetic resonance (NMR). Metabolic changes were monitored using metabolic cages. The results indicated that 80mW/cm² intensity level significantly improved glucose tolerance, insulin sensitivity, and metabolic function after LIPUS exposure. Significant reductions in body fat content and enhanced thermogenesis were observed, highlighting the potential of LIPUS in T2D management. This provides the basis for the dose study of LIPUS in the treatment of T2D.

Catharanthus roseus leaves have been traditionally described to possess potent antidiabetic activity and some leaf-specific alkaloids, including vindoline, have been studied for their antidiabetic potential. The aim of the present study was to validate the antidiabetic property of the plant with special reference to vindoline. An Ayurveda-based method was used to prepare the Swaras [leaf juice extract (LJE)] of three familial C. roseus genotypes differing in their vindoline content [CIM-Sushil (CS) > Dhawal (D) > Nirmal (N)]. In vivo experiments using LJE were performed in Charles Foster rats, whereby metformin (M100, 100 mg/kg BW) and vindoline (V20, 20 mg/kg BW) were used for comparison. OGTT-based screening for LJE doses (N100, N300, N500, D100, D200, D300, CS100, CS200, CS300 mg/kg BW) was carried out. Further analysis of the effective doses (D100, D200, D300, CS100, CS200, CS300) in streptozotocin-induced diabetic rats indicated highest blood glucose depletion in D300 (52.51%) and CS200 (64.55%) together with V20 (56.96%) on the 14th day. CS-LJE was found to be safe up to 2000 mg/kg BW. The role of LJE/vindoline in maintaining glucose homeostasis in liver was found to be mediated through the expression of insulin pathway genes (IRS-1, PI3K, AKT, GLUT2). TNF-α-induced insulin resistance in L6 skeletal muscle cells was used to analyze the effect of LJE/vindoline through glucose uptake assay and expression analysis of insulin pathway genes (IRS-1, PI3K, AKT, GLUT4). The results indicated that the antidiabetic effect of LJE/vindoline is mediated through activation of IRS/PI3K/AKT/GLUT signaling pathway.

Pentachlorophenol (PCP) is a pervasive endocrine-disrupting compound present in the environment. Limited research has explored the effects of PCP exposure on gestational diabetes mellitus (GDM), particularly the metabolites-related mechanism. Our study seeks to characterize the interrelationships between PCP exposure, plasma metabolomic markers, and GDM, aiming to elucidate the metabolomic profile mediating PCP-GDM relationship. From a prospective cohort in Changzhou, China, a nested case-control study was conducted, involving 154 GDM cases and 308 controls. We collected fasting blood samples before 16 weeks of gestation and determined PCP levels by UPLC-MS/MS. Plasma metabolomic markers were identified using untargeted metabolomics. Multivariate logistic regression and mediation analysis were used to examine the relationships among PCP exposure, metabolomic markers, and GDM. Using the Mann-Whitney U test, we found that serum PCP levels were significantly higher in GDM cases (median: 0.43 ng/mL, IQR: 0.28-0.77) compared to controls (median: 0.38 ng/mL, IQR: 0.24-0.64; P = 0.041). In the fully adjusted model, which additionally accounted for dietary patterns, the OR (95 %CI) values for GDM across tertiles of serum PCP were 1 (reference), 1.24 (0.73, 2.11), and 2.17 (1.28, 3.68), respectively, indicating a potential dose-response relationship (P trend = 0.004). Furthermore, 152 differential metabolites were identified between groups (FDR <0.05), implicating 4 metabolic pathways: "Nitrogen metabolism", "Alanine, aspartate and glutamate metabolism", "Glycerophospholipid metabolism", and "Pyrimidine metabolism" (FDR <0.1). Mediation analysis revealed that 5 metabolomic markers (such as N-Acetylalanine and 4-Acetamidobutyric acid) significantly mediated the association between PCP and GDM (FDR <0.05), with mediated proportions ranging from 0.15 to 0.31. Together, pregnant women in Eastern China exhibit widespread PCP exposure, with serum PCP levels positively associated with GDM risk. PCP exposure-related metabolomic changes may partially mediate the link between PCP and GDM.

BackgroundSupplementary feeding, colostrum or, in some countries, commercial milk formula, is given to newborns of women with Type 1 diabetes to prevent neonatal hypoglycemia. Few studies have explored the content of colostrum from women with Type 1 diabetes.Research AimsThis study aimed to investigate the macronutrients in colostrum collected during pregnancy and in the early postpartum period to compare colostrum contents in women with and without Type 1 diabetes.MethodsIn this cohort study, we collected colostrum among 20 women, 10 with and 10 without Type 1 diabetes, at 10 different time points in gestational weeks 36-40 and postpartum Days 1-5. We measured carbohydrates, protein, fat, and kilocalories in colostrum using a human milk analyzer; and we analyzed data using linear mixed models. In a follow-up analysis, we compared the content of colostrum from Day 1 with the nutritional values provided on the commercial milk formula, using a one-sample t test.ResultsThere were no mean differences in carbohydrates (6.6 g/100 ml; 95% CI [6.3, 6.9] vs. 6.7 g/100 ml; 95% CI [6.4, 7.0] p = 0.29); kilocalories (71.1 kcal/100 ml; 95% CI [62.9, 79.3] vs. 85.3 kcal/100 ml; 95% CI [77.2, 93.3] p = 0.21], and fat (2.7 g/100 ml; 95% CI [1.8, 3.6] vs. 2.3 g/100 ml; 95% CI [1.4, 3.2] p = 0.55) in colostrum when comparing women with and without Type 1 diabetes. However, antenatal protein differed at all timepoints tested (p = 0.01). Colostrum macronutrients on Day 1 differed from that of commercial milk formula and all other colostrum time points, except Gestational Week 38.ConclusionsOur study provides insights into antenatal and postnatal colostrum macronutrients among women with and without Type 1 diabetes. Further studies are needed to understand the effects of supplementary feeding using antenatal or postnatal colostrum or commercial milk formula on neonatal hypoglycemia.

Long-term recurrent weight gain remains a persistent challenge in metabolic bariatric surgery (MBS). One strategy for managing recurrent weight gain involves the placement of a non-adjustable silicone ring around the reduced stomach pouch. This technique may lead to more significant weight loss and a reduced risk of long-term recurrent weight gain. Although several studies have demonstrated the effectiveness of silicone rings in combination with Roux-en-Y gastric bypass (RYGB), randomized studies providing long-term data on the effectiveness of primary banded one-anastomosis gastric bypass (OAGB) are lacking.

A total of 210 patients will be included in this prospective, non-blinded, single-center randomized controlled trial. The primary endpoint is the difference in total weight loss percentage (%TWL) 5 years post-surgery. Secondary outcomes include excess weight loss percentage (%EWL), changes in obesity complications, quality of life, and adverse events related to the surgical procedures. The study population will consist of patients eligible for primary OAGB aged 18 years and older.

The RiMini trial aims to investigate whether there is a significant difference in long-term weight reduction expressed as %TWL in patients undergoing an OAGB with or without the addition of a silicone ring 5 years after surgery.

This study is registered at Clinicaltrials.gov (NCT05472922) on the 25th of July, 2022.

Maternal age (MA) and body mass index (BMI) are known risk factors for hypertensive disorders of pregnancy (HDP). Different threshold values are used to calculate preeclampsia risk scores, but the appropriateness of a cut point model has not been extensively evaluated. This is because the effects of both MA and BMI occur continuously. We aimed to investigate the relationship between MA, BMI, and HDP, respecting the continuous nature of the two independent variables.

We retrospectively selected all nulliparous women with singleton pregnancies who delivered after 22 gestational weeks from January 2005 to December 2019 (25,165 women). We used univariate and multivariable logistic regression analyses implementing linear, quadratic, cubic, and penalized splines functions to test, investigate, and describe the relationship between continuous BMI, continuous MA, and risk of HDP.

MA, BMI, and infertility treatments are independently associated with the risk of developing all HDP in nulliparous women. The impacts of MA and BMI on the risk of developing HDP occur gradually, and penalized splines functions resulted in the best model to describe these associations with a different model for each HDP. No interaction factors were retained between MA, BMI, and infertility treatments.

Given the relevance of HDP on maternal mortality, an accurate identification of women at increased risk of developing the disease is crucial. In an era where technology is rapidly advancing, new models for customized risk assessment of HDP, considering the continuous nature of MA and pregestational BMI, must be implemented.

Background/Objectives: Natural therapeutics for the treatment of diabetes mellitus represent a common challenge for many researchers. Thus, the aim of this study was to evaluate the antihyperglycemic and anti-inflammatory effects and the hepatic antioxidant activities of both diosmin and linagliptin on nicotinamide/streptozotocin-induced diabetes mellitus in rats. Methods: Induction of diabetes mellitus was produced by injecting an intraperitoneal dose of nicotinamide (60 mg/kg) to 16-hour-fasted rats, then after 15 min, an intraperitoneal dose of streptozotocin (60 mg/kg) was injected. The rats with diabetes were orally treated with linagliptin (1 mg/kg), diosmin (10 mg/kg), and both of them every other day for 4 weeks. Results: The elevated hepatic glucose-6-phosphatase and glycogen phosphorylase activities, the lowered concentrations of serum insulin, C-peptide, and hepatic glycogen, and the diminished hepatic antioxidant defense system of nicotinamide/streptozotocin-induced diabetic rats were all potentially improved by the therapies. The treatments also improved the deteriorated adiponectin and resistin mRNA expression in visceral adipose tissue of nicotinamide/streptozotocin-induced diabetic rats. In addition, the treatments induced a recovery of damaged islets of Langerhans and a regeneration of islet cells in association with the enhancement of the formation of insulin granules in β-cells and the improvement of kidney function; the combined effect was the most potent. Conclusions: Diosmin alone or in combination with linagliptin has potent antidiabetic effects, which were managed through their insulinotropic and insulin-improving actions. The diosmin in combination with linagliptin has the most potent antihyperglycemic effects.

Polycystic ovarian syndrome (PCOS) is a prevalent endocrine condition in women of reproductive age, characterized also by insulin resistance, affecting both obese and non-obese individuals. Hyperprolactinemia in patients with PCOS may additionally aggravate the decline in insulin sensitivity, attributable to prolactin lipogenic effects and influence on metabolic profile. Therefore, this study aimed to investigate the serum levels of prolactin in women with PCOS and their associations with obesity, insulin resistance and prediabetes. A retrospective monocentric study was performed using the electronic database of 157 women diagnosed with PCOS. Serum prolactin, BMI, complete glucose-insulin profile and insulin resistance indices following OGTT were determined. The women with hyperprolactinemia (40.8%) had significantly higher BMI (p = 0.007), fasting glucose (p = 0.003), insulin levels (p < 0.001) and HOMA-IR (p < 0.001). The women with PCOS categorized as overweight/obese (47.1%), insulin resistant (68.8%), having impaired fasting glycaemia (28.7%) and prediabetes (36.3%) showed significantly higher levels of prolactin compared to the respective counterparts. Consequently, higher prolactin levels were significantly associated with an elevated risk of development of overweight/obesity (OR 2.59; 95% CI: 1.34-4.97, p = 0.004), insulin resistance (OR 3.33; 95% CI: 1.54-7.19, p = 0.002) and prediabetes (OR 1.98; 95% CI: 1.02-3.85, p = 0.043) in women with PCOS. Our results suggest that hyperprolactinemia might be a pathophysiological link between obesity, insulin resistance, and carbohydrate metabolism impairments in patients with PCOS. Increased prolactin levels may serve as an additional indicator of insulin resistance and even further exacerbate it in women with PCOS.

There is a well-established social gradient in the occurrence of type 2 diabetes, but the extent to which behavioural or metabolic risk factors explain these inequalities remains unclear. Leveraging data from 7123 adults and over 20 years of follow-up, we used counterfactual mediation analysis to estimate the direct effect of low socioeconomic status (measured as educational attainment and occupational class) on the risk of type 2 diabetes, and the indirect effect through behavioural and metabolic risk factors. Mediators included were smoking, high alcohol consumption, low physical activity, diet low in vegetables or fruits, high body mass index (BMI), high fasting glucose, and hypertension. We compared the results to mediation analysis using the difference and the product of coefficients methods. We found an association between low educational attainment 1.31 (95% CI 1.16, 1.45) and low occupational class 1.24 (95% CI 1.09, 1.38) with future risk of type 2 diabetes. In the counterfactual mediation analysis, behavioural and metabolic risk factors explained 60% (95% CI 41%, 75%) of the effect of low educational attainment and 42% (95% CI 19%, 65%) of the effect of occupational class on the risk of type 2 diabetes. The difference and product of coefficients methods yielded similar results. Well-established behavioural and metabolic mediators explained roughly half of the health inequalities in the incidence of type 2 diabetes. Public health interventions should consider alternative mechanisms to reduce disparities in the incidence of type 2 diabetes.

Urinary incontinence (UI) is associated with body mass index (BMI) and may be influenced by depressive symptoms. This study was aimed at assessing the relationship between BMI and UI risk and frequency in adult women, with a focus on depressive symptoms, measured by Patient Health Questionnaire-9 (PHQ-9) score, as a potential mediator.

Data from 6107 adult women in the National Health and Nutrition Examination Survey from 2005 to 2018 were analyzed. Weighted multivariable-adjusted regression analysis determined odds ratios (ORs) and 95% confidence intervals (CIs) for BMI-UI associations. Restricted cubic spline (RCS) analysis evaluated nonlinear relationships, and causal mediation analysis examined the mediating role of depressive symptoms. Subgroup analyses were stratified by PHQ-9 score.

Higher BMI was associated with increased UI risk and frequency. When BMI was categorized into quartiles, UI risk progressively increased from Q2 to Q4. In the fully adjusted model, OR for UI risk in Q4 vs Q1 was 2.53 (95% CI 1.83, 3.52; p < 0.001), with a significant trend across quartiles. RCS analysis indicated a nonlinear relationship, with increased UI risk, particularly at BMI levels above 30. Depressive symptoms were independently associated with higher UI risk and frequency, with significant mediation effects. Mediation analysis revealed that PHQ-9 score accounted for approximately 6.8% of the effect of the BMI on UI risk and 6.5% on UI frequency (both p < 0.001).

Elevated BMI and depressive symptoms are independently associated with increased UI risk and frequency among adult women. The mediation effect of depressive symptoms underscores the importance of addressing mental health and weight management to reduce UI risk. These findings advocate a holistic approach to UI prevention and treatment, integrating physical and mental health strategies.

Background: Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disease with global implications, necessitating effective management strategies. Dipeptidyl peptidase IV (DPP-4) inhibitors have shown promise as potent agents for T2DM treatment. Methods: This study combines chemical synthesis, molecular modelling, and inhibitory activity assays to characterise the structure-activity relationship of novel isomeric 1,2,4-oxadiazole-substituted derivatives of the 2-azabicyclo[2.2.1]heptane scaffold acylated with (R)-3-amino-4-(2,4,5-trifluorophenyl)butanoic acid. Results: In this article, we demonstrate the efficacy of new compounds as robust inhibitors of DPP-4. The attempts to further modify neogliptin (our lead compound described previously) resulted in a more potent DPP-4 inhibitor 9a (IC50 = 4.3 nM), which did not mediate any substantial inhibition of DPP-8 and DPP-9. Conclusions: This study demonstrates that pseudo peptides incorporating (R)-3-amino-4-(2,4,5-trifluorophenyl)butanoic acid, a 2-aza-bicyclo[2.2.1]heptane moiety, and 1,2,4-oxadiazole substituents act as potent and selective DPP-4 inhibitors. By the stereochemical refinement of oxadiazole derivatives of neogliptin, we discovered compound 9a, a strong candidate for further development in T2DM treatment.

Background: Probiotics alter gut microbiota and have beneficial effects on immune homeostasis. The role of probiotics in diabetes has been shown in some studies. Interleukin (IL)-21 and IL-22 have been implicated in the pathogenesis of type 1 diabetes mellitus (T1DM). Objectives: This study aimed to assess the effect of oral supplementation with probiotics on glycemic control and IL-21 and IL-22 levels in pediatric patients with T1DM. Methods: This randomized controlled trial was registered in ClinicalTrials (NCT04579341) and included 70 children and adolescents with T1DM. They were randomly assigned into two groups to receive either an oral probiotic tablet containing 0.5 mg Lactobacillus acidophilus once daily or a matching placebo. Both groups were followed up for 6 months with assessment of fasting blood glucose (FBG), lipids, hemoglobin A1c (HbA1c), and IL-21 and IL-22 levels. Results: Baseline clinical characteristics and laboratory parameters were similar between both groups (p > 0.05). After six months, probiotic supplementation for the intervention group resulted in significant decreases in FBG, HbA1c, total cholesterol, and IL-21 levels, while IL-22 was increased compared with baseline levels (p < 0.001) and compared with the placebo group (p < 0.001). No adverse reactions were reported. Baseline IL-21 was positively correlated to FBG, HbA1c, and total cholesterol while there were negative correlations between these variables and IL-22 levels. Conclusions: Probiotic supplementation improved glucose homeostasis and glycemic control, possibly through their immunomodulatory effects on cytokines IL-21 and IL-22. Thus, probiotics could be a safe adjuvant therapy to intensive insulin in pediatric patients with T1DM.

Large-scale reports on growth hormone-secreting pituitary adenomas (GHPA) with hyperprolactinemia (HPRL) remain limited. The relationship between clinical characteristics and pathological subtypes of GHPA patients, based on the 2022 classification of pituitary neuroendocrine tumors (PitNET), has rarely been elucidated. This study aims to enhance the understanding of clinicopathological features in GHPA and clarify differences between patients with and without HPRL.

We retrospectively collected the clinical data of 810 patients diagnosed with GHPA. The clinical and pathological characteristics were compared between the HPRL and non-HPRL groups. Patients were categorized according to 2022 pathological classification and their differences were compared.

Compared to the non-HPRL group, the HPRL group exhibited more visual acuity/field impairment and galactorrhea and had higher GH levels. The tumor volume (TV) in the HPRL group was significantly larger, with more severe cavernous sinus invasion and optic chiasm compression, and a higher proportion of mammosomatotroph PitNETs. The most common pathological types of GHPA included sparsely granulated somatotroph PitNETs (46.19%), mammosomatotroph PitNETs (17.37%), and plurihormonal PitNETs (17.80%). Patients with immature PIT-1 lineage PitNETs had the lowest biochemical remission rate and highest tumor residual/recurrence rate.

The symptoms of galactorrhea and visual acuity/field impairment contribute to early diagnosis in GHPA patients with HPRL. Although TV is larger and invasiveness is greater, HPRL does not significantly affect the biochemical remission rate. Nearly half of GHPA cases are sparsely granulated somatotroph PitNETs, which are often associated with poor tumor outcomes, highlighting the critical role of pathological type in predicting clinical prognosis.

Resistance exercise training is an effective treatment strategy to counteract the age-related loss of muscle mass and strength in older adults. However, there is a large inter-individual variation in muscle fiber hypertrophy following resistance exercise training. It has been hypothesized that a less than optimal muscle fiber capillarization and perfusion capacity may compromise muscle hypertrophy during resistance exercise training in older adults.

We assessed whether 8 weeks of aerobic exercise preconditioning, to improve muscle fiber capillarization and perfusion capacity, augments the gains in muscle mass and strength during subsequent resistance exercise training in older adults.

In total, 34 healthy older males and females (71 years standard deviation (SD) ± 5 years) participated in 12 weeks of progressive resistance exercise training, preceded by either 8 weeks of aerobic preconditioning (AER, n = 17) through cycle-ergometer endurance training, or a no exercise control condition (CON, n = 17). Muscle strength (one repetition maximum (1RM)) and muscle fiber characteristics (histochemistry) were assessed at baseline, following 8 weeks of AER or CON, and after 12 weeks of resistance exercise training. Femoral artery blood flow and vastus lateralis muscle microvascular perfusion kinetics were assessed at baseline and following 8 weeks of AER or CON intervention. Thigh muscle volume (magnetic resonance imaging scan) was assessed before and after the 12 weeks of resistance exercise training.

Aerobic exercise preconditioning increased type I (+ 19 ± 19%, P < 0.05) and type II (+ 35 ± 37%, P < 0.05) muscle capillary-to-fiber ratio, with no changes in the CON group (type I: + 0 ± 17%; type II: - 3 ± 26%). Muscle microvascular perfusion following a submaximal resistance exercise stimulus was reduced following aerobic exercise preconditioning, whereas no changes were observed in the CON group (interaction effect, P = 0.051). Resistance exercise training increased leg press 1RM (+ 16 ± 10% versus + 12 ± 8%, respectively, P < 0.001) and thigh muscle volume (+ 0.42 ± 0.69 versus + 0.31 ± 0.62 L, respectively, P < 0.001) in both the AER and CON groups, with no differences between the groups. No differences were observed in type I and type II muscle fiber hypertrophy in response to the entire intervention program between groups (interaction effect, P > 0.5).

Aerobic exercise preconditioning increases type I and type II muscle fiber capillarization in healthy older adults. Aerobic exercise preconditioning does not further increase muscle hypertrophy during subsequent resistance exercise training in healthy older adults. Both structural and functional microvascular characteristics do not seem to restrict the skeletal muscle adaptive response to resistance-type exercise training in healthy older adults.

Objectives: This systematic review with meta-analysis compared cardiometabolic syndrome (CMS) in adults with chronic (≥1 year) spinal cord injury (SCI) to non-SCI individuals (controls) and athletes, analyzing the effect of specific injury characteristics and exploring temporal and geographical trends. Methods: Ovid Medline, Embase, Cochrane, CINAHL, Scopus, and Web of Science were searched from inception to September 2024. Adults with chronic SCI were included based on observational and baseline data derived from experimental studies. Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields assessed quality. Weighted means with 95% bootstrapped confidence intervals (CI) were computed for risk stratification. Group differences were assessed using random effects meta-analysis, calculating weighted mean differences with 95% bootstrapped CI. Temporal and geographical trends were evaluated with linear regression based on sample-size-weighted distributions and relevant covariates. Results: Of 31,163 identified records, 471 studies were included (n ≤ 31,782 SCI participants). CMS was present in men with SCI, paraplegia, tetraplegia, and injuries above T6; men with complete SCI (AIS A); and men and women with motor-complete SCI (AIS A-B). Compared to controls, adults with SCI had a lower body mass index (BMI), higher total and visceral fat, and worse lipid and carbohydrate profiles, including increased insulin resistance (IR). Tetraplegia was associated with greater visceral fat, poorer glycemic control, and lower BMI, insulin sensitivity, high-density lipoprotein-cholesterol (HDL-C), and triglycerides than paraplegia. Motor-complete SCI had lower BMI, HDL-C, and fasting glucose than motor-incomplete injuries. Injuries above T6 had lower blood pressure and higher fasting insulin levels than those below T6. Athletes with SCI had a lower BMI, fat mass, and fasting glucose, and higher systolic blood pressure than non-athletes with SCI, but frequently presented with obesity and carbohydrate dysfunction. Temporal analysis revealed increasing obesity trends and improved systolic blood pressure, while other CMS risk factors remained unchanged. We also identified global variations in obesity, lipids, blood pressure, and carbohydrate patterns. Conclusions: With a large sample, we revealed a widespread cardiometabolic burden in chronic SCI, even among athletes. Specifically, obesity, IR, and hypoalphalipoproteinemia worsened with increasing injury severity, alongside rising obesity trends and geographic disparities in risk profiles. These patterns highlight the evolution of what was deemed an epidemic into a global cardiometabolic pandemic.

The investigation of the association between blood glucose within normal range and all-cause mortality among individuals without traditional risk factors is limited.

To determine the associations of 3 glycemic measures (fasting plasma glucose [FPG], hemoglobin A1c [HbA1c], and 2-hour glucose) in the normal range with all-cause mortality among individuals without traditional risk factors.

Retrospective cohort study of US National Health and Nutrition Examination Survey in 1988-1994 and 1999-2018. Nonpregnant adults who had a measurement of 2-hour glucose, FPG, and HbA1c, and absence of traditional risk factors were included. Cox proportional hazard models were performed to examine the associations of normal FPG (n = 5793), normal HbA1c (n = 8179), and normal 2-hour glucose (n = 3404) with all-cause mortality.

A significant association was found between 2-hour glucose within the normal range and all-cause mortality among those without traditional risk factors. Compared with participants with 2-hour glucose <80 mg/dL, participants with a higher normal 2-hour glucose level had a higher risk of all-cause mortality (110-139 mg/dL; HR 1.80, 95% CI 1.03-3.15). In the subgroup analysis, significant associations were also found among people aged ≥60 years and men. No significant associations were found between normal FPG and HbA1c levels and all-cause mortality.

Among US adults without traditional risk factors, high normal 2-hour glucose level was positively associated with all-cause mortality. This result highlights the potential importance of maintaining a lower normal level of 2-hour glucose for preventing mortality in individuals who are conventionally considered to be cardiovascular healthy.

Apart from classical elements in primary hyperparathyroidism (PHPT), non-classical complications, including type 2 diabetes mellitus (T2DM), are reported in some patients, but currently, they do not represent a parathyroidectomy (PTx) indication.

to explore the latest data regarding glucose profile, particularly, T2DM and metabolic syndrome (MetS) in PHPT, including post-PTx.

PubMed-based review included English-published original studies between January 2020 and December 2024 (n = 20).

Studied population: 764,485 subjects (female-to-male ratio of 1.26:1; 23,931 were PHPT patients vs. 740,502 controls). T2DM prevalence (n = 13; N = 763,645 patients; 55.92% females): 4-60% (higher vs. controls); for the largest study (N = 699,157) of 31.3%. Age-based analysis: higher T2DM prevalence at >50 vs. <50 years (14.4% vs. 2.6%, p < 0.001), but not all studies agreed. Concurrent vitamin D deficiency as a contributor to a higher risk had limited evidence. The association MetS-PHPT (n = 2) had no clear conclusion. Post-PTx showed the following: lower glycaemia, fasting insulin, insulin resistance (HOMA-IR) improvement, and reduced rate (but not all studies agreed). PHPT patients with prediabetes might represent the population sub-group with the highest post-PTx benefit.

The panel of PHPT-T2DM interplay remains heterogeneous. Data regarding post-PTx improvement of glucose disorders are still conflicting, recent findings suggested that surgery has beneficial effects, especially in patients with confirmed pre-existing prediabetes. Patients with the normocalcemic variant seemed to be less affected by the glucose-related disturbances, but further studies are needed. A better understanding of the intricate relationship between PHPT and glucose metabolism anomalies will help in providing optimal management to reduce the overall disease burden.

To elucidate the association between dietary iron intake and diabetic retinopathy (DR) in type 2 diabetes (T2D) patients.

Participants from the National Health and Nutrition Examination Survey (NHANES) 2005-2008 aged over 40 years with T2D were included. Dietary iron intake was estimated from standardised questionnaires. The presence of DR and vision-threatening DR (VTDR) was determined through retinal imaging. We used logistic regression to assess the relationship between iron intake and DR, and restricted cubic splines to reveal nonlinear links.

The study enrolled 1172 T2D adults. We found significant nonlinear associations between dietary iron intake and DR among females (P = 0.023), but not in males (P = 0.490). Compared with the lowest quartile of iron intake, the third quartile (13.2-18.1 mg/d) yielded significantly lower odds of developing DR (odds ratio [OR], 0.59; 95% CI, 0.39-0.90) and VTDR (OR, 0.42; 95% CI, 0.19-0.94). Stratified logistic analyses showed that medium-high iron intake was associated with lower risks of DR in females (OR, 0.44; 95% CI, 0.24-0.81), non-Hispanic Blacks (OR, 0.38; 95% CI, 0.17-0.85), and individuals with obesity (OR, 0.45; 95% CI, 0.25-0.82), high HbA1c (OR, 0.56; 95% CI, 0.34-0.93), long diabetes duration (OR, 0.40; 95% CI, 0.21-0.76) or low blood haemoglobin (OR, 0.17; 95% CI, 0.05-0.60).

Dietary iron intake was nonlinearly negatively associated with the prevalence of DR and VTDR, showing protective effect against retinopathy of medium-high iron intake in T2D patients. Such associations significantly vary by multiple factors such as age, ethnicity, obesity and glycaemic control.

Increased blood urea nitrogen (BUN) levels have been demonstrated to be associated with broader metabolic disturbances and the incidence of type 2 diabetes (T2D), potentially playing a role in the development of diabetic complications, including diabetic peripheral neuropathy.

To examine the relationship between BUN levels and peripheral nerve function in patients with T2D.

This observational study involved the systematic recruitment of 585 patients with T2D for whom BUN levels and estimated glomerular filtration rate were measured. Electromyography was used to assess peripheral motor and sensory nerve function in all patients, and overall composite Z-scores were subsequently calculated for nerve latency, amplitude, and conduction velocity (NCV) across the median, ulnar, common peroneal, posterior tibial, superficial peroneal, and sural nerves.

Across the quartiles of BUN levels, the overall composite Z-score for latency (F = 38.996, P for trend < 0.001) showed a significant increasing trend, whereas the overall composite Z-scores for amplitude (F = 50.972, P for trend < 0.001) and NCV (F = 30.636, P for trend < 0.001) exhibited a significant decreasing trend. Moreover, the BUN levels were closely correlated with the latency, amplitude, and NCV of each peripheral nerve. Furthermore, multivariate linear regression analysis revealed that elevated BUN levels were linked to a higher overall composite Z-score for latency (β = 0.166, t = 3.864, P < 0.001) and lower overall composite Z-scores for amplitude (β = -0.184, t = -4.577, P < 0.001) and NCV (β = -0.117, t = -2.787, P = 0.006) independent of the estimated glomerular filtration rate and other clinical covariates. Additionally, when the analysis was restricted to sensory or motor nerves, elevated BUN levels remained associated with sensory or motor peripheral nerve dysfunction.

Increased BUN levels were independently associated with compromised peripheral nerve function in patients with T2D.

Few studies have been conducted to investigate the association between the triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio and major adverse cardiac and cerebrovascular events (MACCEs) in a predominantly male cohort from China.

A prospective cohort study was conducted on a total 95,837 individuals (males account for 79.67) extracted from the Kailuan study. All individuals were grouped according to the TG/HDL-C ratio quartile. The endpoints of this study were composite MACCEs and its subtypes [non-fatal myocardial (MI), non-fatal stroke and all-cause mortality]. The Kaplan-Meier method was employed to illustrate the cumulative incidence curve. The incidence rate was reported as per 1000 person-years. To explore the impact of varying quartiles of the TG/HDL-C ratio on the risk of MACCEs, Cox proportional hazard regression analysis was conducted. Furthermore, multivariate adjusted spline regression models were applied to examine the relationship between the TG/HDL-C ratio and the risk of MACCEs.

A total of 18,430 cases of composite MACCEs occurred during a 13.97-year follow-up. In brief, 1762 cases of MI, 6653 cases of stroke, and 12,524 cases of all-cause mortality were reported, respectively. The cumulative incidence and incidence rate of composite MACCEs, MI, and stroke increased with increment in the TG/HDL-C ratio (p < 0.001). In comparison to quartile 1, the hazard ratios of quartile 4 for composite MACCEs, MI, stroke, and all-cause mortality were 1.13 (95% CI 1.07-1.19), 1.55 (95% CI 1.30-1.84), 1.21 (95% CI 1.12-1.31), and 1.12 (95% CI 1.05-1.20), respectively. Multivariate adjusted spline regression models showed a nonlinear relationship between baseline TG/HDL-C ratio and risk of composite MACCEs (p for non-linearity < 0.01), MI (p for non-linearity < 0.01), stroke (p for non-linearity < 0.01), and all-cause mortality (p for non-linearity = 0.029).

The TG/HDL-C ratio is significantly associated with an increased risk of MACCEs in a predominantly male cohort from northern China.