Monocyte to high-density lipoprotein cholesterol ratio (MHR) is considered a novel marker of inflammation. However, whether MHR can predict the risk of diabetic kidney disease (DKD) remains uncertain. Our research aimed to investigate the relationship between MHR and DKD.

This was a cross-sectional retrospective study of 159 participants with type 2 diabetes mellitus. MHR, urinary albumin-to-creatinine ratio (UACR) and other indexes were measured. According to UACR, participants were divided into normal group (UACR < 30 mg/g), moderately increased group (UACR 30-300 mg/g) and severely increased group (UACR > 300 mg/g). The association between MHR and DKD was analyzed.

MHR was significantly elevated in severely increased albuminuria group (p = 0.029). The prevalence of DKD increased in parallel with the elevation in MHR (p = 0.009). MHR was positively related with DKD in univariate logistic regression analysis (ORs = 11.27, 95%CI 1.26-101.24, p = 0.031). Multivariable logistic regression analysis showed MHR significantly correlated with DKD (ORs = 6.20, 95%CI 1.49-25.84, p = 0.012). Each quartile elevation in MHR was associated with an increased risk of DKD (ORs = 1.90, 95%CI 1.19-3.01, p = 0.007). In subgroup analyses MHR was a risk factor for DKD, particularly in patients with HbA1c <8.0%.

Our findings suggest that MHR can be used as a marker for the presence and progression of DKD.

A non-invasive glucose biosensor for multiple biofluids based on platinum nanoparticle (Pt-NP)-modified laser-induced graphene (LIG) electrodes coated with a zein/gelatin/glucose oxidase (GOx) for amperometric detection of glucose is created. The biosensor fabrication is cost-effective and scalable, as it combines simple LIG electrode fabrication with direct Pt-NP electrodeposition and a sequence of drop-and-dry steps for zein and gelatin layer then GOx enzyme. The Pt-NP modification on the LIG electrode functions as an electrocatalyst to enhance the anodic H2O2 signal, which is directly proportional to glucose concentration. The zein layer acts as a diffusion barrier to mitigate potential interferences, while the gelatin film provides amine groups for the glutaraldehyde-mediated immobilization of the GOx enzyme.

The key parameters of LIG were optimized, such as power laser, number of Pt-NP cycles, and zein concentration. In addition, LIG was characterized by Raman spectroscopy, SEM, and cyclic voltammetry (CV) to ensure graphitization and electron transfer performance. The as prepared LIG/Pt-NP/Zein/Gel-GOx glucose biosensor was in anodic H2O2 detection mode and tested for glucose measurements in multiple biofluids including sweat, saliva, and urine. At H2O2 detection potential of +0.4 V, a linear detection range from 0 up to 2 mM glucose was obtained with a limit of detection (LOD) of 0.01 mM, making it feasible for glucose determination in various clinically relevant biofluids. By comparing with the commercial SPE, this LIG-based sensor offered much higher detection sensitivity towards both H2O2 and glucose, making it a superior choice for electrochemical analysis.

This LIG/Pt-NPs/Zein/Gel-GOx offers a practical and high sensitivity approach to glucose measurement with a wide linearity for multiple biofluids. Given the straightforward and easily scalable process, this high-performance, LIG-based glucose biosensor presents a compelling alternative over commercial screen-printed electrode. Highlighted the novelty using zein as a protective layer to reduce interferences. Owing to the simplicity of fabrication with high potential for up-scaling, this high analytical performance biosensor might be an alternative tool for multiplex glucose biosensors in point-of-care applications.

The present study described the case of a 50-year-old male patient. The patient had type 2 diabetes since the age of 38 years (in 2013) with an initial elevated glycated hemoglobin A1c of 7.2%, with a significant cardiovascular (CV) history consisting of an aneurysm of the anterior communicating artery that had been operated on in 1998 and a ruptured basilar artery tip aneurysm embolized with a stent in 2013; the case was also associated with bronchiectasis (since 2020), non-alcoholic fatty liver disease (since 2018), diabetic neuropathy (since 2023) and obesity with a body mass index of 31.72 kg/m2 (since 2010). Over the years the patient exhibited good metabolic control, initially treated with Metformin and managed through a change of diet. However, due to intolerance to Metformin, the patient stopped receiving treatments and only managed his diet. Since diabetes is by definition a condition that implies a high CV risk by itself, the primary focus with this patient was to provide additional CV protection, particularly secondary protection against any other potential future, and possibly fatal, CV events. After a brief introduction regarding the available therapeutic options, the case is presented along with the medical history, concomitant medications and evolution after 1 year. In the discussion section, similar documented cases in the literature were compared with the present case, and the potential effects of the therapeutic intervention in the present study were compared.

To study trajectories of HbA1c in type 2 diabetes (T2D) patients referred to diabetes outpatient clinics (DOCs), and to explore characteristics of referrals and patient pathways in patients treated in DOCs.

We retrospectively followed T2D patients from the Norwegian population-based ROSA 4 study to identify persons with T2D who were referred to a DOC. We used latent class trajectory modelling to identify subgroups of patients with similar patterns of HbA1c one year before to one year after the first consultation at a DOC. We performed multinomial regression analyses to identify baseline characteristics associated with group membership.

Four hundred and two of 6716 T2D patients started treatment at a DOC, constituting a yearly starting rate of 1.5%. We identified three classes of HbA1c trajectories: (1) stable moderate hyperglycaemia (75%); (2) severe hyperglycaemia with a decline in HbA1c around referral (14%) and (3) severe hyperglycaemia with a decline in HbA1c after starting treatment at the DOC (11%). HbA1c trajectories were associated with diabetes duration RRR 0.92, CI (0.87, 0.97) in class 2 vs. 1 and 0.93 (0.88, 0.98) in class 3 vs. 1. Some differences were found between clinics in rejection rate, processes of care, and duration of follow-up.

Norwegian GPs handle most T2D patients themselves. Those with T2D and severe hyperglycaemia had a considerable benefit from being referred to a DOC, though with two separate trajectories: One where HbA1c improved around the time of referral, and another that improved after starting in a DOC.

Traumatic injuries among patients with diabetes mellitus (DM) are associated with extended hospital stays and higher mortality rates.

This study aimed to estimate the prevalence of DM among traumatic patients admitted to Aseer Central Hospital, Aseer Region, Saudi Arabia.

A cross-sectional design was conducted among trauma casualties aged 18 years and older admitted to the Trauma Center of Asser Central Hospital, Abha, Saudi Arabia, for six months from July 1 to December 31, 2024. Data were collected using an interviewer-administered questionnaire. The questionnaire covered various aspects, including demographic information, smoking status, presence of chronic diseases, previous diabetes diagnoses, details of any accidents, diabetes diagnosis during the accident, and self-care practices.

Three hundred and eleven trauma casualties were included with a mean age of 46.7 ± 12.9. Of them, 60.8% were men. The study found that the prevalence of diabetes among trauma casualties was 8.7%, with 48.2% incidentally discovered during the current trauma. Among diagnosed patients, 33.3% had glycated hemoglobin (HbA1c) levels between 7.51-8.5%, 11.1% between 8.51-9.5%, and 22.2% exceeded 9.5%. The predictors of diabetes diagnosis included smoking (OR = 6.39, 95% CI = 2.08-19.63), lower levels of education levels (OR = 0.75, 95% CI = 0.58-0.96), and a positive family history (OR = 24.9, CI = 7.96-78.36).

The study found an 8.7% prevalence of diabetes among trauma casualties, with nearly half discovered during the event. Factors like smoking, education, and family history of diabetes were associated with diagnosis. Routine diabetes screening is crucial for early detection and management. Targeted interventions, such as multidisciplinary care teams and telemedicine, can improve diabetes management. Further research is needed to address cultural and socioeconomic factors.

Theaim of this review is to determine the proportion of awareness, treatment, and control of diabetes in the South American region. A comprehensive search was conducted using PubMed, EMBASE, SCOPUS, and LILACS databases from January 1, 2014, to March 23, 2024. We included observational, population-based studies that assessed the rates of awareness, treatment, and control of diabetes. The risk of bias was evaluated as proposed by Hoy and cols. A meta-analysis was performed using the random effects model, and heterogeneity was assessed using the I2 statistic. Additionally, a metaregression analysis was conducted to further explore heterogeneity. Fourteen studies met our eligibility criteria. The disease awareness meta-analysis, which included six studies, revealed that 71.7% (95% CI: 65.2%-77.8%, I2: 94.2%) of participants had a previous diagnosis of diabetes. The disease treatment meta-analysis, which included five studies, indicated that 64.6% (95% CI: 52.9%-75.3%, I2: 98.7%) of participants were receiving some form of treatment for diabetes, and 42.4% (95% CI: 36.0%-49.1%, I2: 96.3%) had their glycemic values within target ranges. All included studies were assessed to have a low risk of bias. In South America, the limited available evidence suggests a significant portion of individuals with diabetes remain untreated and uncontrolled. Numerous countries lack critical information on the diabetes care cascade necessary to inform health policies.

Open-source automated insulin delivery (OS-AID) systems combine commercially available insulin pumps and continuous glucose monitors with open-source algorithms to automate insulin dosing for people with insulin-requiring diabetes. Two data sets (OPEN and the OpenAPS Data Commons) contain anonymized OS-AID user data.

We assessed glycemic variability (GV) outcomes in the OPEN data set and characterized it alongside a comparison to the n = 122 version of the OpenAPS Data Commons. Glucose data are analyzed using an unsupervised machine learning algorithm for clustering, and GV metrics are quantified using statistical tests for distribution comparison. Demographic data are also analyzed quantitatively.

The n = 75 OPEN data set contains 36 827 days worth of data. Mean TIR is 82.08% (TOR < 70: 3.66%; TOR > 180: 14.3%). LBGI (P < .05) differs by gender whereas HBGI distributions are similar (P > .05). GV metrics (except TOR < 70, LBGI) show a statistically significant difference (P < .05) between data sets.

Both the OPEN and OpenAPS Data Commons data sets show TOR < 70, TIR, and TOR > 180 within recommended goals, adding additional evidence of real-world efficacy of OS-AID. Future research should evaluate in more detail potential data set differences and relationships between individual patterns of user behaviors and GV outcomes.

HbA1c testing in African populations may be limited due to high prevalence of hemoglobinopathies, anaemia, malaria and renal impairment. We aimed to assess the performance of glycated albumin (GA) and fructosamine in comparison to HbA1c for determining glycaemic control in Africans living with type 2 diabetes.

We compared the relationship between fructosamine, GA, and HbA1c with mean continuous glucose monitoring (CGM) glucose and assessed the impact of sickle cell trait (SCT), anaemia and renal impairment on the relationship between each measure and CGM glucose.

The overall association of HbA1c, GA and fructosamine with CGM glucose was similar (r = 0.88 [95%CI: 0.84, 0.91], 0.84 [0.79, 0.88] and 0.84 [0.79, 0.88]), respectively. For detecting those with mean CGM glucose >8 mmol/L HbA1c had similar diagnostic accuracy to GA and fructosamine, even in those with conditions reported to affect HbA1c performance (n = 63). We found no evidence that SCT (n = 43/192) altered the relationship between HbA1c, fructosamine or GA with CGM glucose (p > 0.3 for all). However, individuals with anaemia showed an underestimation of CGM glucose by HbA1c and fructosamine compared to those without anaemia (p for interaction <0.005 for both). In contrast, GA with average CGM glucose between those with anaemia and those without were not significantly different.

Switching to fructosamine or GA is unlikely to improve the accuracy of laboratory glycaemic monitoring beyond that of HbA1c in a population with high prevalence of conditions reported to affect HbA1c reliability.

The triglyceride‒glucose index (TyG index) has been verified to be a useful predictor of insulin resistance (IR), and is associated with the occurrence of acute coronary syndrome (ACS). However, the effect of the TyG index on vulnerable plaques (VP), which were identified when at least two high-risk features are present within the same lesion, in type 2 diabetes mellitus (T2DM) patients is not fully understood. This study aimed to explore the association between the TyG index and the presence of VP.

We retrospectively enrolled 2056 T2DM patients who underwent coronary computed tomography angiography (CCTA) examinations at West China Hospital from February 2017 to February 2022. These patients were divided into four groups on the basis of the quartiles of the TyG index. The high-risk coronary plaque features, vulnerable plaques, plaque type, coronary artery stenosis, segment involvement score (SIS), segment stenosis score (SSS) and multivessel disease (MVD) based on CCTA data were evaluated and compared among the four groups.

Patients with a higher TyG index had more noncalcified and mixed plaques, high-risk plaque features, vulnerable plaques and fewer calcified plaques (P < 0.05 for all). The proportion of patients with high-risk plaque features, including low-attenuation noncalcified plaques, positive remodeling and "napkin ring" sign was associated with the TyG index (P for trend < 0.05 for all). Multivariate analysis revealed that the TyG index was significantly associated with vulnerable plaques in T2DM patients [OR = 1.23 (95% CI 1.00-1.51), P = 0.046]. Subgroup analysis revealed that the association between the TyG index and vulnerable plaques varied with age and the prevalence of cardiovascular (CVD) symptoms, even after controlling for confounding factors (P for interaction < 0.05 for both).

The TyG index was independently associated with vulnerable plaques of the coronary artery among patients with T2DM. The TyG index could be regarded as a marker to reduce the incidence of cardiovascular events in the targeted population of T2DM patients.

The number of people living with dementia and/or cognitive impairment worldwide is rising with a negative effect on quality of life for many older adults. This study aims to examine the factors associated with cognitive function among older adults in Kuwait.

This cross-sectional study recruited 253 older adults ≥ 60 years from a Geriatric outpatient unit in Kuwait. Cognitive function (dependent variable) was assessed using the Arabic version of the Mini-Mental State Examination (MMSE) with scores < 24 indicative of cognitive impairment. Biochemical, nutritional, clinical, lifestyle, anthropometric, and sociodemographic independent variables were included.

A normal MMSE score was reported for 51.0% (n = 129) of the sample, with 34.7% and 14.2% of participants having mild and moderate/severe cognitive impairment, respectively. Multivariate ordinal logistic regression analysis indicated that Type 2 diabetes was associated with more than double the odds of cognitive impairment (OR = 2.15, 95% CI: 1.19-3.94; P = 0.01). Each additional level of education was associated with a lower likelihood of cognitive impairment (OR = 0.34, 95% CI: 0.26-0.43; P < 0.001).

This study identifies key risk factors associated with cognitive impairment in older Kuwaiti adults. These findings underscore the need for targeted interventions to mitigate cognitive decline in aging populations and provide context-specific data to support policy decisions.

The glycemia risk index (GRI) is an emerging metric designed to quantify the risk of both hypo- and hyperglycemia, providing a combined assessment of glycemic control quality. A high GRI is associated with an increased risk of diabetic complications. In this study, we leverage long-term continuous glucose monitoring (CGM) data to develop and validate predictive models for a high GRI (>60) in individuals with T1D. We assessed over 250 000 days of measurements collected over four years from 736 patients with type 1 diabetes. Our modeling approach shows promise for predicting glycemic control quality (area under the receiver operating characteristic curve [ROC-AUC] of 0.87) six to nine months from baseline. However, additional analysis and validation are imperative to determine its full clinical utility.

To assess the efficacy and safety of automated insulin delivery (AID) systems compared to standard care in managing glycaemic control during pregnancy in women with Type 1 Diabetes Mellitus (T1DM).

We searched MEDLINE, Cochrane Library, registries and conference abstracts up to June 2024 for randomized controlled trials (RCTs) and observational studies comparing AID to standard care in pregnant women with T1DM. We conducted random effects meta-analyses for % of 24-h time in range of 63-140 mg/dL (TIR), time in hyperglycaemia (> 140 mg/dl and > 180 mg/dL), hypoglycaemia (< 63 mg/dl and < 54 mg/dL), total insulin dose (units/kg/day), glycemic variability (%), changes in HbA1c (%), maternal and fetal outcomes.

Thirteen studies (450 participants) were included. AID significantly increased TIR (Mean difference, MD 7.01%, 95% CI 3.72-10.30) and reduced time in hyperglycaemia > 140 mg/dL and > 180 mg/dL (MD - 5.09%, 95% CI - 9.41 to - 0.78 and MD - 2.44%, 95% CI - 4.69 to - 0.20, respectively). Additionally, glycaemic variability was significantly reduced (MD - 1.66%, 95% CI - 2.73 to - 0.58). Other outcomes did not differ significantly.

AID systems effectively improve glycaemic control during pregnancy in women with T1DM by increasing TIR and reducing hyperglycaemia without any observed adverse short-term effects on maternal and fetal outcomes.

Underestimating hyper-/hypoglycemia or failure to perceive hyperglycemia hinders optimal glucose management in diabetes care. Our study investigated individuals who, while aware of their hyper-/hypoglycemia, may not perceive them as problematic. Also, we clarified the factors contributing to discrepancies between these individuals' perceptions and the objective measurements.

This study was a prospective observational study comprising 284 Japanese individuals with type 2 diabetes who underwent ambulatory blinded professional continuous glucose monitoring (CGM) and self-administered the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Individuals with a time above range (TAR; > 180 mg/dL) ≥ 25% and those who answered 0 ("never") or + 1 ("almost never") for the frequency of hyperglycemia in the DTSQ were defined as having no-perception of hyperglycemia. Individuals with a time below range (TBR; < 70 mg/dL) ≥ 4% with an answer of 0 or + 1 for the frequency of hypoglycemia were labeled as having no-perception of hypoglycemia. Multivariate logistic regression analysis was performed to analyze clinical characteristics associated with the discrepancies between failure to perceive hyper-/hypoglycemia and TAR ≥ 25% or TBR ≥ 4%.

Insulin-use (odds ratio [OR] = 0.29, p < 0.05) and older age (OR = 1.05, p < 0.05) were independent determinants of no-perception of hyperglycemia. Low eGFR was an independent determinant of no-perception of hypoglycemia (OR = 0.94, p < 0.05).

No-insulin-use, being an older adult, and renal dysfunction are linked to the discrepancy between the perception of hyper-/hypoglycemia and actual blood glucose. These results will help create personalized diabetes care.

The Glucose Management Indicator (GMI) is a biomarker of glycemic control which estimates hemoglobin A1c (HbA1c) based on the average glycemia recorded by continuous glucose monitoring sensors (CGMS). The GMI provides an immediate overview of the patient's glycemic control, but it might be biased by the patient's sensor wear adherence or by the sensor's reading errors. This study aims to evaluate the GMI's performance in the assessment of glycemic control and to identify the factors leading to erroneous estimates. In this study, 147 patients with type 1 diabetes, users of CGMS, were enrolled. Their GMI was extracted from the sensor's report and HbA1c measured at certified laboratories. The median GMI value overestimated the HbA1c by 0.1 percentage points (p = 0.007). The measurements had good reliability, demonstrated by a Cronbach's alpha index of 0.74, an inter-item correlation coefficient of 0.683 and an inter-item covariance between HbA1c and GMI of 0.813. The HbA1c and the difference between GMI and HbA1c were reversely associated (Spearman's r = -0.707; p < 0.001). The GMI is a reliable tool in evaluating glycemic control in patients with diabetes. It tends to underestimate the HbA1c in patients with high HbA1c values, while it tends to overestimate the HbA1c in patients with low HbA1c.

Automated insulin delivery (AID) systems adapt insulin delivery via a predictive algorithm integrated with continuous glucose monitoring and an insulin pump. Automated insulin delivery has become standard of care for glycemic management of people with type 1 diabetes (T1D) outside pregnancy, leading to improvements in time in range, with lower risk for hypoglycemia and improved treatment satisfaction. The use of AID facilitates optimal preconception care, thus more women of reproductive age are becoming pregnant while using AID. The effectiveness and safety in pregnant populations of using AID systems with algorithms for non-pregnant populations may be impacted by requirements for lower glucose targets and existence of increased insulin resistance during gestation. The CamAPS FX is the only AID system approved for use in pregnancy. A large randomized controlled trial (RCT) with this AID system demonstrated a 10.5% increase in time in pregnancy range (an additional 2.5 hours/day) compared with standard insulin therapy in pregnant women with T1D with a baseline glycated hemoglobin A1c (HbA1c) ≥48 mmol/mol (6.5%). A RCT of AID not approved for use in pregnancy (MiniMed 780G) has also demonstrated some benefits of AID compared with standard insulin therapy with improved time in pregnancy range overnight (24 minutes), less hypoglycemia, and improved treatment satisfaction. There is also increasing evidence that AID can be safely continued during delivery and postpartum, while maintaining glycemic goals with lower risk for hypoglycemia. More AID systems are needed with flexible glucose targets in the pregnancy range and possibly with algorithms that better adapt to changing insulin requirements. More evidence is needed on the impact of AID on maternal and neonatal outcomes. We review the current evidence on the use of AID in pregnancy and postpartum.

Over the last four decades, glucose-responsive materials have emerged as promising candidates for developing smart insulin delivery systems, offering an alternative approach to treating diabetes. These materials replicate the pancreas's natural "closed loop" insulin secretion function by detecting changes in blood glucose levels and releasing insulin accordingly. This perspective highlights the evolution of glucose-responsive materials from protein-based materials, such as glucose oxidase (GOx), and glucose-binding proteins, such as concanavalin A (ConA), to protein-free materials, including phenylboronic acid (PBA) and their applications in smart insulin delivery. We first describe protein-based glucose-responsive systems that depend on different macromolecules, including enzymes and proteins, that interact directly with glucose to promote insulin release. However, these systems encounter significant stability, scalability, and immunogenicity challenges. In contrast, protein-free systems include hydrogels, nanogels/microgels, and microneedle patches, offering long-term stability and storability. In this direction, we discuss the design principles, mechanisms of glucose/pH sensitivity, and the disintegration of both protein-based and protein-free systems into different glucose environments. Finally, we outline the key challenges, potential solutions, and prospects for developing smart insulin delivery systems.

This multicenter study evaluated the diagnostic accuracy of coronary computed tomography angiography (CCTA) and computed tomography-derived fractional flow reserve (FFRCT) in diagnosing coronary artery disease (CAD), focusing on the impact of coronary calcification, using invasive coronary angiography (ICA) as the reference.

The study analyzed 4172 patients from 3 centers who underwent CCTA and FFRCT between August 2021 and August 2022. Exclusion criteria included the absence of ICA within 90 days after CCTA, left main disease, previous coronary revascularization, or unmeasurable Agatston score (AS).

The study included 492 patients. In patients with less than mild calcification (AS < 100), the area under the receiver operating characteristic curve (AUC) for FFRCT was superior to CCTA (0.87 [95% confidence interval (CI): 0.82-0.92] vs. 0.78 [95% CI: 0.73-0.84], P = 0.009). As the severity of calcification increased, both CCTA and FFRCT showed reduced diagnostic efficacy, but FFRCT maintained higher accuracy. In patients with greater than moderate calcification (AS ≥ 100), FFRCT significantly outperformed CCTA (0.80 [95% CI: 0.74-0.85] vs. 0.62 [95% CI: 0.56-0.68], P < 0.001). Furthermore, integrating FFRCT with CCTA and baseline factors using least absolute shrinkage and selection operator (LASSO) improved diagnostic performance in patients with greater than moderate calcification (AS≥100) than FFRCT (0.85 [95% CI: 0.78-0.92] vs. 0.81 [95% CI: 0.72-0.90], P = 0.003).

FFRCT offers superior diagnostic accuracy over CCTA, particularly in patients with moderate to severe calcification. Furthermore, the LASSO model enhances diagnostic performance in these cases, demonstrating potential for improving CAD diagnosis in patients with significant coronary calcification.

Comparing continuous glucose monitoring (CGM)-recorded metrics during treatment with insulin degludec (IDeg) versus insulin glargine U100 (IGlar-100) in people with type 1 diabetes (T1D) and recurrent nocturnal severe hypoglycemia.

This is a multicenter, two-year, randomized, crossover trial, including 149 adults with T1D and minimum one episode of nocturnal severe hypoglycemia within the last two years. Participants were randomized 1:1 to treatment with IDeg or IGlar-100 and given the option of six days of blinded CGM twice during each treatment. CGM traces were reviewed for the percentage of time-within-target glucose range (TIR), time-below-range (TBR), time-above-range (TAR), and coefficient of variation (CV).

Seventy-four participants were included in the analysis. Differences between treatments were greatest during the night (23:00-06:59). Treatment with IGlar-100 resulted in 54.0% vs 49.0% with IDeg TIR (70-180 mg/dL) (estimated treatment difference [ETD]: -4.6%, 95% confidence interval [CI]: -9.1, -0.0, P = .049). TBR was lower with IDeg at level 1 (54-69 mg/dL) (ETD: -1.7% [95% CI: -2.9, -0.5], P < .05) and level 2 (<54 mg/dL) (ETD: -1.3% [95% CI: -2.1, -0.5], P = .001). TAR was higher with IDeg compared with IGlar-100 at level 1 (181-250 mg/dL) (ETD: 4.0% [95% CI: 0.8, 7.3], P < .05) and level 2 (> 250 mg/dL) (ETD: 4.0% [95% CI: 0.8, 7.2], P < .05). The mean CV was lower with IDeg than that with IGlar-100 (ETD: -3.4% [95% CI: -5.6, -1.2], P < .05).

For people with T1D suffering from recurrent nocturnal severe hypoglycemia, treatment with IDeg, compared with IGlar-100, results in a lower TBR and CV during the night at the expense of more TAR.

Mobile applications (apps) have proven to be highly effective tools to empower patients with type 1 diabetes mellitus (T1DM) and enable them to achieve better self-care, quality of life (QOL), and glycemic control. The aim of the study is to examine whether mySugr®, an app for diabetes management, together with teleconsultations, can have a positive impact on these factors and, thereby, replace current clinical care.

This study concerns an exploratory randomized clinical trial of 12 months' duration. People with T1DM using multiple daily injections were randomized to usual care (bolus calculator, five face-to-face visits) or intervention (mySugr® app, three face-to-face visits, and two teleconsultations). The main outcome was increase in empowerment assessed with the Diabetes Empowerment Scale Short Form questionnaire (DES-SF-S). Secondary outcomes were change in additional glucose-related (blood glucose monitoring, mean blood glucose, standard deviation, coefficient of variation (CV), and high and low blood glucose index) and patient-reported outcome measures (PROMs) (self-management, QOL, and distress).

A total of 25 out of 28 participants completed the study (52% men, age 44.52 years, diabetes duration 21.28 years). At 12 months, no significant differences were identified in the change of DES-SF-S and additional PROMs between arms. Similarly, no differences were observed in glucose-related outcomes except for the change in CV at 9 (control - 1.87 ± 4.98 vs. intervention 5.89 ± 11.33, p = 0.008) and 12 months (control - 2.33 ± 3.54 vs. intervention 5.12 ± 11.32, p = 0.018). Adherence to and satisfaction with the app were high.

Patients with diabetes using the mySugr® app and teleconsultation achieved similar results to those following usual care in empowerment, other PROMs, and most glucose-related outcomes, thus supporting its use in combination with face-to-face visits. The RCT was registered with ClinicalTrials.gov (NCT03819335, first registration 28/01/2019).

Current guidelines recommend assessing glycemic control using continuous glucose monitoring (CGM), which provides a comprehensive glycemic profile to supplement HbA1c measurement. However, the association between CGM-derived metrics and risk of adverse kidney outcomes is not entirely clear. This retrospective cohort study included 1274 patients with type 2 diabetes hospitalized from July 2020 to December 2022, with a median follow-up time of 923 days. Monitor using CGM at baseline and evaluate renal function indicators of participants at baseline and end of follow-up. Multiple CGM-derived metrics, particularly time in range (TIR) and glucose coefficient of variation (CV), were calculated from 3-day glucose profiles obtained from CGM. Relevant clinical data was collected from clinical records and/or patient interviews. The primary outcome was chronic-kidney-disease (CKD) progression. Secondary outcomes included worsening of albuminuria and, all-cause mortality and major-adverse-cardiac-events(MACE). Multivariate regression models were employed to analyze the association between CGM-derived indices, particularly TIR and CV, and the risk of adverse kidney outcomes. We demonstrated that the lower TIR categories had a remarkably increased risk of CKD progression, with a HR per 10 % increment of 0.90 (95 %CI:0.83-0.91). Conversely, higher CV was positively related to the subsequent risk of CKD progression, with an HR per 10 % increment of 1.30 (95 %CI:1.07-1.59). These results were consistent across various subgroups and sensitivity analyses. This study found that TIR and CV are significantly associated with CKD progression, proteinuria deterioration, all-cause mortality, and the risk of MACE. These findings have elasticity in adjusting for multiple covariates and have been confirmed in different subgroups and sensitivity analyses.

We compared biochemical and clinical data of individuals with type 2 diabetes (T2D) who opted for only teleconsultation (ie, no in-person visit at all), hybrid visits (combining home blood tests and in-person consultation), and fully in-person visits (both tests and consultation in person) at a tertiary care diabetes center.

In this observational cohort study, we retrieved demographic, anthropometric, and biochemical data of 8197 individuals with T2D who sought diabetes care between 2021 and 2023 (384 participants with only teleconsultations, 721 with hybrid visits, and 7092 with fully in-person visits) from the electronic medical records of a chain of tertiary diabetes care centers across India.

Individuals who opted for teleconsultation had a shorter duration of diabetes compared with those who opted for hybrid or fully in-person visits. Although participants who opted for a teleconsultation had better glycemic and lipid control at baseline, those who underwent hybrid and in-person visits showed greater improvements in fasting plasma glucose, glycated hemoglobin (A1c), and LDL cholesterol (LDL-C) during follow-up. Improvements in overall ABC target achievement (A1c, Blood pressure, and LDL-C) were greater in participants who had in-person visits compared with the other two groups.

While teleconsultation is a useful complement to in-person visits, the latter results in better glycemic and lipid control, perhaps due to more effective engagement with the diabetes care team.

Type 2 diabetes mellitus (T2DM) often leads to vascular complications, such as albuminuria. The role of insulin autoantibodies (IAA) and their interaction with D-dimer in this context remains unclear.

To investigate the characteristics of IAA and its effect on albuminuria in T2DM patients.

We retrospectively analyzed clinical data from 115 T2DM patients with positive IAA induced by exogenous insulin, and 115 age- and sex-matched IAA-negative T2DM patients as controls. Propensity scores were calculated using multivariate logistic regression. Key variables were selected using the least absolute shrinkage and selection operator (LASSO) algorithm. We constructed a prediction model and analyzed the association between IAA and albuminuria based on demographic and laboratory parameters.

The IAA-positive group had significantly higher D-dimer levels [0.30 (0.19-0.55) mg/L vs 0.21 (0.19-0.33) mg/L, P = 0.008] and plasma insulin levels [39.1 (12.0-102.7) μU/mL vs 9.8 (5.5-17.6) μU/mL, P < 0.001] compared to the IAA-negative group. Increases in the insulin dose per weight ratio, diabetes duration, and urinary albumin-to-creatinine ratio (UACR) were observed but did not reach statistical significance. The LASSO model identified plasma insulin and D-dimer as key factors with larger coefficients. D-dimer was significantly associated with UACR in the total and IAA-positive groups but not in the IAA-negative group. The odds ratio for D-dimer elevation (> 0.5 g/L) was 2.88 (95% confidence interval: 1.17-7.07) in the IAA-positive group (P interaction < 0.05).

D-dimer elevation is an independent risk factor for abnormal albuminuria and interacts with IAA in the development of abnormal albuminuria in T2DM patients.

The relationship between glycated hemoglobin (HbA1c) levels and mortality outcomes in elderly patients with non-diabetic chronic kidney disease (CKD) has not been well characterized. This study aimed to investigate the correlation between HbA1c levels and all-cause and cardiovascular disease (CVD) mortality in elderly individuals with non-diabetic CKD.

Data from the NHANES (1999-2018) were analyzed to measure HbA1c levels in whole blood using high-performance liquid chromatography (HPLC). Information on deaths and subsequent details was collected through the National Mortality Index until December 31, 2019. Hazard ratios (HR) and 95% confidence intervals (CIs) for all-cause and CVD mortality were calculated using weighted Cox proportional hazards and restricted cubic spline models.

Among the 1,931 participants (mean [SE] age, 73.2 [0.2] years; 61.9% female), over a median follow-up period of 7.6 years, a total of 1,003 deaths were observed, including 412 from CVD. HbA1c was divided into four quartiles: Quartile 1 (3.7-5.3%), Quartile 2 (5.4-5.6%), Quartile 3 (5.7-5.8%) as the reference group, and Quartile 4 (5.9-6.4%). Higher risks of all-cause mortality were noted in the lowest and highest HbA1c quartiles, with adjusted HR (95% CI) of 1.48 (1.18-1.87) and 1.31 (1.01-1.70) respectively. For CVD mortality, the lowest quartile showed a significantly increased risk (HR 1.94, 95% CI: 1.29-2.90), but the highest quartile did not significantly differ from the reference, with HR 1.14 (0.73-1.77). The RCS analysis indicated a U-shaped nonlinear relationship between HbA1c levels and all-cause mortality (P = 0.026 for nonlinearity) and a J-shaped nonlinear relationship with CVD mortality (P = 0.035 for nonlinearity).

This cohort study suggests that both low and high HbA1c levels are associated with an increased risk of all-cause mortality in elderly patients with non-diabetic CKD.

Background: The risk of dying from chronic liver diseases (CLDs) is two to three times higher for patients with diabetes (DM). Nonalcoholic fatty liver disease (NAFLD) is the primary cause of this increased risk, which has an etiology unrelated to alcohol or viruses. Previous research reported that diabetes and CLD are related, since they influence each other. Aim: Estimation of the impact of diabetes (DM) on liver diseases (LD), and of the impact of liver diseases on DM among Egyptian and Saudi patients. It is a descriptive and prospective analytical study design. The investigation was carried out in Saudi Arabia and Egypt at gastroenterology outpatient clinics. Methods: Prospective data were collected through face-to-face patient interviews during clinic visits between June 2021 and June 2023. The interviews covered the patients' basic characteristics and information on DM and LD. Certain laboratory tests were conducted on these patients, such as liver function, glucose level, lipid profile, INR, and prothrombin time. Results: The total of 2748 participants in this study included 1242 diabetic patients of both genders from Saudi Arabia and 1506 from Egypt. Most Saudis had between 10 and 20 years' duration of DM (35.5%), with HbA1c (7-10%) values of 47.8%, while the Egyptian patients had >20 years' duration of DM (39.8%), with HbA1c (7-10%) values of 49.8%. Regarding the impact of DM on the development of liver diseases, about 35.5% (Saudis) vs. 23.5% (Egyptians) had liver diseases due to DM, a significant difference (p-value = 0.011). Liver enzymes were increased in many of the Egyptian and Saudi patients (41.4% vs. 33%), while the presence of fatty liver (28.2% vs. 35.7%) and hepatocellular carcinoma (13.7% vs. 6.1%) were also significantly different (p-value = 0.047). While the impact of liver diseases on DM was observed more among Egyptian (59%) than among Saudi (46.4%) patients because of liver cirrhosis (HCV or HBV), known to be a reason for diabetes in Egyptians (27.9%) vs. Saudis (8.0%), a higher incidence of fatty liver leading to DM was observed in Saudis than in Egyptians (15.9% vs. 11.6%) (p-value = 0.000. Obesity was more prevalent among Saudi patients (63.8%) than among Egyptian patients (48.6%) (p-value = 0.019). Fewer Egyptians (about 65%) suffered from dyslipidemia than Saudis (about 80%). Higher INR and longer prothrombin times were observed in Egyptians (29.9% and 29.1%, respectively) than in Saudis (20.3% and 18.8%, respectively), with a significant difference between the two nations (p-value < 0.050). Conclusions: We may conclude that diabetes in most patients has a negative impact on the development of liver diseases (particularly fatty liver in Saudi patients). In addition, most liver diseases (liver cirrhosis) have a negative influence on the development of DM (more so in Egyptian patients). There is a link between DM and liver disease. In particular, liver cirrhosis and diabetes were found to influence each other. Therefore, correct medication, adherence to treatment, lifestyle modifications, successful cirrhosis control (in patients with liver diseases), and diabetic control (in diabetic patients) could lead to effective management of both diseases. The negative fallouts in the two cases were prompted by obesity, morbid eating, and poor quality of life.

Psoriasis is an immune-mediated skin disease with a chronic relapsing-remitting course. Hyperglycemia has been shown to correlate with psoriasis severity. However, whether it could trigger psoriasis flares is not known.

To investigate the association between hyperglycemia and psoriasis exacerbation.

We conducted a retrospective cohort study at a university-affiliated hospital in Bangkok, Thailand, between 2008 and 2022 to examine the effects of elevated HbA1c on psoriasis flares. Patients with psoriasis vulgaris and either type 2 diabetes mellitus (T2DM) or impaired fasting glucose (IFG) who had at least 2 HbA1c values were identified. Statistical analyses were performed using mixed-effects logistic regression.

A total of 201 psoriasis patients (95 with severe psoriasis and 106 with mild psoriasis) with 1,717 follow-up visits were included in the analysis. In patients with severe psoriasis, HbA1c ≥ 7% (adjusted odds ratio (OR): 1.905 (95% confidence interval: 1.328-2.731)) and alcohol consumption status (adjusted OR: 3.328 (1.235-8.965)) were identified as independent prognostic factors for psoriasis flares. Meanwhile, in mild psoriasis patients, none of the variables were independently associated with psoriasis flares.

Hyperglycemia and alcohol consumption were associated with exacerbation in patients with severe psoriasis who had T2DM/IFG.

This post hoc analysis explored the effects of semaglutide on estimated glomerular filtration (eGFR) slope by baseline glycemic control, blood pressure (BP), body mass index (BMI) and albuminuria status in people with type 2 diabetes and high cardiovascular risk.

Pooled SUSTAIN 6 (Trial to Evaluate Cardiovascular and Other Long-Term Outcomes With Semaglutide in Subjects With Type 2 Diabetes) and PIONEER 6 (A Trial Investigating the Cardiovascular Safety of Oral Semaglutide in Subjects With Type 2 Diabetes) data were analyzed for change in eGFR slope by baseline hemoglobin A1c (HbA1c) (<8%/≥8%; <64/≥64 mmol/mol), systolic BP (<140/90/≥140/90 mmHg) and BMI (<30/≥30 kg/m2). SUSTAIN 6 data were analyzed by baseline urinary albumin:creatinine ratio (UACR; <30/30-300/>300 mg/g).

The estimated absolute treatment differences overall in eGFR slope (95% confidence intervals) favored semaglutide versus placebo in the pooled analysis [0.59 (0.29; 0.89) mL/min/1.73 m2/year] and in SUSTAIN 6 [0.60 (0.24; 0.96) mL/min/1.73 m2/year]; the absolute benefit was consistent across all HbA1c, BP, BMI and UACR subgroups (all P-interaction >.5).

A clinically meaningful reduction in risk of chronic kidney disease progression was observed with semaglutide versus placebo regardless of HbA1c, BP, BMI, and UACR levels.

Individuals with type 1 diabetes (T1D) require lifelong insulin replacement to compensate for deficient endogenous insulin secretion, which would otherwise result in abnormal blood glucose levels. In recent years, significant investments have been made to improve T1D management, leading to the widespread adoption of accurate technology such as continuous glucose monitoring (CGM) sensors and automated insulin delivery systems. However, malfunctions in these devices, particularly pump systems, can cause undesirable interruptions of insulin delivery posing significant safety risks if not promptly addressed. Due to the low frequency of these episodes, developing accurate algorithms to identify insulin pump faults remains a challenge. To address these issues, this paper proposes a novel approach for detecting insulin pump faults (IPFs) by combining the ability of a long short-term memory (LSTM) autoencoder to extract features, with the strength of random forest to distinguish between anomalous and normal patterns. This method was developed and evaluated using data from 100 subjects, simulated over 90 days with the UVa/Padova T1D Simulator, an FDA-approved nonlinear computer simulator of T1D physiology. In the test set, the proposed algorithm identified the 93% of the total faults, while raising 2 false alarms in 3 months on average. These findings suggest that deep learning algorithms can enhance the safety and reliability of insulin pump systems, contributing to more effective therapeutic technologies.

Patients with diabetes are at increased risk of HBV infection; however, the effects of HBV infection and anti-HBV therapy on the management of type 1 diabetes (T1D), type 2 diabetes (T2D), and latent autoimmune diabetes in adults (LADA) remain unclear. From 2016 to 2023, we recruited a multicenter cohort of 355 HBV-infected inpatients, including 136 with T1D, 140 with T2D, and 79 with LADA. The control group included 525 HBV-uninfected inpatients, comparing 171 with T1D, 204 with T2D and 150 with LADA. We employed propensity-score matching between cases and controls to minimize confounding effects. Hemoglobin A1c (HbA1c) was monitored at baseline and at months 1, 2, and 3. At baseline, median HbA1c was significantly higher in HBV-infected patients compared to their HBV-uninfected controls: T1D (10.4% vs. 7.5%, p < 0.01), T2D (9.6% vs. 8.6%, p = 0.01), and LADA (9.4% vs. 8.4%, p = 0.03). Baseline HbA1c levels were significantly lower in HBV-treated patients compared to those HBV-untreated patients, regardless of whether they were on antidiabetic therapy (p < 0.05). A 90-day follow-up consistently indicated lower HbA1c levels at baseline, as well as at months 1, 2, and 3 among HBV-treated patients with T1D, T2D, or LADA. Both univariate and multivariate analyses identified HBV therapy (OR = 0.44, p < 0.001) and antidiabetic treatment(OR = 0.51, p = 0.031) as protective factors for glycemic control in HBV-infected patients with diabetes. Poor glycemic control is found in HBV-infected patients with diabetes, but the intervention of anti-HBV therapy and antidiabetic treatment contributes to improved glycemic control in HBV-infected patients with T1D, T2D, or LADA.

Effect heterogeneity analyses using causal machine learning algorithms have gained popularity in recent years. However, the interpretation of estimated individualized effects requires caution because insights from these data-driven approaches might be misaligned with the contextual needs of a human audience. Thus, a practical framework that integrates advanced machine learning methods and decision-making remains critically needed to achieve effective implementation and scientific communication. We introduce a 2-step framework to identify characteristics associated with substantial effect heterogeneity in a practically relevant format. The proposed framework applies distinct sets of covariates for (i) estimation of individualized effects and (ii) subgroup discovery and shows the subgroups with heterogeneity based on highly interpretable if-then rules. By referring to existing metrics of interpretability, we describe how each step contributes to leveraging a theoretical advantage of machine learning models while creating an interpretable and practically relevant framework. We applied the pragmatic subgroup discovery framework for the Look AHEAD (Action for Health in Diabetes) trial to assess practically relevant and comprehensive insights into the effect heterogeneities of intense lifestyle intervention for individuals with diabetes on cardiovascular mortality. Our analysis identified (i) individuals with history of cardiovascular disease and myocardial infarction had the least benefit from the intervention, while (ii) individuals with no history of cardiovascular diseases and HbA1c < 7% received the highest benefit. In summary, our practical framework for heterogeneous effects discovery could be a generic strategy to ensure both effective implementation and scientific communication when applying machine learning algorithms in epidemiological research.

To explore the relationship between glucose management indicator (GMI) and HbA1c and find the affecting factors in adult T2D patients with good glycemic control.

Adult T2D patients with both HbA1c < 7% and time in range (TIR) > 70% were retrospectively analyzed. A significant difference between GMI and HbA1c was defined as an absolute value of hemoglobin glycation index (|HGI|, HbA1c minus GMI) ≥ 0.5%. Factors associated with high |HGI| were determined by logistic regression analysis. The performance of possible factors in predicting high |HGI| was verified by ROC curve analysis. And the linear relationship between GMI and HbA1c was also investigated.

Of all the 94 patients (median HbA1c 6.18%, mean GMI 6.34%) included, 28.72% had an |HGI | ≥ 0.5% and only 15.96% had an |HGI | < 0.1%. Standard deviation of blood glucose (SDBG), a glycemic variability index, affected |HGI| (OR = 3.980, P = 0.001), and showed the best performance in predicting high |HGI| (AUC = 0.712, cutoff value = 1.63 mmol/L, P = 0.001). HbA1c was linearly correlated with GMI (β = 0.295, P = 0.004). Their correlation weakened after further adjusting for SDBG (β = 0.232, P = 0.012). Linear correlation between them was closer in patients with smaller SDBG ( < 1.63 mmol/L) than those with larger SDBG (P = 0.004).

Even in adult T2D patients with good glycemic control, the discrepancy between GMI and HbA1c existed. Their relationship was affected by glycemic variability. SDBG mainly accounted for this consequence.

Chinese clinical trial registry ( www.chictr.org.cn ), ChiCTR2000034884, 2020-07-23.

Long-acting insulin analogues are the standard of care for people with type 1 diabetes (T1D) in high-income countries but remain largely inaccessible and understudied in low-resource settings. In settings where glycaemic control is typically poor and food insecurity is common, long-acting insulin analogues may offer tangible clinical benefits for people with T1D. To determine whether insulin glargine, a long-acting insulin analogue, reduces the risk of serious hypoglycaemia and/or improves glycaemic time-in-range (TIR) versus human insulin regimens in this population, we are conducting the Human vs Analogue Insulin for Youth with Type 1 Diabetes in Low-Resource Settings randomised controlled trial.

This is a 1:1 randomised, parallel-group clinical trial comparing biosimilar insulin glargine with human insulin (Neutral Protamine Hagedorn (NPH) or premixed 70/30 insulin) in 400 youth with type 1 diabetes (T1D) recruiting in Dhaka, Bangladesh (n=250) and Mwanza, Tanzania (n=150). Blinded continuous glucose monitors will be used to assess glycaemic control in both study arms over 14-day periods at baseline and at 3, 6 and 12 months after randomisation. The co-primary outcomes are the per cent time in serious hypoglycaemia (<54 mg/dL) and TIR (70-180 mg/dL) at 6 months of follow-up. Secondary outcomes include TIR at 12 months and time-in-hypoglycaemia, time-above-range, nocturnal hypoglycaemic events and glycaemic control (ie, haemoglobin A1C (HbA1c)) at 6- and 12-months of follow-up. Treatment satisfaction and quality of life are assessed at baseline, 6- and 12 month follow-up. Additionally, the study is conducting qualitative interviews, quantitative assessments of treatment satisfaction and quality of life, as well as assessing the cost-effectiveness of analogue insulin use in low-resource settings.

This study was approved by the Institutional Review Board at the University of Pittsburgh (STUDY21110122), the National Health Research Ethics Committee at the National Institute for Medical Research in Tanzania (NIMR/HQ/R.8a/Vol.IX/4265) and the Ethical Review Committee (ERC) of Diabetic Association of Bangladesh (BADAS-ERC/EC/22/405). Research findings will be shared by the local partner organisations and institutions with relevant stakeholders including youth living with diabetes, policy makers, healthcare workers and the general public. Findings will also be shared at local, regional and international scientific meetings.

ClinicalTrials.gov: NCT05614089.

Hemorrhoidal disease is a common anorectal condition characterized by the enlargement and distal displacement of the typical vascular structures in the anal canal. The relationship between DM, lipid metabolism, and hemorrhoidal disease remains underexplored. This study aims to investigate the prevalence of hemorrhoids and the association between glycemic control and lipid profile in diabetic patients.

This retrospective cross-sectional study included 752 patients who underwent colonoscopy at Erzurum Regional Training and Research Hospital between June 2021 and August 2024. The study population comprised 452 patients with type 2 diabetes mellitus (mean age 63.4 ± 11.0) and 300 nondiabetic patients (mean age 62.8 ± 10.8). The presence of hemorrhoids was confirmed through colonoscopy. Glycemic control parameters, lipid profile, and other biochemical parameters were analyzed.

Hemorrhoids were found in 47.3% (n = 214) of diabetic patients and 17.3% (n = 52) of nondiabetic patients, indicating a significantly higher prevalence in the diabetic group (OR = 4.3, CI = 3.0-6.2, p < 0.001). Diabetic patients with hemorrhoids had significantly higher mean HbA1C (8.1 ± 2.1 vs. 7.5 ± 1.8, p < 0.001), low-density lipoprotein (p < 0.001), and triglyceride levels (p = 0.005) compared to those without hemorrhoids. Additionally, a longer duration of diabetes and higher hypertension prevalence were observed in the hemorrhoid group.

The findings suggest that poor glycemic control and dyslipidemia are significantly associated with an increased prevalence of hemorrhoids in diabetic patients. These results highlight the importance of comprehensive management of diabetes, including lipid control, to potentially reduce the risk of hemorrhoidal disease.

Altered tyrosine kinase signaling is associated with a variety of diseases. Tyrosine kinases can be classified into two groups: receptor type and nonreceptor type. Nonreceptor-type tyrosine kinases are subdivided into Janus kinases (JAKs), focal adhesion kinases (FAKs) and tec protein tyrosine kinases (TECs). The beneficial effects of receptor-type tyrosine kinase inhibitors (TKIs) for the treatment of diabetes mellitus (DM) and the mechanisms involved have been previously described. Recently, several clinical cases involving the reversal of type 1 diabetes mellitus (T1DM) during treatment with JAK inhibitors have been reported, and clinical studies have described the improvement of type 2 diabetes mellitus (T2DM) during treatment with JAK inhibitors. In vivo and in vitro experimental studies have elucidated some of the mechanisms behind this effect, which seem to be based mainly on the reduction in β-cell disruption and the improvement of insulin resistance. In this review, we briefly describe the beneficial effects of JAK inhibitors among nonreceptor tyrosine kinase inhibitors for the treatment of DM and attempt to analyze the mechanisms involved.

To determine the satisfaction of patients with diabetes mellitus who used subcutaneous insulin application devices in Colombia.

An observational prospective study of patients with diabetes mellitus receiving insulin treatment in Colombia. Sociodemographic, comorbidity and pharmacological data were taken from a drug dispensing database. Through telephone calls, satisfaction with application devices was evaluated with Diabetes Treatment Satisfaction Questionnaire status version (DTSQ-s). Satisfaction was considered high at a score ≥30 points. The change in the type of insulin delivery device (ie, from pen to vial/syringe, and from vial/syringe to pen) was evaluated during a 1-year follow-up.

A total of 382 patients from 75 cities were selected, with a median age of 66.0 years, and 56.3% were women, and 65.2% were treated with long-acting insulins. The mean DTSQ-s score was 26.6±5.3 points, and 38.7% presented high satisfaction, without statistically significant differences between pen and vial/syringe. A total of 18.8% changed the administration device, mainly those that came from Bogotá-Cundinamarca (OR:2.19; 95% CI:1.01-4.75), in concomitant treatment with other antidiabetic drugs (OR:2.28; 95% CI:1.00-5.22) and those who previously used insulin in vial/syringe (OR:33.90; 95% CI:11.88-96.74).

The participants had low satisfaction with the insulin delivery device. No statistically significant differences were found in satisfaction between those who received pen vs vial/syringe insulin, and patients using the latter had a high probability of switching to insulin pen.

Glycated haemoglobin (HbA1c) is currently the gold standard for assessing glycaemic control in diabetes, given the established relationship with microvascular and macrovascular complications in this condition. However, HbA1c is affected by non-glycaemic factors, while also failing to provide data on hypoglycaemic exposure and glucose variability, which are associated with adverse vascular outcomes. Continuous glucose monitoring (CGM)-derived glucose metrics provide a more comprehensive assessment of glycaemia, but their role in predicting future vascular complications remains unclear. Here, we present the protocol for a real-world cohort study, aiming to establish the relationship between CGM-derived glycaemic metrics and the incidence of macrovascular and/or microvascular complications in people with diabetes.

This cohort study will use data from all CGM new users (FreeStyle Libre system) in France who uploaded their glycaemic values onto the LibreView cloud-based system, linked with data from the French nationwide Système National des Données de Santé claims database. The study is expected to include a minimum of 70 000 individuals with diabetes with a first date of glucose data upload to the LibreView platform after 1 January 2018 and with a 6-year follow-up period. The primary outcomes are the first occurrence of new macrovascular or microvascular complications, analysed as a composite outcome and separately. Secondary outcomes will include all-cause mortality and hospital admissions for any cause. This longitudinal study will provide key data on the relationship between CGM-derived glycaemic metrics and micro/macrovascular complications in diabetes. This will have an impact on routine clinical practice by setting targets for the different glycaemic markers, based on robust outcome data, thus helping to optimise glucose management in diabetes.

The study data-collection protocol is approved by the French National Commission for Informatics and Liberties, including approval from the Comité Ethique et Scientifique pour les Recherches, les Etudes et les Evaluations dans le domaine de la Santé. This study complies with French and European regulations, including those relating to the General Data Protection Regulation. This study uses pseudonymous information, not requiring informed consent. Dissemination plans include full publication of the study outcomes in peer-reviewed journal(s) with open access and presentations at national and international diabetes and cardiovascular conferences.

This study aimed to evaluate the effects of autologous dendritic cell (DC) immunotherapy on clinical outcomes (glomerular filtration rate/GFR and urine creatinine albumin ratio/UACR) and endothelial dysfunction (ICAM, VCAM, VEGF) in patients with diabetic kidney disease (DKD). Endothelial dysfunction induced by inflammation is one of the key factors in the pathogenesis of DKD. In this one-group pretest-posttest quasi-experimental study, 69 subjects with DKD were administered a single dose of autologous DC immunotherapy ex vivo. UACR was measured at baseline and at weeks 1, 2, 3, and 4, while ICAM, VCAM, VEGF, and GFR were measured at baseline and at week 4 post-immunotherapy. The results showed a significant reduction in median UACR from 250 (IQR 71-668) mg/g at baseline to 164 (IQR 49-576) mg/g at week 4 (p < 0.05). GFR did not show any significant changes after immunotherapy. HbA1c (B = -33.270, p = 0.021) and baseline UACR (B = -0.185, p < 0.001) were identified as significant predictors of UACR change. Although there were no significant changes in ICAM, VCAM, and VEGF, subgroup analysis revealed a decrease in VCAM in macroalbuminuria patients and an increase in those with good glycemic control, suggesting differing endothelial responses. In conclusion, autologous DC immunotherapy effectively reduced UACR in DKD patients, and significant VCAM changes were found in macroalbuminuria and good glycemic control subjects. Further research is needed to understand the mechanisms behind UACR reduction and the long-term impact of this therapy.

No previous research has specifically investigated the relationship between postoperative glycemic variability (GV) and acute kidney disease (AKD) in patients undergoing cardiac surgery. In this study, several methods of modelling postoperative GV were used to examine the association between GV and AKD risk and subtypes of AKD.

We undertook a retrospective study involving a total of 8,090 adult patients from three academic medical centers in Eastern China who underwent cardiac surgery with cardiopulmonary bypass between 2015 and 2023. Seven-day postoperative GV was calculated using the standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE), average daily risk range (ADRR), and time out of target range (TOR). The primary focus was on the occurrence of AKD between 8 and 90 days post-surgery, which was further categorized into persistent AKD and delayed AKD depending on the acute kidney injury (AKI) status in the first 7 days.

During the 8-90 days postoperative period, AKD occurred in 522 out of 8,090 patients (6.5%). Seven-day postoperative GV was significantly and consistently higher in the AKD group (p<0.001 for each metric). After adjusting for relevant covariates, 7-day GV metrics were significantly associated with elevated AKD risk (standardized hazard ratio (SHR):1.20 (95% confidence interval (CI): (1.12 - 1.27) for SD; SHR: 1.30 (95% CI: 1.20 - 1.40) for TOR). GV was correlated with persistent AKD, while no statistically significant association was observed between GV and delayed AKD. Unique cutoff thresholds were calculated for each GV metric to provide a quantitative indicator of high GV, enhancing its practical utility.

Our study highlights the association between postoperative GV and increased AKD risk, and identifies specific GV thresholds in adults undergoing cardiac surgery.

With increasing prevalence of obesity and cardiovascular diseases, there is a growing interest in the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) as an adjunct therapy in type 1 diabetes (T1D). The GLP-1RAs are currently not approved by the US Food and Drug Administration for the treatment of T1D in the absence of randomized controlled trials documenting efficacy and safety of these agents in this population. The Diabetes Technology Society convened a series of three consensus meetings of clinicians and researchers with expertise in diabetes technology, GLP-1RA therapy, and T1D management. The project was aimed at synthesizing current literature and providing conclusions on the use of GLP-1RA therapy as an adjunct to automated insulin delivery (AID) systems in adults with T1D. The expert panel members met virtually three times on January 17, 2024, and April 24, 2024, and August 14, 2024, to discuss topics ranging from physiology and outcomes of GLP-1RAs in T1D to limitations of current sensors, algorithms, and insulin for AID systems. The panelists also identified research gaps and future directions for research. The panelists voted to in favor of 31 recommendations. This report presents the consensus opinions of the participants that, in adults with T1D using AID systems, GLP-1RAs have the potential to (1) provide effective adjunct therapy and (2) improve glycemic and metabolic outcomes without increasing the risk of severe hypoglycemia or diabetic ketoacidosis.