Gestational diabetes mellitus (GDM) affects 9-25% of pregnancies. Undiagnosed or poorly managed GDM is associated with both short- and long-term complications in the fetus and mother. The pathogenesis of GDM is complex and has not yet been fully elucidated. Several biomarkers found in maternal serum have the potential for the early diagnosis of GDM. The aim of this narrative review was to explore novel biomarkers that have not been comprehensively described in previous reviews. We believe these biomarkers may allow for the detection of GDM in the early stages of pregnancy, enabling timely proper treatment and potentially preventing complications for both the mother and the fetus.

In recent years, the increase of the post-transplantation diabetes mellitus (PTDM) after renal transplantation encourages people to do a lot of research on the disease. This paper conducted a bibliometric study on PTDM related literature to explore the risk factors of diabetes after kidney transplantation, as well as the current status, hotspots and development trends of PTDM research, so as to provide reference for researchers in related fields.

We searched the Web of Science Core Collection (WoSCC) database for PTDM literature from January 1, 1990, to August 20, 2023, and used VOSviewer, CiteSpace, and the R package 'bibliometrix' to do bibliometric analysis.

Obesity, 3 months after transplantation tacrolimus concentration >10 ng/mL, temporary hyperglycemia, delayed graft function, acute rejection is specific risk factors related to PTDM in renal transplant recipients. In addition, 74 countries led by China and the United States published 1546 papers, and the number of PTDM-related publications is increasing every year. Primary institutions included the University of California, Los Angeles, Mayo Clinic, University of Oslo, and University of Toronto. The Journal of Transplantation is the most widely read journal in the subject. The authors with the most published literature are Trond Jenssen and Adnan Sharif, and the most cited author is Kasiske BL. Expectations for continued growth in global PTDM research are increasingly high. Future studies will mainly focus on exploring the risk factors of PTDM and identifying new therapeutic approaches and targets.

Data on the association between the degree of platelet and coagulative-fibrinolytic variables abnormalities and the risk of in-hospital mortality in acute aortic dissection (AAD) are limited.

This multicentre retrospective cohort study included patients diagnosed with AAD by aortic computed tomographic angiography between 2010 and 2021 in five tertiary hospitals in China. The primary outcome was defined as all-cause mortality during hospitalization. Associations between platelet counts, coagulation-fibrinolytic parameters and all-cause in-hospital mortality were assessed using Cox proportional hazards regression models.

Among the 2567 participants, the median age was 54 years (interquartile range, IQR: 47-63); 531 (20.7%) were female, and the in-hospital mortality rate was 589 (23.0%). The Cox proportional hazards regression model indicated that lower platelet count, prothrombin activity (PTA), and fibrinogen levels and longer prothrombin time (PT) and thrombin time (TT) were linearly positively associated with an increased risk of in-hospital mortality (p < 0.05). A non-linear and positive association was confirmed between D-dimer levels and in-hospital mortality risk (p < 0.05). Additionally, a significant interaction between platelet counts and D-dimer levels was observed (p = 0.029). According to the subgroup analysis, compared to those in the reference group, those with thrombocytopenia (<140 × 109/L) and high D-dimer levels (>14.6 µg/mL) had a 3.59-fold increased risk of in-hospital mortality (HR, 3.59; 95% CI, 2.00-6.42).

Our analysis revealed associations between changes in platelet count, PT, PTA, TT, fibrinogen and D-dimer levels and outcomes in patients with AAD. Furthermore, the combined effect of thrombocytopenia and high D-dimer levels significantly increased the risk of in-hospital mortality.

Obesity is a major health problem associated with global metabolic dysfunction and increased inflammation. It is thus critical to identify the mechanisms underlying the crosstalk between immune cells and adipose tissue that drive cardiovascular and metabolic dysfunction in obesity. Expression of the kallikrein-related serine protease 7 (KLK7) in adipose tissue is linked to inflammation and insulin resistance in high fat diet (HFD)-fed mice. Here, we engineered mice with a macrophage-specific KLK7 knockout (KLK7MKO) to investigate how KLK7 loss impacts immune cell function and obesity-related pathology. Compared to control mice, we observed lower levels of systemic inflammation, with less infiltration and activation of inflammatory macrophages in HFD-fed KLK7MKO mice, particularly in the epididymal adipose tissue. Mechanistically, we uncover that Klk7 deficiency reduces pro-inflammatory gene expression in macrophages and restricts their migration through higher cell adhesion, hallmark features of macrophages in obese conditions. Importantly, through analyses of 1143 human visceral adipose tissue samples, we uncover that KLK7 expression is associated with pathways controlling cellular migration and inflammatory gene expression. In addition, serum KLK7 levels were strongly correlated with circulating inflammatory markers in a second cohort of 60 patients with obesity and diabetes. Our work uncovers the pro-inflammatory role of KLK7 in controlling inflammatory macrophage polarization and infiltration in visceral obesity, thereby contributing to metabolic disease. Thus, targeting KLK7 to control immune cell activation may dissociate adipose dysfunction from obesity, thereby representing an alternative obesity therapy.

Objective  Surgery is the first-line treatment in acromegaly but it takes months to confirm remission. It is crucial to determine remission early in order to inform the patient and plan further treatment options. We aimed to evaluate the predictors of remission at the early phase after endoscopic endonasal pituitary surgery in acromegaly patients. Methods  Fifty-four growth hormone (GH)-adenoma patients operated via pure endoscopic endonasal approach were analyzed in this observational study. We compared the basic clinical, radiological characteristics, and the preoperative and postoperative hormone levels in terms of remission according to current guidelines. Results  The surgical remission rate was 61.1%. When the patients were compared according to surgical remission, the age, gender, and immunohistochemical granulation type were found to be nonsignificant, while diabetes mellitus was more common (55.6 vs. 44.4%). The preoperative tumor volume (1.2 ± 0.9 vs. 4.1 ± 4.2 cm 3 ) and postoperative GH and insulin-like growth factor-1 (IGF-1) levels were higher in the nonremission group ( p  < 0.05). We defined a number of cut-off values of both GH and IGF-1 levels to predict remission at the postoperative phase. Age standardized regression analyses showed that postoperative day 1 (POD-1) GH levels (odds ratio [OR]: 8.9; 95% confidence interval [CI]: 1.99-40.0, p  = 0.004) and tumor volume (OR: 3.14; 95% CI: 1.09-9.0, p  = 0.034) were found to be significant independent predictors for remission. Conclusion  We demonstrated that tumor volume and POD-1 GH levels are independent predictors of remission in acromegaly patients operated via the pure endoscopic endonasal technique and may be used as an early marker of remission, and this may lead to taking adjuvant medical therapies early into account to improve prognosis.

Diabetic peripheral neuropathy (DPN) is a common complication of diabetes, particularly affecting the elderly and increasing their risk of falls due to impaired balance. This study investigates the effect of a multifactorial balance rehabilitation program on postural stability, fall risk, and quality of life in elderly individuals with DPN.

In a randomized controlled trial, 150 elderly participants (aged 60-80) diagnosed with DPN were enrolled. Comprehensive demographic data were collected, diabetic foot assessments were performed, and key outcome measures included postural sway parameters, fall risk, and quality of life. Participants were randomly assigned to two groups: the study group underwent a 12-week multifactorial balance rehabilitation program (3-5 days a week), while the control group received standard medical care and advice.

The study identified statistically significant improvements in postural sway parameters (AP sway Z = -3.16, ML sway Z = -2.20, COP length Z = -6.27, COP area Z = -2.25), a substantial reduction in fall risk (F (1, 134) = 263.42), and enhanced quality of life, as measured by physical health domain of WHOQOL-BREF (D1F (1, 134) = 3.94) and MDQoL 17 (F (1, 134) = 7.67), among the study group participants (p < .05).

Following the 12-week multifactorial balance rehabilitation program, participants in the study group demonstrated notable improvements in postural stability, reduced risk of falls, and improved quality of life compared to the control group.

Obesity is a complicated, multifactorial, and highly avoidable disease. There is a complicated relationship between type 2 diabetes mellitus (T2DM) and obesity. Surgical intervention is regarded as one of the greatest efficacious treatments for morbid obesity, where T2DM exhibits remarkable amelioration and remission. The objective of this work is to evaluate endogenous insulin by measuring postprandial C-peptide before and 6 months after LSG. We will also assess metabolic improvement, including remission of T2DM and prediabetes, 6 months after LSG. A total of 60 Egyptian patients, aged 18-60 years, with a body mass index (BMI) > 35, prediabetes, or type 2 diabetes, were recruited from bariatric outpatient clinics at Cairo University Hospitals. The study assessed the postprandial C-peptide, fasting blood sugar, HbA1C, and lipid profile before and 6 months following LSG. A significant improvement was observed in the metabolic profile in the form of reduction of BMI, HbA1c, lipid profile, and control of hypertension 6 months postoperatively. There was a significant reduction of postprandial C-peptide 6 months postoperatively. Fifty-five patients (91.7%) achieved complete remission of prediabetes and diabetes 6 months postoperatively, while 4 patients showed only improvement of diabetes and 1 patient in the prediabetic group did not achieve remission. In conclusion, LSG demonstrates encouraging outcomes in terms of metabolic profile enhancement, insulin resistance improvement as indicated by significant reduction in C-peptide level, remission of prediabetes and T2DM, and effective weight loss.

Paget's disease of the bone (PDB) is a metabolic bone disorder involving one or more skeletal sites. Cardiovascular diseases (CVDs) have been described in patients with PDB but have not been systematically analysed.

This study aimed to compare standard and advanced (speckle-tracking) echocardiographic parameters measured in patients with PDB and controls matched for age, weight, height and history of hypertension but without metabolic bone disorders.

This multicentre case-control study included all patients with PDB referred to the Federico II and Siena Universities, Italy, from March 2019 to October 2022. During the same time, we enrolled at least one control for each patient, matched for age, sex, body mass index (BMI) and history of hypertension.

Sixty-nine patients with PDB and 115 healthy controls were enrolled in this study. All patients with PDB were treated with zoledronic acid at the time of diagnosis. Compared with controls, on standard echocardiography, patients with PDB showed a high prevalence of aortic and mitral valve calcifications and/or sclerosis, reduced left ventricular (LV) ejection fraction, stroke volume, cardiac output, increased interventricular septum thickness, posterior wall thickness, LV mass index, relative wall thickness, relative diastolic wall thickness, E/e' ratio and systemic vascular resistance. Using speckle-tracking echocardiography, patients with PDB showed a lower global longitudinal strain and global myocardial work efficiency than controls. There was no relationship between the PDB activity and extent and severity of cardiac abnormalities.

Overall, the myocardial function and structure were impaired in patients with PDB. Additionally, PDB was associated with early subclinical myocardial damage.

Focusing on noncommunicable diseases in displaced Syrian populations and comparing it Jordanians can improve health outcomes, reduce suffering, and better integrate displaced individuals into broader public health strategies.

A secondary analysis was conducted to STEPs 2019 Survey done in Jordan, the total sample size was 5713 participants, where a multistage stratified clustered sampling was used for both Jordanian and Syrian aged between 18 and 69 years. The Chi-square test was used to compare character variables while T-test was used for continuous variables. A multivariate stepwise logistic regression model was used to identify the risk factors for hypertension (HTN), diabetes (DM), and hyperlipidemia (HLD). Significance was set to 0.05 and was adjusted for multiple comparisons.

Jordanians exhibit high rates of smoking (35.4%), and high salt intake (30.2%), while Syrians have lower vegetable intake (8%), were more involved in vigorous work-related activity (18.7%), and using active transportation (75.2%). HTN (50.2%), DM (12.3%) and HLD (84.5%) prevalence was higher in Jordanians. However, the HTN prevalence in displaced Syrians (46.6%) in this analysis was much higher than most recent reported numbers in literature prior to the war and DM (7.2%) was lower. HTN, DM, HLD and metabolic syndrome exhibited strong associations with demographic and lifestyle factors, where older age groups were more predisposed (p < 0.00). Both college and school education had lower odds from metabolic syndrome, (odds ratio [OR] = 0.29, 95% CI = 0.17-0.48), and (OR = 0.53, 95% CI = 0.37-0.76) respectively in both populations. Lower education was also associated with higher odds of HTN, DM, and dyslipidemia in Jordanian population only. DM had lower odds in men (vs. women) only in the Syrian population (OR = 0.68, 95% CI = 0.51-0.92). Rural residence had higher odds of HTN in both populations (OR = 1.24, 95% CI = 1.02-1.49). The use of active transportation has lower odds of MS and DM in both populations. Being active in leisure-or-work was positively associated with lower odds of MS in both populations. Jordanians showed higher odds of MS (OR = 1.48, 95%CI 1.15-1.89) and HDL compared to Syrians (OR = 1.29, 95% CI = 1.09-1.52).

The disease burden in Syrian refugees in Jordan is related to barriers to healthcare access and economic stability, lower awareness when to seek medical attention, and increasing stress levels, which all leads to disruption in the longitudinal care needed for NCD management. This necessitates tailored interventions to ensure accessibility and responsiveness to healthcare needs as the blame is not on displacement by itself given its effect cannot be proven.

Numerous studies have reported an association between neutrophils and type 2 diabetes mellitus (T2DM), although this relationship remains unclear.

To investigate the interaction of neutrophils and a dietary intervention on T2DM incidence after 60 months of follow-up.

A comprehensive analysis was conducted on the framework of the CORDIOPREV study, which included 462 patients without T2DM at the beginning of the study, randomly assigned to either a Mediterranean or a low-fat diet; 107 developed T2DM. Absolute neutrophil counts and neutrophil-related ratios were measured.

Kaplan-Meier curves showed that the lowest tertile of basal neutrophils was associated with a reduced likelihood of T2DM incidence when compared to the middle (hazard ratio [HR] = 0.499 [95% CI, 0.287-0.866]) and the highest tertiles (HR = 0.442 [95% CI, 0.255-0.768]) in the overall population, after adjusting for clinical variables. This association only remained significant in patients who followed a Mediterranean diet when comparing the lowest to the middle (HR = 0.423 [95% CI, 0.213-0.842]) and the highest tertiles (HR = 0.371 [95% CI, 0.182-0.762]). The predictive capacity yielded an AUC of 0.711 (95% CI, 0.652-0.769), with neutrophils being the most important variable in the in the model. Decrease in neutrophils over the 60 months was associated with increased insulin sensitivity index (R = -0.31; P = .019), particularly in patients who followed the Mediterranean diet.

These findings suggest that monitoring neutrophils can help prevent the development of T2DM, as a reduction in neutrophil counts could be associated with improved insulin sensitivity. Following a Mediterranean diet might be a potential strategy to reduce the incidence of T2DM by lowering neutrophil levels. Further research is necessary to gain a deeper understanding regarding this mechanism.

Non-alcoholic fatty liver disease (NAFLD), a metabolic liver disorder closely associated with obesity and diabetes, urgently requires early screening. This population-based study is the first to explore the relationship between glycemic control and a novel dyslipidemia composite index-the glycated hemoglobin/high-density lipoprotein cholesterol (HbA1c/HDL-C) ratio in individuals with NAFLD and liver fibrosis.

Data from 5,891 adults in the 2017-2020 National Health and Nutrition Examination Survey (NHANES) were analyzed. Binary logistic regression and restricted cubic spline (RCS) analyses were used to evaluate the association between HbA1c/HDL-C ratio and the risk of NAFLD and liver fibrosis. The reliability of the results was confirmed using subgroup, interaction, and sensitivity analyses. Screening performance was assessed using receiver operating characteristic (ROC) curves, and differences between various indicators were compared using the DeLong test.

After adjusting for confounding factors, each 1% increase in the HbA1c/HDL-C ratio was associated with a 20% higher risk of NAFLD (odds ratio [OR] = 1.20, 95% confidence interval [CI]: 1.14-1.27, P < 0.001). Sensitivity analyses confirmed the robustness of these findings (P < 0.001). However, the associations with liver fibrosis (P = 0.064) and moderate-to-severe liver fibrosis (P = 0.130) were not statistically significant. Participants in the highest HbA1c/HDL-C quartile had significantly higher odds of NAFLD than those in the lowest quartile (OR = 2.21, 95% CI: 1.74-2.79). RCS analysis revealed a non-linear positive correlation between the HbA1c/HDL-C and NAFLD risk (P for non-linear = 0.003). Subgroup and interaction analyses showed that this association was more pronounced in the non-diabetic population. The ROC curve yielded an AUC of 0.713 for NAFLD screening.

In U.S. adults, the HbA1c/HDL-C appears to be an effective tool for NAFLD screening. As a novel composite index, it also holds considerable reference value for identifying NAFLD risk in the non-diabetic population.

Sex differences in the life course development of brachial blood pressure (Bi et al. N Engl J Med, 2024. https://doi.org/10.1056/NEJMoa2412006 ) and the association between brachial and central BP are well documented.

To explore if the associations of brachial and central BP with the presence of increased arterial stiffness differ between older women and men.

Data from 1135 women and 943 men aged 68 in the Hordaland Health Study were used. Brachial BP was categorised as normal (BP< 130/85 mmHg), high-normal (BP 130-139/85-89 mmHg) or hypertension (BP≥140/90 mmHg). Arterial stiffness was assessed from carotid-femoral pulse wave velocity (cfPWV), and central systolic BP from brachial pulse wave analysis. Sex-specific associations between BP and increased arterial stiffness (cfPWV >10 m/s) were tested in logistic regression analyses and reported as odds ratio (OR) and 95% confidence intervals (CI).

In multivariable analyses, both hypertension and high-normal BP were more strongly associated with presence of increased arterial stiffness in women (OR 5.81 [95% CI 3.86-8.75] and OR 2.56 [95% CI 1.43-4.56], respectively) compared to men (OR 2.56 [95% CI 1.43-4.56] and OR 2.01 [95% CI 1.22-3.33], both p for sex-interaction <0.05). Additionally, central systolic BP showed a stronger association with increased arterial stiffness in women (OR 1.06 [95% CI 1.05-1.07]) than in men (OR 1.05 [95% CI 1.04-1.06], p for sex-interaction <0.05).

In 68-year-old individuals, a high normal BP, hypertension and higher central systolic BP were all more strongly associated with the presence of increased arterial stiffness in women than in men.

The Data-Driven Fasting (DDF) app implements glucose-guided eating (GGE), an innovative dietary intervention that encourages individuals to eat when their glucose level, measured via glucometer or continuous glucose monitor, falls below a personalized threshold to improve metabolic health. Clinical trials using GGE, facilitated by paper logging of glucose and hunger symptoms, have shown promising results.

This study aimed to describe user demographics, app engagement, adherence to glucose monitoring, and the resulting impact on weight and glucose levels.

Data from 6197 users who logged at least 2 days of preprandial glucose readings were analyzed over their first 30 days of app use. App engagement and changes in body weight and fasting glucose levels by baseline weight and diabetes status were examined. Users rated their preprandial hunger on a 5-point scale.

Participants used the app for a median of 19 (IQR 9-28) days, with a median of 7 (IQR 3-13) weight entries and 52 (IQR 25-82) glucose entries. On days when the app was used, it was used a median of 1.8 (IQR 1.4-2.1) times. A significant inverse association was observed between perceived hunger and preprandial glucose concentrations, with hunger decreasing by 0.22 units for every 1 mmol/L increase in glucose (95% CI -0.23 to -0.21; P<.001). Last observation carried forward analysis resulted in weight loss of 0.7 (95% CI -0.8 to -0.6) kg in the normal weight category, 1 (95% CI -1.1 to -0.9) kg in the overweight category, and 1.2 (95% CI -1.3 to -1.1) kg in the obese category. All weight changes nearly doubled when analyzed using a per-protocol (completers) analysis. Fasting glucose levels increased by 0.11 (95% CI 0.09-0.12) mmol/L in the normal range and decreased by 0.14 (95% CI -0.16 to -0.12) mmol/L in the prediabetes range and by 0.5 (95% CI -0.58 to -0.42) mmol/L in the diabetes range. Per-protocol analysis showed fasting glucose reductions of 0.26 (SD 4.7) mg/dL in the prediabetes range and 0.94 (16.9) mg/dL in the diabetes range.

The implementation of GGE through the DDF app in a real-world setting led to consistent weight loss across all weight categories and significant improvements in fasting glucose levels for users with prediabetes and diabetes. This study underscores the potential of the GGE to facilitate improved metabolic health.

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.

The complex relationship between obesity and dyslipidemia in type 2 diabetes mellitus (T2DM) remains an area of interest but is not fully understood. This study aimed to evaluate the intricate links between atherogenic index of plasma (AIP), body mass index (BMI), and T2DM risk.

Based on data from the China Health and Retirement Longitudinal Study, this analysis comprised 6754 individuals aged 45 and over, free of T2DM in 2011. BMI and AIP were the exposures, with T2DM incidence as the primary focus. Logistic regression models generated odds ratios (ORs), and a thorough decomposition of BMI's impact on T2DM revealed natural indirect and direct effects. The study also examined the complex interactions and combined effects of these two exposures.

By the end of 2018, 972 individuals were diagnosed with T2DM. The AIP played a significant association in the relationship between BMI and T2DM, explaining 21.7% and 18.9% of the association in different BMI ranges. A significant additive effect was observed between BMI and AIP, with a relative excess risk due to interaction of 0.62. BMI ≥ 24.0 kg/m2 and AIP above the median together conferred the highest risk of T2DM, with an OR of 2.31 and a 95% confidence interval (CI) of 1.92-2.79.

Exposure to overweight/obesity or high AIP raises T2DM risk among Chinese ≥ 45 years, AIP partly mediates BMI-T2DM link.

To examine the associations between glucose levels from the antepartum 100 g oral glucose tolerance test (OGTT) and the 6-week postpartum 75 g oral glucose tolerance test (OGTT) and fatty liver disease (FLD) at 1 year postpartum in women with a history of gestational diabetes mellitus (GDM).

A prospective cohort study.

A tertiary hospital centre in Bangkok, Thailand.

A total of 130 women with a history of GDM who underwent liver fat assessment at 1 year postpartum.

FLD and metabolic dysfunction-associated steatotic liver disease were assessed at 1 year postpartum, with diagnosis based on transient elastography and specific cardiometabolic criteria. The associations between OGTT glucose values and FLD were evaluated using logistic regression models, adjusted for potential confounders, including age, pre-pregnancy weight, weight and waist circumference at 1 year postpartum and exclusive breastfeeding. Receiver operating characteristic analyses were also conducted to assess the predictive performance of glucose parameters from antepartum and postpartum OGTTs.

A total of 44 participants (33.8%) were diagnosed with FLD, with 97.7% meeting metabolic dysfunction-associated steatotic liver disease criteria. Elevated fasting plasma glucose levels during pregnancy (adjusted odds ratio (aOR): 1.49; 95% CI: 0.93 to 3.57), in the early postpartum period (aOR: 1.77; 95% CI: 0.92 to 5.05), or across both periods combined (aOR: 2.16; 95% CI: 0.93 to 7.41) were not independently associated with FLD. In contrast, four abnormal glucose values during pregnancy (aOR: 2.53; 95% CI: 1.03 to 7.87) and two abnormal values on the 6-week postpartum 75 g OGTT (aOR: 2.95; 95% CI: 1.06 to 11.20) were independently associated with FLD. The combined presence of abnormal OGTT values from both periods showed the strongest association with FLD (aOR: 3.04; 95% CI: 1.03 to 13.99), demonstrating high specificity (95.3%) but low sensitivity (13.6%).

Elevated glucose levels from the antepartum 100 g OGTT and the 6 week postpartum 75 g OGTT were associated with FLD at 1 year postpartum in women with a history of GDM. Comprehensive glucose monitoring during and after pregnancy may aid early identification of individuals at higher risk.

Thai Clinical Trials Registry: Registration no. TCTR20211027007. Date of registration: 27 October 2021. Date of initial participant enrolment: 1 November 2021.

Introduction: Hyperinsulinemia and insulin resistance are strong predictors of cardiometabolic diseases, which disproportionately affect individuals across gender, racial/ethnic, and socioeconomic groups. We aim to estimate and test the temporal trends in the prevalence of hyperinsulinemia and insulin resistance (IR) by sociodemographic groups among nondiabetic adults in the United States from 1999 to 2018. Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. We fitted linear and joinpoint logistic regression models to test the sample weighted and age-standardized time trends for linear and nonlinear trends in the prevalence of hyperinsulinemia and IR, respectively. Results: We included 17,310 nondiabetic men and nonpregnant women aged 20 years or older. The age-standardized prevalence of hyperinsulinemia increased from 28.2% in 1999-2000 to 41.4% in 2017-2018, with IR prevalence similarly rising from 24.8% in 1999-2000 to 38.4% in 2017-2018. Across the entire period examined, individuals who were male; non-Hispanic Black; Hispanic; or had a lower educational level or lower family income consistently had a higher prevalence of hyperinsulinemia and IR than other groups. We found increasing temporal trends in the prevalence of hyperinsulinemia and IR for all the sociodemographic subgroups, at least in some periods from 1999 to 2018. Conclusions: There was an increased age-standardized prevalence of hyperinsulinemia and IR among nondiabetic adults in the US across each defined sociodemographic group from 1999 to 2018. The difference in prevalence across subgroups underscores the need for designing personalized and targeted interventions to address disparities.

One in two people with diabetes in sub-Saharan Africa remains undiagnosed, which has contributed to the region's high rates of diabetes-related morbidity and mortality. While the COVID-19 pandemic likely exacerbated diabetes prevalence, limited data from the region, including Uganda, hampers our understanding of this impact. To address this gap, we analysed the diabetes prevalence and correlates among adults from three rural districts of Uganda using data from a community-based screening programme conducted by community health workers (CHWs) during the pandemic.

We used anonymised data of 2587 records to analyse the prevalence and correlates of diagnosed and undiagnosed diabetes. Prevalence was presented as proportions with 95% CIs. Correlates of diabetes and undiagnosed diabetes prevalence were analysed using logistic regression and presented as ORs.

The overall prevalence of diabetes was 11.3% (95% CI 10.2 to 12.5%), with a 7.2% (95% CI 6.2 to 8.1%) prevalence for diagnosed diabetes. A high proportion (36.4%) of diabetes cases were undiagnosed. Older age, high body mass index and pre-existing hypertension were associated with high diabetes prevalence.

There was a high proportion of undiagnosed diabetes among rural adults during the pandemic. Engaging CHWs in routine diabetes screening and awareness programmes can reduce the burden of undiagnosed diabetes.

The association between apolipoprotein B (apoB) and residual cardiovascular (CV) risk in patients with chronic coronary syndrome (CCS) remains unclear. We aimed to investigate the association between apoB levels and CV outcomes in statin-treated CCS patients.

We enrolled 8641 statin-treated CCS patients at Fuwai Hospital. The patients were divided into 5 groups based on to apoB quintiles (Q1 to Q5). The primary endpoint was 3-year CV events, including CV death, nonfatal myocardial infarction, and nonfatal stroke.

During a median follow-up of 3.17 years, there were 232 (2.7%) CV events. After multivariable adjustment, a restricted cubic spline illustrated a J-shaped relationship between apoB levels and 3-year CV events, with the risk remaining flat until apoB levels exceeded 0.73g/L, after which the risk increased (nonlinear P <.05). Kaplan-Meier curves showed the lowest CV event rate in the Q3 group (0.68-0.78g/L). Compared with the Q3 group, multivariable Cox regression models revealed that both low (Q1, ≤0.57g/L) and high (Q5, >0.93g/L) apoB levels were associated with an increased risk of major adverse cardiac events (all P <.05). Notably, patients with low apoB levels (Q1) had the highest risk of CV death (HR, 2.44; 95%CI, 1.17-5.08).

Our analysis indicates that both low and high levels of apoB are associated with elevated CV risk, with the risk being particularly pronounced at higher levels (> 0.73g/L).

The goal of this study was to explore the complex relationship between obesity, dietary content, weight loss, and cortisol concentrations in postmenopausal women with overweight and obesity.

Women completed basal cortisol testing, a dexamethasone suppression test (DST), DXA scan, 3-hour oral glucose tolerance test (OGTT), and food records before (n = 60) and a subset after 6-months of weight loss (WL; n = 15) or aerobic exercise training+weight loss (AEX+WL, n = 34).

At baseline, plasma cortisol concentrations decreased significantly after DST in the entire group, a 54% suppression which was associated with basal glucose. Basal glucose levels and glucose AUC from the OGTT are associated with basal cortisol levels (r = 0.44 and r = 0.29, p < 0.05 respectively). The intervention resulted in significant weight loss (-8%) but no significant changes in basal cortisol or changes in cortisol from basal to DST were observed.

Additional research is necessary to better comprehend cortisol regulation in postmenopausal women particularly in response to effective weight reduction interventions.

The study aims to explore the relationship between serum uric acid (UA) levels in the first trimester and pregnancy outcomes.

The clinical data of 1381 pregnant women who delivered in the Department of Obstetrics and Gynecology of Beijing Chao-Yang Hospital from June 2021 to July 2022 were collected. All patients were categorized into four groups (Q1-Q4) according to quartiles of UA, using the first quartile of UA as the reference group. Logistic regression analysis was used to observe the correlation between UA and pregnancy outcomes. Restricted cubic spline (RCS) was drawn to observe the dose-response relationship between UA and pregnancy outcomes.

The numbers of GDM patients in Q1-Q4 were 40 (11.70%), 46 (13.49%), 60 (17.29%) and 83 (23.65%), respectively (p < 0.001). Logistic regression analysis showed that higher quartiles of UA were significantly associated with an increased prevalence of gestational diabetes mellitus (GDM). After adjusting for confounding factors (maternal age, prepregnancy BMI, gestational weight gain, and gestational age), compared with the lowest quartile of UA, the highest quartile of UA had 2.06 times odds of GDM (OR, 2.06; 95% CI, 1.34, 3.18; p = 0.001) in Q4. RCS suggested that the risk of GDM increased slowly until UA levels reached 219.43 µmol/L and then began to increase rapidly afterward (overall p = 0.0037).

Increased uric acid concentrations in the first trimester are associated with an increased risk of GDM and gestational hypertension.

Previous evidence suggests that infectious diseases may contribute to the development of neurodegenerative diseases (NDDs) while individuals with hyperglycemia may be at increased risk for both infection and NDDs due to dysregulated inflammation levels. This study aimed to examine the association between hospital-treated infectious diseases and the risk of NDDs among patients with prediabetes and diabetes and whether the associations differed by the number of infections and potential effect modifiers.

Using data from the UK Biobank, we conducted a prospective study involving 69,731 individuals, consisting of 48,149 participants with prediabetes and 21,582 participants with diabetes. Hospital-treated infectious diseases and NDDs were identified through record linkage to Health Episode Statistics and the Scottish Morbidity Records. Cox regression models were applied to assess the association between hospital-treated infectious diseases and the risk of developing NDDs, and to evaluate the trend of this association in relation to the number of infections. The modification effects by age, sex, smoking status, alcohol consumption, sleep duration, body mass index (BMI), glycated hemoglobin (HbA1c) levels, comorbidities, and diabetes medication use were investigated.

Over a median follow-up of 10.75 years, 1,867 participants (2.57 per 1,000 person-years) were diagnosed with NDDs. We found hospital-treated infectious diseases were significantly associated with an increased risk of NDDs among both individuals with prediabetes or diabetes (adjusted HR [aHR] 3.11, 95 % CI 2.83-3.42). Specifically, hospital-treated infectious diseases were associated with a higher risk of developing Alzheimer's disease, vascular dementia, all-cause dementia, Parkinson's disease, and multiple sclerosis. Moreover, a greater number of infection diagnoses was associated with a higher risk of NDDs. Consistent associations between infection and an increased risk of NDDs were observed, regardless of factors representing age, sex, lifestyle, and diabetes severity.

Hospital-treated infectious diseases were significantly associated with the risk of NDDs in individuals with diabetes and prediabetes, with similar associations observed for bacterial and viral infections. These findings emphasize the importance of implementing infection prevention strategies and monitoring of infectious comorbidities in the management of NDDs among patients with prediabetes and diabetes.

Pancreas transplantation (PT) is a definitive treatment for diabetes mellitus (DM), restoring endogenous insulin secretion and improving glycemic control. Despite its efficacy, PT is less common in South Korea compared to Western nations. This study aims to report the clinical outcomes of PT over 2 decades at a single center, focusing on surgical techniques, complications, and graft survival.

A retrospective analysis of 69 PT recipients at Seoul National University Hospital between January 2002 and December 2023 was conducted. Data on recipient and donor demographics, surgical details, immunosuppressive regimens, and graft outcomes were collected. Graft survival was evaluated using Kaplan-Meier analysis, with subgroup comparisons using the log-rank test. Graft failure was defined as graft removal, PT re-registration, insulin dependence exceeding 0.5 units/kg/day for more than 90 days, or patient death.

Among the 69 recipients, 50 (72.5%) had type 1 DM, and 18 (26.1%) had type 2 DM. Simultaneous pancreas-kidney (SPK) transplantations comprised 84.1% (n = 58), and pancreas-after-kidney (PAK) transplantations accounted for 10.1%. The 1-year and 5-year death-censored pancreas graft survival rates were 92.7% and 89.6%, respectively, with no significant difference between SPK and PAK (P = 0.330). Graft failure occurred in 10 patients, primarily due to pancreatitis and rejection. Donor-related factors, particularly anoxic brain injury, were significantly associated with lower graft survival (P = 0.045).

PT outcomes in this cohort align with international standards, emphasizing the importance of donor selection and tailored immunosuppression. Expanding PT indications to include selective type 2 DM patients could benefit South Korea's PT programs with adequate resource allocation.

Personal care products frequently contain endocrine disrupting chemicals (EDCs) including parabens and phthalates, which can alter glucose metabolism. The postpartum period is a time of rapid metabolic change, but whether EDC-associated product use impacts postpartum glucose metabolism is unknown.

We included 270 participants from the Boston, MA-based Environmental Reproductive and Glucose Outcomes (ERGO) pregnancy cohort with data on self-reported personal care product use at ≤4 pregnancy visits (median: 11, 19, 26, 36 weeks of gestation) and 1 postpartum visit (median: 9 weeks). We quantified postpartum hemoglobin A1c (HbA1c), fasting insulin, fasting- and 2-h glucose post-75-g oral glucose tolerance test, and calculated homeostatic model assessment for insulin sensitivity (HOMA2-S) and beta-cell function (HOMA2-B). Using covariate-adjusted linear regression, we estimated visit-specific associations of product use with postpartum glycemic outcomes.

Associations of product use with postpartum glycemic measures were mixed. Users of certain hair products had lower postpartum insulin sensitivity compared to non-users (e.g., Visit1 hair gel/spray: 22.8% difference [95% CI: 39.2, -1.9] in mean HOMA2-S). Conversely, users of products like deodorant, liquid- and bar soap, had higher insulin sensitivity and lower glucose levels (e.g., postpartum deodorant: 32.1% difference [95% CI: 7.0, 63.1] in mean HOMA2-S; -3.1 mg/dL [95% CI: 6.3, -0.04] mean fasting glucose). Associations with other products were inconsistent across timepoints or null.

Use of certain personal care products during the perinatal period was associated with altered postpartum glucose metabolism. Larger studies are needed to understand the impacts of product use patterns on glycemic outcomes.

Aims: Identifying participants with type 2 diabetes (T2D) based only on electronic health record (EHR) or self-reported data has limited accuracy. Therefore, the objective of the study was to develop an algorithm using EHR and self-reported data to identify participants with and without T2D. Methods: We included participants enrolled in the Mayo Clinic Biobank. At enrollment, participants completed a baseline questionnaire on health conditions, including T2D, and provided access to their EHR data. T2D status was based on self-report and EHR data (International Classification of Diseases codes, hemoglobin A1c [HbA1c], plasma glucose, and glucose-regulating medications) within 5 years prior to and 2 months after enrollment. Participants who self-reported T2D but lacked corroborating EHR data were categorized separately ("only self-reported T2D"). After identifying participants with T2D, we identified participants without T2D based on normal HbA1c and plasma glucose. Participants who self-reported the absence of T2D but lacked corroborating EHR data were categorized separately ("only self-reported no T2D"). Using manual chart reviews (gold standard), we calculated the positive and negative predictive values (NPV) to identify T2D. Results: Of 57,000 participants, the algorithm classified participants as having T2D (n = 6,238), no T2D (n = 38,883), "only self-reported T2D" (n = 757), and "only self-reported no-T2D" (n = 9,759). The algorithm had a high positive predictive value (96.0% [91.5%-98.5%]), NPV (100% [98.0%-100%]), and accuracy (99.5% [98.3%-99.8%]). Participant age (median [range]) ranged from 52 (18-98) years (only self-reported T2D) to 67 (19-99) years (T2D) (P < 0.0001), and the proportion of women ranged from 45.3% (T2D) to 69.6% (only self-reported no T2D) (P < 0.0001). Most participants were of the White race (84.0%-92.7%) and non-Hispanic ethnicity (97.6%-98.6%). Conclusions: In this study, we developed an algorithm to accurately identify participants with and without T2D, which may be generalizable to cohorts with linked EHR data.

The effects of per- and polyfluoroalkyl substances (PFASs) on type 2 diabetes (T2D) remain unclear. We aimed to explore the effects of PFASs exposure on glucose metabolism disorders in older adults. We enrolled 704 elderly individuals aged over 65 years from Wuhan, China. Plasma concentrations of 12 PFASs were measured using liquid chromatography-mass spectrometry. Generalized linear models and quantile-based g computation (qgcomp) were employed to evaluate the effects of individual and combined PFAS exposures on T2D risk. Additionally, a meta-analysis was conducted to consolidate findings reported in the literature for validation purposes. The detection rate of all 12 PFASs exceeded 80%, with median concentrations ranging from 0.01 to 15.22 ng/mL. Single exposure analysis revealed an inverse association between perfluorododecanoic acid (PFDoA) and impaired fasting glucose (IFG), as well as between PFDoA, perfluoroundecanoic acid (PFUdA), perfluorodecanoic acid (PFDA), perfluorononanoic acid (PFNA), and perfluorooctanoic acid (PFOA) and T2D risk (P < 0.05). Quantile-based g-computation analysis showed an inverse association between the PFAS mixture and IFG and T2D risk, although these associations lacked statistical significance. PFDA exhibited the greatest weight in the negative associations with IFG and T2D. Meta-analysis demonstrated an inverse association between PFDA and PFUdA and T2D risk, and PFOA demonstrated an inverted U-shaped nonlinear dose-response relationship with the risk of T2D (Pnonlinear = 0.026). The potential impact of PFAS exposure on glucose metabolism merits attention, underscoring the need for a thorough comprehension of the biological mechanisms underlying PFAS-mediated metabolic effects to facilitate precise risk assessment.

Type 1 diabetes is categorised into autoantibody positive and autoantibody negative. Most type 1 diabetes research has focused on European populations, leaving a gap in understanding in relation to other ethnic groups, including Thai populations. This lack of data is significant given Thailand's poor prevention and therapeutic management strategies. We aimed to investigate the frequency and distribution of islet autoantibodies among Thai individuals with long-standing type 1 diabetes diagnosed before the age of 30 years.

We conducted a nationwide population-based study involving 48 hospitals in Thailand from May 2020 to September 2023, enrolling 953 participants. Demographic and clinical characteristics of individuals with autoantibody-positive and -negative type 1 diabetes were analysed. The autoantibodies GAD65, IA-2 and ZnT8 were measured using ELISA. A random C-peptide level was detected by electrochemiluminescence immunoassay.

Thai individuals with autoantibody-negative type 1 diabetes comprised 34.2% of the population. Among all individuals, the frequency of GAD65, IA-2 and ZnT8 was 56%, 37% and 33%, respectively. Autoantibody-negative individuals with type 1 diabetes were older at diagnosis, had higher BMI and had higher random C-peptide levels compared with autoantibody-positive individuals with type 1 diabetes. Female individuals had a higher prevalence of type 1 diabetes than male individuals (58% vs 42%; p=1.531 × 10-5). The southern region of Thailand exhibited a distinct pattern of autoantibody frequency compared with other regions (p=0.0001561).

The frequency, distribution and characteristics of autoantibody-positive and -negative long-standing type 1 diabetes in Thailand showed uniqueness from other populations. This provides insight into the disease that may have implications for type 1 diabetes prediction, treatment and pathogenesis, especially in the Southeast Asian population.

To investigate the predictive value of the biliverdin reductase-A (BVR-A) and the homeostasis model assessment for insulin resistance (HOMA-IR) on mild cognitive impairment (MCI) in patients with type 2 diabetes mellitus, and to establish a nomogram model.

This study included 140 patients with type 2 diabetes mellitus. Based on Montreal Cognitive Assessment (MoCA) scores, participants were categorized into the normal cognitive function (T2DM-NCF) group (65 cases) and the mild cognitive impairment (T2DM-MCI) group (75 cases). Multivariate logistic regression analysis was performed to identify the factors associated with MCI in patients with type 2 diabetes mellitus. A nomogram prediction model was developed using R software for the selected factors, and its predictability and accuracy were verified.

Compared with the T2DM-NCF group, subjects with MCI were older, had a longer duration of diabetes, higher HOMA-IR, lower BVR-A, lower cognitive scores, and lower education levels (all P < 0.05). Multivariate logistic regression analysis showed that duration of diabetes (OR = 1.407, 95% CI: 1.163-1.701), HOMA-IR (OR = 1.741, 95% CI: 1.197-2.53), and BVR-A (OR = 0.528, 95% CI: 0.392-0.712) were significantly associated with the development of MCI in patients with type 2 diabetes mellitus. The C-index of the nomogram was 0.863 (95% CI: 0.752-0.937).

Our findings suggest that BVR-A and HOMA-IR are significantly associated with the development of MCI in patients with type 2 diabetes mellitus. The nomogram incorporating BVR-A and HOMA-IR aids in predicting the risk of developing MCI in these patients.

Low muscle mass (LMM) is a critical complication in patients with obesity and diabetes, exacerbating metabolic and cardiovascular risks. Novel obesity indices, such as the body roundness index (BRI), conicity index, and relative fat mass, have shown promise for assessing body composition. This study aimed to investigate the associations of these indices with LMM and to develop machine learning models for accurate and accessible LMM prediction.

Data from NHANES 2011-2018 (n = 2,176) were analyzed. Obesity was defined by body fat percentage, and LMM was determined using skeletal muscle mass index thresholds adjusted for BMI. Predictive models were developed using logistic regression, random forest, and other algorithms, with feature selection via LASSO regression. Validation included NHANES 2005-2006 data (n = 310). Model performance was evaluated using AUROC, Brier scores, and SHapley Additive exPlanations (SHAP) for feature importance.

BRI was independently associated with LMM (odds ratio 1.39, 95% confidence interval 1.22-1.58; P < 0.001). Eight features were included in the random forest model, which achieved excellent discrimination (AUROC = 0.721 in the validation set) and calibration (Brier score = 0.184). Feature importance analysis highlighted BRI, creatinine, race, age, and HbA1c as key contributors to the model's predictive performance. SHAP analysis emphasized BRI's role in predicting LMM. An online prediction tool was developed.

BRI is a significant predictor of LMM in patients with obesity and diabetes. The random forest model demonstrated strong performance and offers a practical tool for early LMM detection, supporting clinical decision-making and personalized interventions.

Previous studies on the relationship between serum uric acid to serum creatinine ratio (SUA/SCr) and stroke have shown inconsistent results. This study investigates the association between SUA/SCr and stroke risk using data from the National Health and Nutrition Examination Survey (NHANES).

A cross-sectional analysis was conducted using NHANES data from 1999 to 2018. Weighted univariate and multivariate logistic regression models were used to evaluate the association between SUA/SCr and stroke. The restricted cubic spline (RCS) curve was used to explore the nonlinear relationship between SUA/SCr and stroke risk.

In the regression model adjusted for all covariates, the OR (95% CI) for the association between SUA/SCr and stroke was 0.84 (0.78, 0.92), indicating a significant association between SUA/SCr and stroke risk. When SUA/SCr was analyzed as a categorical variable by quartiles, participants in the highest SUA/SCr quartile (Q4) had a 53% lower risk of stroke compared to those in the lowest quartile (Q1), with an OR (95% CI) of 0.47 (0.31, 0.71). RCS analysis revealed a nonlinear relationship between SUA/SCr and stroke risk (nonlinearity p = 0.048). Before the nonlinear inflection point (6.33), stroke risk significantly decreased as SUA/SCr increased. After this point, the decrease in stroke risk with increasing SUA/SCr slowed down markedly.

Our study indicates that higher SUA/SCr levels are associated with a lower risk of stroke. However, further prospective longitudinal studies are required to establish the causal relationship and explore the potential role of SUA/SCr in stroke risk assessment and prevention strategies.

Steroid-induced diabetes mellitus (SDM) is a common complication in patients with nephrotic syndrome (NS) undergoing steroid therapy. Effective blood glucose control is critical for improving outcomes in these patients. This study evaluates the impact of mobile educational platforms on blood glucose control and patient adherence in patients with NS combined with SDM.

A randomised controlled study was conducted involving 56 patients with NS and SDM at Shanxi People's Hospital between April 2019 and December 2020. Participants were recruited using convenient sampling and were randomly assigned to either the intervention group (n = 28) or the control group (n = 28). The control group received routine health management, whereas the experimental group was provided with health management via a mobile educational platform. Blood glucose levels (fasting glucose and postprandial blood glucose), self-management efficacy and patient adherence to treatment were assessed over a 6-month period.

The 56 participants included in the study had a mean age of 69.0 ± 10.5 years and an average diabetes duration of 7.2 ± 3.5 years. At the end of 6 months, the intervention group showed significant reductions in fasting blood glucose and postprandial blood glucose levels (P < 0.001). Self-management efficacy, assessed using the Diabetes Self-Efficacy Scale, improved significantly post-intervention (4.42 ± 0.53 vs. 4.15 ± 0.56, P = 0.020). Additionally, patient adherence to treatment improved by 25% in the intervention group compared with the control group.

The use of mobile educational platforms significantly resulted in better glycemic control and treatment adherence in the patients with NS and SDM compared to the control group. These findings suggest that integrating mobile health technologies into routine care can enhance disease management and optimise outcomes.

The study was retrospectively registered "ISRCTN23135945" on 05/11/2024.

Obesity, characterized by excess body fat, has been recognized as one of the main global health problems of the current times. This article, based on the data from the Cohort study of risk factors for non-communicable diseases in Indonesia (FRPTM), aims to analyze the food consumption patterns and their association with the risk of obesity and related non-communicable diseases (NCDs) in the Indonesian population.

The article presents data collected from 867 respondents aged 25 years and above observed for 5 years: 2011, 2013, 2015, 2017 and 2019. It includes sociodemographic characteristics, consumption (1 × 24-h recall), anthropometry, and biomedical data (lipid profile, blood glucose, blood pressure).

The study identified cereals as the food group consumed in the largest amount and the largest contributor to energy, protein, carbohydrates and fiber intake. The fats and oils group exceeded the recommended intake, while vegetable and fruit consumption, and consequently the fiber intake, were far below the recommendations. The energy and macronutrient intake, and the percentage of respondents with excessive intake levels, were consequently increasing during the studied years. The consumption patterns were associated with the incidence of obesity, which increased from 43.9% in 2011 to 69.9% (central obesity) and 67.9% (BMI-based obesity) in 2019.

The dynamics of the consumption patterns clearly impacted the obesity prevalence. At the same time, the NCDs biomarkers measured remained relatively stable despite increasing obesity and macronutrient intake over the study period. The study provides important insights into diet-related risks for obesity in Indonesia, with a potential to inform public health policies and relevant intervention strategies.

Digital health interventions (DHIs) have rapidly evolved and significantly revolutionized the health care system. The quadruple aims of health care (improving population health, enhancing consumer experience, enhancing health care provider [HCP] experience, and decreasing health costs) serve as a strategic guiding framework for DHIs. It is unknown how DHIs can impact the burden of type 2 diabetes mellitus (T2DM), as measured by the quadruple aims.

This study aimed to systematically review the effects of DHIs on improving the burden of T2DM, as measured by the quadruple aims.

PubMed, Embase, CINAHL, and Web of Science were searched for studies published from January 2014 to March 2024. Primary outcomes were the development of T2DM, hemoglobin A1c (HbA1c) change, and blood glucose change (dysglycemia changes). Secondary outcomes were consumer experience, HCP experience, and health care costs. Outcomes were mapped to the quadruple aims. DHIs were categorized using the World Health Organization's DHI classification. For each study, DHI categories were assessed for their effects on each outcome, categorizing the effects as positive, negative, or neutral. The overall effects of each DHI category were determined by synthesizing all reported positive, neutral, or negative effects regardless of the number of studies supporting each effect. The Cochrane risk-of-bias version 2 (RoB 2) tool for randomized trials was used to assess the quality of randomized controlled trials (RCTs), while the ROBINS-I (risk of bias in nonrandomized studies of interventions) tool was applied for nonrandomized studies.

In total, 53 papers were included. For the T2DM development outcome, the effects of DHIs were positive in 1 (1.9%) study and neutral in 9 (17%) studies, and there were insufficient data to assess in 4 (7.5%) studies. For the dysglycemia outcome, the effects were positive in 23 (43.4%) studies and neutral in 24 (45.3%) studies, and there were insufficient data in 6 (11.3%) studies. There were mixed effects on consumer experience (n=13, 24.5%) and a lack of studies reporting HCP experience (n=1, 1.9%) and health care costs (n=3, 5.7%). All studies that reported positive population health outcomes used a minimum of 2 distinct categories of DHIs. Among these successful studies, the one that reported delaying the development of T2DM and 16 (69.6%) of those reporting improvements in dysglycemia involved HCP interaction. Targeted communication with persons (TCP), personal health tracking (PHT), and telemedicine (TM) showed some evidence as a potentially useful tool for T2DM prevention and dysglycemia.

The effects of DHIs on T2DM prevention, as measured by the quadruple aims, have not been comprehensively assessed, with proven benefits for population health, mixed results for consumer experience, and insufficient studies on HCP experience and health care costs. To maximize their effectiveness in preventing T2DM and managing dysglycemia, DHIs should be used in combination and strategically integrated with in-person or remote HCP interaction.

PROSPERO CRD42024512690; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024512690.

Objective: Metabolic syndrome (MS) is the most important risk factor for Type 2 diabetes mellitus (T2DM) and cardiovascular disease. This study used a retrospective dataset from the First Affiliated Hospital of Shenzhen University and aimed to develop and validate a novel model nomogram based on clinical parameters to predict MS in patients with T2DM. Methods: A total of 2854 patients with T2DM between January 2014 and May 2022 were selected and divided into a training dataset (n = 2114) and a validation dataset (n = 740). This study used multivariate logistic regression analysis to develop a nomogram for predicting MS in patients with T2DM that included candidates selected in the LASSO regression model. The data were set standardized before LASSO regression. The area under the receiver operating characteristic curve (AUC-ROC) was used to assess discrimination in the prediction model. The calibration curve is used to evaluate the calibration of the calibration nomogram, and the clinical decision curve is used to determine the clinical utility of the calibration diagram. The validation dataset is used to evaluate the performance of predictive models. Results: A total of 2854 patients were eligible for this study. There were 1941 (68.01%) patients with MS. The training dataset included 20 potential risk factors of the patient's demographic, clinical, and laboratory indexes in the LASSO regression analysis. Gender, hypertension, BMI, WC, HbA1c, TG, LDL, and HDL were multivariate models. We obtained a model for estimating MS in patients with T2DM. The AUC-ROC of the training dataset in our model is 0.886, and the 95% CI is 0.871-0.901. Similar to the results obtained from the training dataset, the AUC-ROC of the validation dataset in our model is 0.859, and the 95% CI is 0.831-0.887, thus proving the robustness of the model. The prediction model is as follows: logit (MS) = -9.18209 + 0.14406 ∗ BMI (kg/m2) + 0.09218 ∗ WC (cm) + 1.05761 ∗ TG (mmol/L)-3.30013 ∗ HDL (mmol/L). The calibration plots of the predicted probabilities show excellent agreement with the observed MS rates. Decision curve analysis demonstrated that the new nomogram provided significant net benefits in clinical applications. Conclusion: The prediction model of this study covers four clinically easily obtained parameters: BMI, WC, TG, and HDL, and shows a high accuracy rate in the validation dataset. Our predictive model may provide an effective method for large-scale epidemiological studies of T2DM patients with MS and offer a practical tool for the early detection of MS in clinical work.