American Diabetes Association Research Articles

Background: Abnormal glycemic status and thyroid dysfunctions are the two most common endocrinopathies. Data regarding glycemic status in Bangladeshi patients with thyroid dysfunctions are scarce. Objective: This study aimed to see the association of glycemic status among patients with thyroid dysfunctions. Methods: This cross-sectional study was done among 370 adults with thyroid dysfunctions. Serum thyroid stimulating hormone and free thyroxine levels were used to categorize the patients with different thyroid dysfunctions. Fasting plasma glucose for all, two hours after breakfast (2HABF) glucose for previously diagnosed patients with diabetes mellitus (DM) and 75 gm oral glucose tolerance test (OGTT) were analyzed by glucose oxidase method. Glycemic status was defined by American Diabetes Association- 2014 guideline. Results: The frequency of hypothyroid, subclinical hypothyroid, euthyroid with levothyroxine, subclinical hyperthyroidism, and hyperthyroidism participants were 79 (21.35%), 131 (35.41%), 111 (30.0%), 15 (4.05%) and 34 (9.19%) respectively. There were significant differences in the percentages of glycemic status (p=0.011) among patients with thyroid dysfunctions. The highest percentages of DM and prediabetes were found among patients with subclinical hyperthyroidism (40.0%) and hyperthyroidism (58.82%) respectively. A significant association was found between the duration of thyroid dysfunctions with glycemic status (p=0.037). Conclusions: Glycemic abnormalities are common in patients with thyroid dysfunctions and require regular screening to prevent mortality and morbidities associated with these combined conditions. J Assoc Clin Endocrinol Diabetol Bangladesh, January 2022; 1 (1): 04-08

Diabetes mellitus, which affects over 537 million people worldwide, considerably increases the risk of emergency room visits and admissions to hospital. Inpatient hyperglycaemia in patients with or without diabetes mellitus is associated with higher rates of complications, extended hospital stays and increased mortality when compared with patients with normoglycaemia. The American Diabetes Association recommends a target range of 5.6-10.0 mmol/l (100-180 mg/dl) for levels of glucose in the blood of patients in intensive care units (ICUs), as well as in general medicine and surgery. Insulin therapy remains the cornerstone of managing inpatient hyperglycaemia, with intravenous insulin preferred in ICU and basal-bolus regimens favoured in non-ICU settings. While bedside capillary blood glucose monitoring is standard for adjusting insulin doses, continuous glucose monitoring provides a more comprehensive glycaemic assessment and enhances the prevention of hypoglycaemia in high-risk hospitalized patients. This Review outlines the latest evidence in managing diabetes mellitus and hyperglycaemia within hospitals.

Prediabetes, a precursor to type 2 diabetes mellitus (T2DM), warrants urgent attention given its global prevalence and heightened burden in Palestine. This cross-sectional study assessed prediabetes prevalence, associated risk factors, and the validity of the American Diabetes Association (ADA) Prediabetes Risk Test among An-Najah National University (ANNU) staff. A 10-month investigation enrolled 365 adults (>18 years), collecting sociodemographic data via interviewer-administered questionnaires. Prediabetes was defined per WHO criteria (HbA1c 5.7%–6.49%), with blood glucose measured via HbA1c testing. The ADA risk test (English version) was employed, and statistical analyses (IBM SPSS v21.0) included sensitivity, specificity, predictive values, and ROC-AUC calculations. Among participants (60.8% male), prediabetes prevalence was 10.1%, with 8 undiagnosed T2DM cases identified. Multivariate regression identified age ≥50 years (50–59: OR=3.1, p=0.02; ≥60: OR=4.6, p=0.01) and obesity (BMI ≥30: OR=2.8, p=0.03) as significant predictors. The ADA test demonstrated moderate accuracy at a ≥4 cut off (sensitivity=72%, specificity=69%, AUC=0.738). This study highlights a concerning prevalence of prediabetes (10.1%) among ANNU staff, with age and obesity as critical modifiable risk factors in Palestine. The ADA tool’s moderate predictive efficacy supports its use for non-invasive screening in resource-limited settings. These findings highlight the need for targeted public health strategies to enhance prediabetes awareness, promote early lifestyle interventions, and mitigate T2DM progression. Further regional studies are recommended to validate these associations and refine risk assessment protocols.

Time in target range of fasting blood glucose ranges defined by WHO and ADA guidelines and cardiorenal Risk: Insights from two cohorts.

Background/Objectives: Physical activity is a cornerstone of diabetes mellitus (DM) management and is strongly recommended in the American Diabetes Association (ADA)’s guidelines. This study aims to investigate the self-reported physical activity levels of individuals with DM in Germany, as well as the barriers and facilitators they encounter. Methods: Individuals with type 1 DM (T1DM) and type 2 DM (T2DM) were asked to fill out an online questionnaire that was partly based on the International Physical Activity Questionnaire (IPAQ). Results: The questionnaire was completed by 338 persons with either T1DM (57.1%) or T2DM (42.9%) (females: 56.2%, males: 42.0%, gender diverse persons: 1.8%) of all age groups (at least 18 years). In total, 80.5% of respondents were aware of the current physical activity recommendations. Among the respondents, 58% reported meeting the recommendations for endurance-type physical activity, while only 30.5% reported meeting those for strength training. The three most frequently cited barriers to physical activity were lack of time, lack of motivation and current state of health. Supporting factors included coverage of costs, availability of exercise programs in close proximity to the patient’s home and target group specific exercise programs. Conclusions: The results imply that many individuals with DM in Germany do not meet ADA’s physical activity recommendations, especially considering that self-reports often overestimate actual behavior. In particular, the actual number of individuals who regularly engage in strength training may be too low. There is a clear need to better communicate the benefits of different forms of physical training and to provide physical activity programs aligned with patients’ individual needs.

PurposeDiabetic ketoacidosis (DKA) is a life-threatening condition, and treatment consists of aggressive fluid replacement and correcting the insulin deficit to resolve the acidosis and hyperglycemia. American Diabetes Association (ADA) guidelines recommend administering insulin glargine after resolution. The purpose of this retrospective study was to determine if early glargine, given within six hours of starting insulin infusion, decreased insulin infusion time in patients admitted to the hospital with DKA.MethodsPatients admitted to our hospital in 2021 with a diagnosis of DKA who were treated with an insulin drip were analyzed. Rebound hyperglycemia was analyzed using Pearson’s chi-squared test. Stepwise linear regression analysis was performed for the primary outcome, insulin duration, and the main predictor was early versus late glargine.ResultsDuration of insulin infusion was shorter in the early glargine group (p=.043). There was a higher incidence of rebound hyperglycemia (>180 mg/dL) in the six hours after insulin discontinuation in the late glargine group, 63 (83%) vs. 35 (50%) (p<0.001). An interaction between early glargine and type 1 diabetes was significant (p=0.047), with analysis showing that early glargine did not reduce the infusion duration in type 1 diabetes but significantly reduced the duration in patients without type 1 diabetes (p=0.010).ConclusionEarly glargine administration can decrease morbidity from rebound hyperglycemia and reduce the cost of care by minimizing the amount of time required to be on an insulin drip in a critical care setting. This effect was only found in individuals without type 1 diabetes, which may require further study.

This was an ongoing quality-improvement (QI) project that aimed to assess the quality of nurse practitioner (NP)-driven diabetes care based on the 2023 American Diabetes Association (ADA) Standards of Care (SOC) at a NP-owned primary care practice. In addition, a more recent focus was the assessment of and intervention on social determinants of health (SDOH). Nationally, 47.4% of people with diabetes mellitus (DM) have an HbA1C of >7.0%. Adherence to ADA SOC for DM management minimizes the risk of diabetes-associated complications. At a NP-owned clinic, within one year, the average A1Cs improved in all patients except those with positive SDOH despite receiving similar care. SDOH predicts DM prevalence and severity of progression, yet screening is not consistently performed or documented. An ongoing retrospective chart review since 2013 has assessed adherence to ADA SOC among adult patients with type 2 DM at an NP-owned practice. Multiple Plan-Do-Study-Act (PDSA) cycles have resulted in new recommendations that have promoted adherence to diabetes metrics and improvement in overall mean A1C. The current PDSA cycle emphasizes the creation and implementation of evidence-based interventions to assist NPs in addressing social needs at a NP-owned practice. Recent data collection has included frequency of SDOH screening, identifying social needs, gaps in SDOH documentation, and has found overall higher A1Cs in patients with positive screens. Project intervention of social workers collaboration with NPs resulted in improvement in addressing social needs in patients with type 2 diabetes mellitus.

Addressing the prediabetes epidemic in India: Challenges and strategies for prevention - A narrative review.

Highlights from the 85th scientific sessions of the American Diabetes Association.

ABSTRACTObjectiveSodium-glucose cotransporter-2 inhibitors (SGLT2is) are recommended as first-line cardiorenal protective therapy in type 2 diabetes. Because SGLT2is cause glycosuria and increase urine volume, they may exacerbate incontinence symptoms among patients with pre-existing urinary incontinence. Our objective was to determine how many adults meeting guideline indications for SGLT2i have frequent urinary incontinence.Research design and methodsWe conducted a cross-sectional analysis of National Health And Nutrition Examination Survey (NHANES) participants aged ≥55 with type 2 diabetes in 2013–2020. We determined whether participants met American Diabetes Association guideline indications for an SGLT2i due to heart failure or chronic kidney disease, or due to atherosclerotic cardiovascular disease or high cardiovascular risk (for the latter two cardiovascular indications, GLP-1RAs are guideline-recommended alternative medications). Frequent urinary incontinence was defined by self-report of leaking urine daily/nightly or a few times per week.ResultsThere were 1726 NHANES participants aged ≥55 with type 2 diabetes, representing 16.0 million US adults; 19.6% (95% CI 17.3% to 22.2%) (3.1 million) met indications for an SGLT2i specifically and 50.9% (95% CI 47.2% to 54.7%) (8.2 million) met indications for either an SGLT2i or a GLP-1RA. Among those with indications for an SGLT2i specifically, 32.4% (95% CI 25.9% to 39.8%) had frequent urinary incontinence, representing 333 000 men and 685 000 women. Among those with indications for either an SGLT2i or GLP-1RA, 25.5% (95% CI 20.8% to 30.8%) had frequent urinary incontinence, representing 630 000 men and 1413 000 women.ConclusionsFrequent urinary incontinence affects >15% of men and >40% of women aged ≥55 years with guideline indications for SGLT2i. Studies are needed to determine if incontinence increases risk of genital infections when initiating SGLT2is.

This cross-sectional study evaluated fasting glucose levels and the main predictors of risk for type 2 diabetes mellitus (T2DM) in a sample of 148 medical students at the University of Guayaquil, Ecuador. Anthropometric and biochemical variables (basal glucose, triglycerides) were evaluated, and the triglyceride-glucose index (TyG) was calculated. Participants were classified according to their risk of developing T2D using the criteria of the American Diabetes Association (ADA). Using Spearman's correlation and machine learning models (Random Forest, XGBoost, logistic regression), basal glucose was identified as the strongest predictor of risk of developing T2DM (ρ=0.75). The average TyG was 8.24, with specific high-risk thresholds established by sex (women: TyG &gt;9.5; men: TyG &gt;9.4), associated with &gt;80% probability of developing T2D. A decision tree (CHAID) confirmed the predictive utility of TyG. Machine learning models showed high accuracy; Random Forest: 97% accuracy; XGBoost 100% accuracy, although it suggested possible overfitting. Anthropometric variables (BMI, waist circumference) had weak correlations, while central obesity and low caloric expenditure increased metabolic risk. It is concluded that fasting glucose and TyG are accessible tools for early detection of T2DM in asymptomatic young people. Their use is recommended in preventive screening in high-stress academic settings. Limitations include the cross-sectional design and specific sample, requiring longitudinal validation.

To investigate the longitudinal association between diabetes and changes in vertebral bone mineral density (BMD) derived from conventional chest CT and to evaluate whether kidney function (estimated glomerular filtration rate (eGFR)) modifies this relationship. This longitudinal study included 1046 participants from the Multi-Ethnic Study of Atherosclerosis Lung Study with vertebral BMD measurements from chest CTs at Exam 5 (2010-2012) and Exam 6 (2016-2018). Diabetes was classified based on the American Diabetes Association criteria, and those with impaired fasting glucose (i.e., prediabetes) were excluded. Volumetric BMD was derived using a validated deep learning model to segment trabecular bone of thoracic vertebrae. Linear mixed-effects models estimated the association between diabetes and BMD changes over time. Following a significant interaction between diabetes status and eGFR, additional stratified analyses examined the impact of kidney function (i.e., diabetic nephropathy), categorized by eGFR (≥ 60 vs. < 60mL/min/body surface area). Participants with diabetes had a higher baseline vertebral BMD than those without (202 vs. 190mg/cm3) and experienced a significant increase over a median followpupof 6.2years (β = 0.62mg/cm3/year; 95% CI 0.26, 0.98). This increase was more pronounced among individuals with diabetes and reduced kidney function (β = 1.52mg/cm3/year; 95% CI 0.66, 2.39) compared to the diabetic individuals with preserved kidney function (β = 0.48mg/cm3/year; 95% CI 0.10, 0.85). Individuals with diabetes exhibited an increase in vertebral BMD over time in comparison to the non-diabetes group which is more pronounced in those with diabetic nephropathy. These findings suggest that conventional BMD measurements may not fully capture the well-known fracture risk in diabetes. Further studies incorporating bone microarchitecture using advanced imaging and fracture outcomes are needed to refine skeletal health assessments in the diabetic population.

Background: Despite the fact that gestational diabetes mellitus (GDM) typically goes away after delivery, women who have already been diagnosed with the condition are at a higher risk of having long-term metabolic disorders like type-2 diabetes. Upon delivery, women with a history of GDM should be observed for at least during 6-12 weeks in order to assess their glycemic status. Aims: The aim of this study was to observe the persistence of glucose intolerance and associated risk factors of GDM mothers at 6-12 weeks post-partum. Methods: This cross-sectional study included 222 mothers from December 2011 to December 2018 who had a history of GDM based on 2013 World Health Organization criteria. Mothers who fulfilled the criteria for diabetes in pregnancy (DIP) were excluded from the analysis. They were recruited consecutively at 6-12 weeks post-partum from ‘GDM Clinic’ as applicable with the elapse of time. GDM mothers were assessed by 75-gm oral glucose tolerance test (OGTT) for the persistence of glucose intolerance. The risk factors associated with the persistence of glucose intolerance were also recorded. Results: Out of 222 GDM, 150 (67.6%) were found normal, while 72 (32.4%) were abnormal glucose tolerance (AGT) [impaired fasting glucose IFG: 16 (7.2%), IFG-IGT: 20 (9%), impaired glucose tolerance IGT: 24 (10.8%) and diabetes mellitus (DM): 12 (5.4%)] following American Diabetes Association (ADA) criteria. The age of the mother was significantly different from AGT to normal glucose tolerance. Conclusion: A good number of GDM mothers express AGT at 6-12 weeks post-partum, which suggests it is necessary to follow GDM mothers after child birth. J Assoc Clin Endocrinol Diabetol Bangladesh, January 2023;2(1): 2-7

No previous research has assessed the long-term individual cardiometabolic risk factors and composite cardiovascular (CV) risk indicators in patients with obesityandtype 2 diabetes (T2DM) after sleeve gastrectomy (SG). The current study undertook this task. This retrospective study examined patients with obesity and T2DM who underwent primary SG at our institution between 2011 and 2015 (N = 361). Individual risk factors included anthropometric, lipid, glycemic, and liver enzymes parameters; composite indicators included the proportion of patients meeting the American Diabetes Association (ADA) goals and the Framingham 10-year cardiovascular risk scores (FRS) at baseline and at 1, 3, 5, 7, and 9years. Changes were evaluated using McNemar's chi-square tests for repeated measures, linear mixed models with restricted maximum likelihood estimation, and split-plot analysis of variance (ANOVA) with post hoc pairwise comparisons. SG considerably improved all individual cardiometabolic risk factors. The improvements were sustained over time except for the low-density lipoprotein and triglycerideslevels which showed no significant change. Composite risk indicators also improved, where the proportion of patients achieving all three ADA goals significantly increased (from preop 0.46 to 5.52% at year 3). Similarly, the predicted cardiovascular risk was also significantly reduced. Categorized by sex, FRS reductions among females amounted to 23.88% at year 1, 28.91% at year 3, and 28.41% at year 5; in male patients, reductions were 19.79% at year 1, 20.69% at year 3, and 13.74% at year 5. By FRS risk groups, low-risk patients showed risk reductions of 14.55% at year 1, 6.67% at year 3, and 9.82% at year 5; medium-risk patients experienced reductions of 19.14% at year 1, 19.48% at year 3, and 19.89% at year 5; and high-risk patients experienced reductions of 24.71% at year 1, 32.01% at year 3, and 24.57% at year 5. High-risk patients showed two characteristics: (1) by timeframe, they obtained the greatest FRS reduction benefits at year 1 compared to other risk categories; and (2) they were the only patients to exhibit a remarkable downward shift in risk category, where their mean FRS decreased from being high-risk to moderate risk at year 3. SG provided sustained long-term cardiovascular benefits. Multiple individual risk factors including anthropometric, glycemic, lipid, blood pressure, and liver enzyme markers showed significant improvement. Composite CV risk indicators also improved. These changes in composite risk factors represent an aggregation of improvements in individual parameters, suggesting possible synergistic or additive interactions among them and highlighting their collective role in modulating overall cardiovascular health.

The prevalence of type 2 diabetes mellitus (T2DM) is steadily increasing and has exceeded 20% in some rural Kentucky counties. In Kentucky, chronic diet-sensitive conditions and unhealthy behaviors are among the highest in the nation, with approximately 36.5% of adults with obesity and 13.3% diagnosed with T2DM, while only 15.3% meet physical activity recommendations, and 4.7% meet fruit and vegetable consumption recommendations. Family-based interventions can be used to promote health in rural communities that often comprise intergenerational households. The purpose of the study is to determine whether leveraging family units as sources of social support promotes nutritional and physical activity changes among those who are overweight or have obesity and are diagnosed with T2DM. This study consists of 3 phases (baseline, intervention, and postintervention). An overview of the study will be provided to interested participants, after which their consent will be sought. At baseline, demographic data, social support, physical activity, diabetes knowledge, diabetes self-management, dietary recall, obstructive sleep apnea, and sleep health, as well as social network data, will be collected using validated questionnaires. Anthropometric (weight, height, lean mass, and body fat) and T2DM-related (blood pressure, glycated hemoglobin A1c [HbA1c], total cholesterol, low-density lipoproteins, high-density lipoproteins, and triglycerides) clinical measures will also be obtained. During the intervention phase, participants will complete 6 months of medical nutrition therapy (MNT) alongside 1 member of their social network (eg, household member). In addition, participants will have the option to attend Dining with Diabetes program sessions that are offered at the county level through Cooperative Extension Service (Extension) agents. Follow-up data collection will include clinical measures, a dietary recall, and the assessment of participants' stage of behavior change at 3, 6, 9, and 12 months postintervention. This study was funded in November 2022 by the American Diabetes Association (ADA). Data collection started on September 1, 2023, and is projected to end in November 2025. We have enrolled a total of 48 participants in the study. T2DM is a growing problem, particularly among vulnerable populations in rural Kentucky. This study plans to leverage family units as sources of social support with MNT and nutrition education through the Dining with Diabetes program. If effective, this approach will inform future family-based interventions in rural communities. ClinicalTrials.gov NCT06080425; https://clinicaltrials.gov/study/NCT06080425. DERR1-10.2196/69301.

The American Diabetes Association recommends continuous glucose monitoring (CGM) to assist people with diabetes in reaching glycemic targets. However, implementation of CGM into routine practice, especially for clinics caring for underserved populations, is not well described. This study assessed the impact of short-term CGM in combination with a pharmacist-led collaborative drug therapy management service on glycemic control in underserved people with diabetes. The pharmacist-led CGM program resulted in improved glycemic control in this population. Future studies should evaluate the scalability and sustainability of this model across diverse clinical practice settings.

Abstract Introduction: The escalating global prevalence of prediabetes and diabetes, particularly in India, underscores an urgent need for a thorough understanding of biochemical markers associated with insulin resistance (IR). This study aimed to comparatively evaluate insulin resistance level indexes (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI), Homeostasis Model Assessment of Beta-cell Function (HOMA-B), along with interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α), adiponectin, C-peptide and insulin levels, across normal, prediabetic and diabetic subjects. Furthermore, a key objective was to investigate the correlation of IL-6, TNF-α and adiponectin with the established IR indexes. Materials and Methods: The study evaluated 309 participants, categorised into three groups according to their glycated haemoglobin and (fasting blood glucose) levels, following the American Diabetes Association 2023 guidelines: normal, prediabetic and diabetic, with each group consisting of 103 subjects. Biochemical markers were examined. This study employed the Pearson correlation coefficient to analyse the relationships between IR indices and TNF-α, IL-6 and other factors, such as adiponectin. Results: Diabetic individuals exhibit significantly lower levels of adiponectin. The levels of TNF-α and IL-6 progressively increase from normal to diabetic conditions. A negative and statistically significant correlation was observed between HOMA-IR and adiponectin in both normal and diabetic subjects (R = −0.3752, P = 0.0001; R = −0.2281, P = 0.02), as well as between HOMA-IR and QUICKI in normal individuals (R = −0.2851, P = 0.003). The study indicated a positive correlation between TNF-α and HOMA-IR in normal and pre-diabetic subjects (R = 0.422, P = 0.000; R = −0.2523, P = 0.01). In addition, IL-6 was positively correlated with HOMA-IR in both normal and diabetic subjects (R = 0.5679, P = 0.000; R = 0.2845, P = 0.0036). Conclusions: The levels of TNF-α, IL-6 and adiponectin showed varied correlations with IR indexes, suggesting their potential as biomarkers in IR and highlighting their differing impacts on the progression to diabetes from normoglycaemia.

Background: Lifestyle modifications are pivotal to preventing the progression of prediabetes and associated cardiometabolic diseases. Recent evidence from cross-sectional analysis of community-dwelling Chinese adults suggests that regular consumption of tea, particularly dark tea, is associated with a reduced risk of both prediabetes and type 2 diabetes. However, the effects of tea consumption on prediabetes progression and regression remain uncertain. This study investigated the associations of tea consumption with prediabetes progression and regression in Chinese adults with prediabetes. Methods: A cohort of 2662 Chinese adults with prediabetes was followed over ~3 years. Baseline tea consumption, including the type (green, black, dark, or other) and frequency (daily, sometimes, or nil), was assessed using standardized questionnaires. Prediabetes was defined according to the American Diabetes Association criteria. Multinomial logistic and linear regression analyses with multivariable adjustment was performed to evaluate associations. Results: Compared to non-tea drinkers, dark tea consumers were less likely to progress to type 2 diabetes (odds ratio [OR]: 0.28, 95% confidence interval [CI]: 0.11, 0.72, p = 0.01), whereas green tea consumption was associated with a reduced probability of regressing to normoglycemia (OR: 0.73, 95 CI%: 0.59, 0.90, p = 0.01). Conclusions: These findings support further exploration of dark tea consumption as a strategy to reduce prediabetes progression, and suggest that effects of green tea consumption should also be examined more closely in this population.

Background: Diabetes mellitus and vitamin D deficiency (VDD) are widespread global health concerns with overlapping metabolic risks. Emerging evidence suggests a bidirectional relationship: VDD exacerbates insulin resistance, whereas diabetes mellitus disrupts vitamin D metabolism. Methods: This meta-analysis was registered prospectively (PROSPERO CRD42025639951). We conducted a comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library from their inception to January 2025 for observational studies examining the bidirectional associations between VDD and diabetes mellitus. Studies were eligible if they (1) employed cohort or case-control designs, (2) defined VDD as serum 25-hydroxyvitamin D [25(OH)D] &lt; 20 ng/mL, and (3) diagnosed diabetes mellitus according to the American Diabetes Association (ADA) criteria. Two reviewers independently extracted data and assessed study quality using the Newcastle-Ottawa scale. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models (STATA 15.1 and RevMan 5.4). Results: Among 53 studies (n = 552,032), individuals with VDD had a 53% increased risk of developing type 2 diabetes mellitus (T2DM) (OR = 1.53, 95% CI: 1.38–1.70). Conversely, individuals with type 1 diabetes mellitus (T1DM) and T2DM had a 2.02-fold and 2.62-fold increased risk of VDD, respectively. Subgroup analyses demonstrated stronger associations in Asian populations (T1DM: OR = 2.21; Europe: OR = 1.65; P &lt; 0.05 for regional difference) and among normal-weight T2DM patients (OR = 7.68, compared to obese: OR = 5.21). Discussion: This meta-analysis reveals a bidirectional link between VDD and diabetes mellitus, emphasizing subtype- and phenotype-specific risk profiles. Clinically, routine monitoring of serum 25(OH)D levels is recommended for diabetic patients, particularly in high-risk subgroups such as individuals with T1DM or lean T2DM phenotypes, and suggests targeted vitamin D supplementation for high-risk groups. On a public health scale, fortifying staple foods with vitamin D in regions with high deficiency rates, such as Asia, could alleviate the dual burden of VDD and diabetes mellitus.

Heart rate turbulence (HRT), a test quantified by turbulence onset (TO) and turbulence slope (TS), has been used to assess cardiac autonomic neuropathy (CAN). CAN is a complication of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM). Thus, this study aimed to assess the association between HRT parameters and CKD in T2DM patients. This retrospective study included 322 patients with T2DM, grouping them into those with and those without CKD; the data collected from the patients with T2DM were analysed. T2DM was diagnosed according to American Diabetes Association criteria. CKD diagnoses were confirmed according to KDIGO Clinical Practice Guidelines. For HRT parameters, T2DM patients with CKD exhibited a significantly higher turbulence onset (TO) (-0.25 [-1.02, 0.23] vs -0.64 [-1.93 0.10], p = 0.034) and lower turbulence slope (TS) (2.49 [1.27, 4.00] vs 6.20 [2.55, 8.80], p < 0.001) than those without CKD. TO was significantly negatively correlated with estimated glomerular filtration rate (eGFR) (r = -0.184, P = 0.001), whereas TS was significantly positively correlated with eGFR in patients with T2DM (r = 0.203, P < 0.001). Multivariable logistic regression analysis revealed that higher TS, but not for TO, was independently associated with CKD in patients with T2DM(OR=0.885, 95%CI:0.8400.932, P < 0.001). Higher TS, an HRT parameter reflecting heart rate deceleration following ventricular premature beat, was independently associated with CKD in T2DM patients. This study suggests that CKD may change heart rate deceleration following ventricular premature beat in T2DM patients, which may be helpful in improving CAN assessment by HRT in patients with CKD.