Diabetes Research Articles

Preliminary observations on the influence of maternal pregnancy factors and birth factors on pediatric astigmatism

Objective: To investigate the impact of maternal factors during pregnancy and birth factors on astigmatism in children. Methods: It was a case-control study. Patients aged 3 to 12 years old were continuously selected from October 2023 to January 2024 in the Pediatric Eye Care Department of Qinhuangdao Maternal and Child Health Care Hospital. Children with astigmatism were included as the case group, and children without astigmatism were included as the control group. All children underwent cycloplegic autorefraction. Astigmatism was defined as a cylinder refractive error with an absolute value of≥1.00 diopter. Only the right eye were included in the analysis. The maternal factors during pregnancy [maternal age at delivery, delivery mode, paternal age, progesterone during pregnancy, pre-pregnancy body mass index (BMI), gestational weight gain, smoking during pregnancy, hypertensive disorders of pregnancy, gestational diabetes mellitus] and children's birth history [birth weight, birth order, BMI, preterm birth, nuchal cord] were recorded. The independent t-test, non-parametric test, and Chi-square test were used for comparison between groups. Multiple logistic regression analysis was performed and risk factors during pregnancy for astigmatism in children were identified by calculating the odds ratio (OR) and its 95% confidence interval (95%CI). Results: A total of 146 children (146 eyes) were included in the case group, consisting of 73 males and 73 females with a median age of 6 (5, 9) years, and 161 children (161 eyes) were included in the control group, consisting of 73 males and 88 females with a median age of 7 (5, 9) years. No statistically significant differences in age and gender were found between the two groups (all P>0.05). Multiple logistic regression analysis, with adjustment for confounding factors, showed that the maternal pre-pregnancy BMI 24.0 to <28.0 kg/m2 (OR=2.79, 95% CI: 1.46 to 5.35, P=0.002) or ≥28.0 kg/m2 (OR=3.97, 95% CI: 1.19 to 13.21, P=0.024), birth weight <2.5 kg (OR=5.44, 95% CI: 1.10 to 26.88, P=0.038), and birth order ≥ 2 (OR=2.06, 95% CI: 1.16 to 3.66, P=0.013) were risk factors of astigmatism in children. Conclusions: Higher maternal pre-pregnancy weight, lower birth weight, and non-firstborn status were associated with pediatric astigmatism.

DI CVD TRI Layer CX Classifier for Secure IoT Enabled Risk Prediction Model

This paper introduces a novel Di-CVD Tri-Layer CX Classifier, an IoT-integrated and machine learning (ML)-driven framework, to predict the individual and joint risk of diabetes (DB) and heart disease (HD). The proposed model comprises three phases: secure IoT-based data collection using Enhanced BGV encryption with Dynamic Distributed Hashing (DDH); a feature extraction (FE) phase leveraging (IGO) Information Gain Ratio and disease-specific ranking and a three-step classifier—Cm-Ro (FS) feature selection, hierarchical XGBoost classification, and synergistic prioritized risk scoring. By integrating multi-attribute features, rule-free optimization, and enhanced interoperability, the model addresses critical challenges such as heterogeneous data formats, poor feature relevance, and low interoperability in previous studies. When compared to conventional classifiers such as SVM and standard XGBoost, experimental evaluation on the NHANES dataset shows improved performance in terms of accuracy (ACC), recall (R), precision (P), and F1-score. The outcomes validate the framework’s effectiveness in early, secure, and individualized risk prediction, offering substantial support for timely interventions and enhanced patient care.

Evaluation of the effect of SGLT-2 inhibitors on atrial fibrillation recurrence in diabetic patients

ABSTRACT Background The aim of this study was to investigate the effect of SGLT-2 (sodium glucose cotransporter-2) inhibitors on AF (atrial fibrillation) recurrence in patients diagnosed with diabetes mellitus (DM) who underwent Direct Current Cardioversion (DCCV) in our clinic. Research design and methods Consecutive DCCV was performed to achieve 120 patients in SR (60 DM patients who used SGLT-2 inhibitors and 60 DM patients who didn’t use SGLT-2 inhibitors). The two groups (SGLT-2 inhibitor user group and control group) were monitored for AF recurrence on the first day, then at one, three, and six months after CV. Results During the six-month follow-up period, AF recurrence developed in 24 (40%) patients in SGLT-2 inhibitor group and in 35 (58.3%) of the control group, p = 0.04. In univariable analysis, AF duration, non-use of SGLT-2 inhibitor, left atrium diameter, TAPSE value and in multivariable analysis, AF duration OR: 4.98; 95%CI (2.39–10.38), p < 0,001 and non-use of SGLT-2 inhibitors OR: 0.35; 95%CI (0.13–0.90), p = 0.03 were found to be independent predictors for AF recurrence. Conclusion AF recurrence ratio is significantly lower in patients using SGLT-2 inhibitors, in six-month follow-up period. AF duration and SGLT-2 inhibitor non-use were independent predictors, for AF recurrence in DM patients (NCT06951737). Clinical trial registration www.clinicaltrials.gov identifier is: NCT06951737

Impact of low cardiac function and diabetes mellitus on survival and causes of death following coronary artery surgery.

To determine the differential impact of low cardiac function (ejection fraction [EF] ≤ 35%) and diabetes mellitus (DM) on survival and to identify causes of death after coronary artery bypass grafting (CABG). Overall, 1036 patients who underwent isolated CABG between 2009 and 2022 were divided into four groups based on EF and DM. Kaplan-Meier analysis was performed to calculate each group's estimated survival. Inter-group multivariate Cox regression was performed with the reference group showing EF > 35% and DM (-). Additional Cox regressions were performed to investigate the associations of EF ≤ 35% and DM (+) with death from heart failure, myocardial infarction, cancer, pneumonia, cerebrovascular disease and renal failure. Off-pump techniques were used in 980 patients (95%). Patient population and estimated 10-year postoperative survival were as follows: EF > 35% DM (-), 430, 75.1%; EF > 35% DM (+), 456, 66.3%; EF ≤ 35% DM (-), 73, 62.5%; and EF ≤ 35% DM (+), 77, 53.5%. Hazard ratios (HRs) (P values) for the three groups were as follows: EF > 35% DM (+), 1.53 (0.006); EF ≤ 35% DM (-), 1.84 (0.017); and EF ≤ 35% DM (+), 2.23 (0.001). For death from heart failure, HR (P value) for EF ≤ 35% versus EF > 35% was 3.62 (0.012). For deaths from cancer and pneumonia, HRs (P values) for DM (+) versus DM (-) were 1.73 (0.097), and 2.72 (0.046), respectively. EF ≤ 35% and DM (+) are associated with worse post-CABG survival. Each is associated with specific causes of death.

Incretin-based therapy: An update focusing on the major revolution in cardiovascular-kidney-metabolic health.

Incretin-based therapy: An update focusing on the major revolution in cardiovascular-kidney-metabolic health.

Antidiabetic Effects and Underlying Mechanisms of Food-Derived Bioactive Peptides.

Type 2 diabetes mellitus (T2DM), characterized by progressive insulin secretion defect based on insulin resistance, is one of the leading public health problems with high morbidity and mortality rates. Uncontrolled hyperglycemia, which becomes a more severe indication with obesity in T2DM patients, increases the risk of cardiovascular disease, kidney damage, and retinal disorder. Effective diabetes treatment is possible with a comprehensive approach that includes controlling blood glucose levels, improving pancreatic β cell functions, and supporting insulin sensitivity through body weight management, nutritional therapy, and drug therapy. At this point, food-derived bioactive peptides and protein hydrolysates, which draw attention with their structural similarity to regulatory peptides in human metabolism, have great potential in treating T2DM and regulating glucose metabolism. Various glucoregulatory properties of bioactive peptides come to the fore through antidiabetic mechanisms such as the digestion of carbohydrates, the release of intestinal hormones, insulin function and secretion, glucose uptake, and adipose tissue modification. This review aims to evaluate the roles of food-derived bioactive peptides and protein hydrolysates in controlling glycemia and insulin sensitivity and their antidiabetic mechanisms of action and to examine the difficulties and opportunities related to the acquisition and research processes.

Rifampicin Exposure in Tuberculosis Patients with Comorbidities in Sub-Saharan Africa: Prioritising Populations for Treatment-A Systematic Review and Meta-analysis.

Emergingevidence suggests that comorbidities like human immunodeficiency virus (HIV) infection, diabetes mellitus (DM), and malnutrition in tuberculosis (TB) patients can alter drug concentrations, thereby affecting the treatment outcomes. For these populations, personalised strategies such as therapeutic drug monitoring (TDM) may be essential. We investigated the variations of drug levels within comorbid populations and analysed the differences in patterns observed between sub-Saharan Africa (SSA) and non-SSA regions. We performed a systematic review and meta-analysis of rifampicin drug pharmacokinetics (PK) through searches of major databases from 1980 to December 2023. A random-effects meta-analysis model using R-studio version 4.3.2 was conducted to estimate pooled serum rifampicin exposure (area under the concentration-time curve [AUC], and peak maximum concentration [Cmax]) between patients with TB-HIV infection, and TB-DM. From 3300 articles screened, 24 studies met inclusion criteria, contributing 33 comorbidity subgroups for meta-analysis. In SSA, 14 subgroups assessed rifampicin PK in TB-HIV, 1 in TB-DM, and none in TB-malnutrition. The pooled mean Cmax was below the recommended range (8-24 mg/L) for all subgroups. For TB-HIV, the pooled Cmax was 5.59 mg/L, 95% CI (4.59-6.59), I2 = 97% for SSA populations and 5.59 mg/L, 95% CI (3.65; 6.59) for non-SSA populations. The Cmax for TB-DM in SSA (9.60 ± 4.4 mg/L) exceeded non-SSA (4.27 mg/L, 95% CI [2.77-5.76]). The lowest AUC was in TB-HIV (SSA, 29.09 mg/Lh, 95% CI [21.06; 37.13, I2 = 91%]). High variability and heterogeneity (I2 >90%) were observed, with most studies (20/23) showing low bias. Our results emphasise the need for individualised dosing and targeted TDM implementation among TB-HIV and TB-DM populations on rifampicin in SSA. Although all populations exhibited low Cmax levels, TB-HIV populations may be prioritised as AUC levels were lowest. In clinical settings in SSA, Cmax-based TDM is more practical, but AUC can be used in treatment where feasible.

Relationships Among Glaucoma, Cardiovascular Diseases, and Mortality.

In order to better understand comorbidity rates and the associated risk of death in patients with glaucoma we retrospective analyzed two groups of subjects aged 50years and above residing in Lombardy Region (Northern Italy) following them from January 1, 2017 to February 1, 2020 (just before the COVID-19 pandemic started in Italy). The two groups were all subjects with incident glaucoma in 2017 and a 3:1 random sample stratified by age and sex of subjects without glaucoma. Main outcome was overall survival. Other outcomes were incidence of cardiovascular diseases (heart attack, stroke, and peripheral arterial disease). All data were taken from Lombardy Region administrative database and therefore the presence of glaucoma was ascertained using antiglaucoma drug prescriptions, being hospitalized or undergoing an intervention for glaucoma, and having a glaucoma exemption for healthcare co-payments. The study identified 14,138 incident cases of glaucoma and selected 42,414 subjects without glaucoma. The number of deaths was higher among glaucoma subjects (11.6%) compared to those without glaucoma (10.5%). The death hazard ratio (HR) for glaucoma subjects compared to controls was 1.07 (95%CI 1.01-1.14, p = 0.015) in the adjusted model. Similarly incidence of stroke was higher in glaucoma compared to non-glaucoma subjects (HR 1.10, 95%CI 1.01-1.20), while the incidence of heart attack and peripheral arterial disease during the follow-up period was similar in the two groups. HRs varied by age classes for death and peripheral arterial disease. Individuals with glaucoma showed higher comorbidity rates compared to those without glaucoma, particularly in diabetes mellitus (16.7% vs. 11.0%) and hypertension (62.2% vs. 58.1%). Our results show an increased risk of mortality in subjects with glaucoma compared to those without glaucoma, with age being a significant factor influencing outcomes. These findings suggest the importance of monitoring and managing comorbidities in individuals with newly incident glaucoma to potentially improve their overall health outcomes and quality of life.

Outcomes and risk factors for complications, readmissions, and reoperations following below-knee amputation: a comprehensive analysis beyond the 30-day window.

This study evaluates the long-term outcomes following below-knee amputation (BKA), focusing on reoperations, readmissions, complications and mortality at 180 and 365days. It aims to identify key risk factors and address the underreporting of long-term outcomes. This retrospective study analyzed adult BKA patients (2005-2022) at a Level I trauma center, analyzing demographics, surgical details, and comorbidities to assess long-term outcomes using statistical analyses (p < 0.05). The study assessed 376 BKAs. Patients had a mean age of 51.4years and body mass index (BMI) of 32.7kg/m2. Complications occurred in 62.5% of cases; 28.2% had direct surgical complications, and 25.8% required unplanned reoperations. Readmission rates were 10.1% by 30days, 29.8% by 180days, and 32.98% by 365days. Diabetes mellitus (DM) (OR 1.98; p = 0.0115) and insurance status were associated with increased readmission. Younger age (OR 0.96; p = 0.001) and employment status were associated with higher odds of direct complications, while diabetes (OR 2.47; p < 0.001) and poor glycemic control (A1c > 5.83%) predicted indirect complications. Mortality increased from 2.7% by 30days to 17.0% by 1year and was independently associated with cancer (OR 4.37; p = 0.005), myocardial infarction (MI), chronic obstructive pulmonary disease (COPD), peripheral vascular disease (PVD), and prior vascular intervention (VI). A substantial proportion of BKA complications and deaths occur beyond 30days. Risk-tailored perioperative management and extended follow-up are essential to improving patient outcomes and reducing long-term healthcare burdens.

The Rising Global Burden of MASLD and Other Metabolic Diseases (2000-2021).

Metabolic diseases are a public health threat to diverse populations worldwide. This study aims to update the epidemiological trends of metabolic diseases across regions and sociodemographic stratifications using the Global Burden of Diseases Study 2021. This study focused on metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes mellitus (T2DM) along with obesity, hypertension, and dyslipidemia. The prevalence and disability-adjusted life years (DALYs) with their age-standardised prevalence rate and DALYs (ASPR and ASDALYs) and uncertainty intervals (UIs) were estimated and stratified by sex, geography, and the Sociodemographic Index (SDI). Epidemiological trends were analysed using the Joinpoint Regression method, which calculated the annual percent change (APC) and confidence intervals (CIs) of age-standardised rates (ASRs) from 2000 to 2021. In 2021, MASLD had a prevalence of 1.27 billion people (ASPR: 15,018.07, 95% UI: 13,756.47 to 16,361.44; ASDALYs: 42.40, 95% UI: 33.60 to 53.31), while T2DM had a prevalence of 0.51 billion people (ASPR: 5885.40, 95% UI: 5467.62 to 6334.18; ASDALYs: 871.78, 95% UI: 735.05 to 1044.78) worldwide. ASPRs of MASLD and T2DM increased over the 2decades. ASDALYs decreased over time for dyslipidemia (APC: -1.43%, 95% CI: -1.58 to -1.27%) and hypertension (APC: -1.32%, 95% CI: -1.43 to -1.21%) but increased for T2DM (APC: 1.09%, 95% CI: 1.04 to 1.14%) and obesity (APC: 0.70%, 95% CI: 0.63 to 0.78%), while it remained stable for MASLD. The global burden of metabolic diseases was generally higher in males compared to females. The highest ASDALYs for all these metabolic diseases were observed in low-middle SDI countries. The global burden of MASLD and other metabolic diseases is substantial. National and global policies must better address metabolic diseases including the MASLD public health threat.

Assessment of neonatologists' competency in managing gestational diabetes complications: a cross-sectional analysis from China

BackgroundGestational diabetes mellitus (GDM) significantly impacts long-term child health outcomes. This study assessed neonatologists' knowledge, attitudes, and practices (KAP) regarding GDM-related complications in offspring.MethodsA cross-sectional study of 1,614 neonatologists in Hubei Province, China, utilized a validated 28-item questionnaire examining knowledge (12 items), attitudes (8 items), and practices (8 items). Responses were scored on a trichotomous scale. Binary logistic regression analyzed predictors of satisfactory performance across domains.ResultsAmong 1,614 neonatologists, 1,437 (89%) demonstrated satisfactory knowledge, 1,513 (94%) positive attitudes, and 1,165 (72%) good practices. Knowledgeable practitioners were significantly older (45.4 vs 36.2 years; OR 1.42 [95% CI 1.40-1.44]; p&amp;lt;.001) with greater experience (13.8 vs 10.5 years; 1.41 [1.35-1.46]; p&amp;lt;.001). Academic hospital affiliation showed higher competency versus community settings (0.12 [0.08-0.20]; p&amp;lt;.001). Practice patterns varied by education, with MD-PhD holders demonstrating higher odds of good practice (1.32 [1.03-1.71]; P=.032) compared with fellowship training (0.69 [0.51-0.92]; p=.009). Universal documentation of maternal GDM coexisted with suboptimal rates of periodic evaluations (81%) and specialist referrals (84%). Knowledge competency (7.52 [5.90-9.60]; p&amp;lt;.001) and positive attitudes (15.81 [9.90-25.26]; p&amp;lt;.001) strongly predicted practice patterns.ConclusionsDespite high knowledge levels and positive attitudes, particularly among experienced practitioners in academic settings, implementation gaps exist in follow-up protocols and specialist referrals. Practice setting significantly influences care delivery, suggesting the need for standardized protocols across healthcare tiers.

Association Between Hemoglobin, Albumin, Lymphocyte, and Platelet Score and Diabetic Foot Ulcer: A Cross-Sectional Study.

BackgroundDiabetic foot ulcer (DFU) is a common and serious complication of diabetes mellitus, with high rates of disability and mortality. Early diagnosis and prevention can effectively reduce its incidence. The relationship between hemoglobin, albumin, lymphocyte count, and platelet (HALP) score, which are biomarkers reflecting the inflammatory and nutritional status of the body, and DFU has not been investigated. This study aimed to investigate the association between HALP score and DFU.MethodsThis cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Logistic regression models assessed the relationship between HALP scores (as both continuous and categorical variables) and DFU, adjusting for confounders. Restricted cubic spline (RCS) analysis was employed to evaluate potential non-linear relationships. Subgroup and sensitivity analyses were conducted to ensure the robustness of the findings.ResultsA total of 1604 participants (mean age: 61.67 ± 11.88 years; 52.9% male) were included. Multivariate logistic regression analysis, after adjusting for multiple confounders, revealed a negative correlation between the HALP score and DFU (OR = 0.98, 95% CI: 0.97-0.99, P = 0.041). This association remained significant when the HALP was categorized into quartiles. RCS analysis identified a non-linear relationship, with an inflection point at 44.98 (non-linear P = 0.017). Subgroup analyses confirmed the consistency of these findings across different demographic and clinical groups. Sensitivity analysis excluding extreme outliers confirmed the stability and reliability of the results.ConclusionLower HALP scores are significantly associated with an increased risk of DFU. This study underscores the potential utility of the HALP score as a tool for identifying individuals at higher risk, supporting its use in the prevention and management of DFU.

OCT Angiography Assessment of Type 1 Diabetes Mellitus Patients Without Diabetic Retinopathy: A 3-Year Follow-Up Study

Background/Objectives: This study aims to investigate the progression of retinal microvascular changes using OCTA in young T1DM patients without clinical signs of DR over a period of 3 years. Methods: This prospective, longitudinal study analyzed OCT angiograms of T1DM patients without clinical signs of DR. It included 40 T1DM patients aged between 7 and 20 years old who formed the T1DM study group and 40 healthy subjects with similar demographic characteristics to the control group. The patients underwent comprehensive ophthalmic examination and OCT imaging using a Retina Wide protocol (6 × 6 mm). We analyzed the following microvascular retinal parameters: FAZ area, perimeter and circularity and superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density. Results: Statistically significant differences between the two groups were identified for the following parameters: the mean FAZ area at follow-up (0.38 ± 0.13) was larger than the mean FAZ area at baseline (0.31 ±0.11), the mean FAZ perimeter at follow-up (3.22 ± 0.75) was larger than the mean FAZ perimeter at baseline (2.61 ± 00.52) and the men FAZ circularity index at follow-up (0.47 ± 0.13) was decreased compared to the FAZ circularity index at baseline (0.56 ± 0.12). A statistically significant difference were also registered for the following parameter: the total SCP and DCP vessel density was decreased at follow-up (37.47 ± 1.57) compared to baseline (38.79 ± 1.00). Conclusions: OCTA long-term monitoring of T1DM patients represents an effective method for tracking progressive changes in FAZ parameters and capillary plexus vascular density.

How Does the Gut Microbiome Contribute to Diabetes Development: A Literature Review

Introduction: Type 2 diabetes mellitus affects over 6% of the world population and is strongly linked to obesity. Traditional views have attributed obesity to sedentary lifestyles and high-fat diets but emerging evidence implicates gut microbiome dysbiosis as a pivotal factor in type 2 diabetes mellitus onset. High fat diets can impair microbiome health, leading to dysbiosis that triggers metabolic deregulation, insulin resistance, and inflammation. The purpose of this review is to elucidate how alterations in the gut microbiota contribute to type 2 diabetes mellitus development, with a focus on obesity, insulin resistance, and inflammatory pathways. Methods: We conducted a comprehensive review of the literature, integrating findings from clinical trials, preclinical studies, and systematic reviews. Our analysis focused on interventions targeting the gut microbiota, including direct supplementation with short-chain fatty acids such as butyrate, probiotic treatments, and fecal microbiota transplantation. Additionally, we examined dietary strategies to boost butyrate production via increased fiber intake. Results: Findings across studies consistently reveal a reduction in butyrate producing bacteria correlates with type 2 diabetes mellitus and metabolic dysregulation. Clinical trials have demonstrated that probiotic interventions, such as the daily consumption of probiotic yogurt, significantly lower fasting blood glucose while enhancing antioxidant defenses. Preclinical research in high fat diet induced obese mice revealed that butyrate supplementation preserves insulin sensitivity, promotes mitochondrial function, and enhances adaptive thermogenesis. Furthermore, specific microbial taxa such as Akkermansia muciniphila exert protective effects. Discussion: These findings suggest that gut microbiota modulate host metabolism via key signaling pathways. The interactions between dietary factors, microbial composition, and host inflammatory responses highlights the potential for microbiome targeted therapies in type 2 diabetes mellitus management. Conclusion: Gut targeted interventions including probiotics, prebiotics, and synbiotics, and fecal microbiota transplantation hold promise for improving glycemic control and mitigating insulin resistance. Future research should focus on optimizing these strategies to restore microbial balance, reducing obesity related metabolic derangements and improved long term outcomes in type 2 diabetes mellitus patients.

Thyroid Dysfunction in Patients with Type 2 Diabetes Mellitus attending Medical Outpatient/Inpatient Departments at a Tertiary Care Hospital

Background &amp; Objectives: Diabetes mellitus and thyroid dysfunction are the two most common endocrine disorders in clinical practice. The unrecognized thyroid dysfunction may adversely affect the metabolic control and add more risk to an already predisposing scenario for cardiovascular diseases. The objective was to find out the spectrum of thyroid dysfunction in patients of type 2 diabetes mellitus. Materials and Methods: Seventy patients (40 female and 30 male) of age more than 30 years with type 2 diabetes mellitus were evaluated for one year visiting Nepal Medical College and Teaching Hospital. All the patients were evaluated for thyroid dysfunction by testing thyroid function test. The correlation of prevalence of thyroid disorder with gender distribution, age distribution, HbA1c, duration of diabetes was evaluated. The observations and interpretations were recorded and results obtained were statistically analyzed. Results: There was a high prevalence (27.1%) of thyroid disorders in patients of type 2 diabetes mellitus. Among all, the most common was subclinical hypothyroidism (20.0%) which was further found to be more in females (30.0%) and elderly patients (37.0%). Duration of diabetes had positive association with the incidence of thyroid disorders (P value 0.003). Conclusion: Findings of this study suggests that thyroid disorders were commonly associated with diabetes mellitus among which subclinical hypothyroidism being the commonest. Moreover, thyroid disorders were more common in females and elderly population.

Assessment of Serum Thyroid Antibody Levels in Patients with Type-I and Type-II Diabetes without Thyroid Disease

Objective: The study assessed differences in the thyroglobulin antibody and thyroid peroxidase antibody between euthyroid Type-I and Type-II diabetes mellitus (DM) and control groups not using thyroid medication. Methods: This was a cross-sectional study. People with Type-I and Type-II diabetes and a control group aged between 18 and 80 years were enrolled at the diabetes and internal medicine outpatient clinic of Istanbul Haydarpaşa Numune Training and Research Hospital between 2020-2023. Data analysis was performed on 103 participants with Type-I DM, 110 with Type-II DM, and 110 control subjects, all randomly selected. Anti-thyroglobulin antibody (anti-TG), anti-thyroperoxidase antibody (anti-TPO), thyroid-stimulating hormone (TSH), fasting blood glucose (FBG), hemoglobin A1c, (HbA1c) and blood creatinine levels were recorded for analysis. Results: In the study, anti-TG and anti-TPO levels were higher in Type-I DM patients than in the control and Type-II DM groups. This elevation was statistically significant in women with Type-I DM compared to women patients in other groups. In this study, thyroid antibody levels in patients with Type-II DM were not significantly higher than those in the control group. Conclusions: This study highlights the importance of regular assessment of thyroid function and antibodies in women diagnosed with Type-I DM, but not necessarily in those with Type-II DM without thyroid disease. doi: https://doi.org/10.12669/pjms.41.7.11918 How to cite this: Dayan A, Yonak AK. Assessment of Serum Thyroid Antibody Levels in Patients with Type-I and Type-II Diabetes without Thyroid Disease. Pak J Med Sci. 2025;41(7):1996-2002. doi: https://doi.org/10.12669/pjms.41.7.11918 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A study on the utilization of canagliflozin in type 1 diabetes mellitus using real-world data from four European countries.

Sodium-glucose co-transporter-2 (SGLT2) inhibitors are not approved for glycaemic control in type 1 diabetes mellitus (T1DM), and concerns exist around off-label use in this patient population. The objective of this study was to investigate whether and how canagliflozin, an SGLT2 inhibitor, has been used in patients with T1DM, and whether the off-label use of canagliflozin for T1DM has changed over time. This observational, retrospective cohort study utilized real-world data from 2016 to 2022 in four European countries (Belgium, Italy, Spain and United Kingdom) with high cumulative exposure to canagliflozin. Analyses were conducted to identify canagliflozin users with T1DM and estimate the prevalence and incidence of off-label use during the entire study period and by year. The overall prevalence and incidence of off-label use of canagliflozin in T1DM were consistently low, ranging from 0.0% to 0.2% across six healthcare databases, using both primary and sensitivity definitions of patients with T1DM. A trend analysis of new users of canagliflozin with T1DM over time was not feasible given that the annual prevalence and incidence calculations for many years were censored. Few (number censored) to no diabetic ketoacidosis (DKA) events were reported among canagliflozin users with T1DM in each database. Real-world data analyses from four European countries showed that off-label use of canagliflozin for T1DM was rare.

An Analysis of Major Adverse Cardiovascular Events, Other Adverse Events, and Efficacy in Patients with Rheumatic Disease Receiving Targeted Therapy: Experience from a Third-Level Hospital

Objectives: We wished to evaluate the safety profile of the Janus kinase (JAK) inhibitors used in the Spanish population; to study the onset of major adverse cardiovascular events (MACEs) and thrombotic events (arterial and venous); and to analyze the factors associated with the onset of these events. Methods: We conducted a retrospective observational study of a cohort of patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA) included in the biological therapy registry of the Rheumatology Department of Virgen Macarena University Hospital (HUVM), Seville, Spain, who started targeted treatment between 2019 and late 2024. We collected data on disease activity, traditional cardiovascular risk factors, the Charlson comorbidity index, previous synthetic or biologic drug therapy, the use of corticosteroids (and their dose), severity data (structural damage, extra-articular manifestations), and adverse events at the end of follow-up (e.g., MACEs, infections, neoplasms, and herpes zoster). We performed a descriptive bivariate analysis and a multivariate logistic regression analysis (dependent variable: MACEs) to identify factors that were independently associated with MACEs. Results: The study population comprised 137 patients (110 with RA, 18 with PsA, and 9 with SpA) who were followed up for a mean of 3.9 (2.6) years. Most patients had received JAK inhibitors as their second-line or subsequent treatment. At the end of the follow-up, 82 patients (66.7%) continued their treatment. Nine patients (6.6%) experienced a MACE, and five experienced a heart attack. All of these patients had RA. We found no differences between JAK inhibitors in terms of the incidence of the adverse events studied. Patients who experienced MACEs were more often male and smokers (current or former) and more often had hypertension and diabetes. No significant differences were found in the association with disease activity or previous or concomitant treatment. The factors that were independently associated with MACEs were a previous cardiovascular event (OR, 10.74; 95%CI, 1.05–113.7; p = 0.036), male sex (OR, 9.7; 95%CI, 1.6–76.5; p = 0.016), diabetes mellitus (OR, 10.3; 95%CI, 1.75–83; p = 0.013), and the duration of treatment with JAK inhibitors (OR, 1.47; 95%CI, 1.13–2.01; p = 0.005). Conclusions: We found no differences in the onset of adverse events, specifically MACEs, between the different JAK inhibitors analyzed. These events are more common in patients who already have cardiovascular risk factors, such as diabetes mellitus, or who have already experienced a cardiovascular event. JAK inhibitors broadly suppress cytokines in patients whose disease is refractory to other treatments. However, we must continue to evaluate their long-term safety in real-world studies.

Impact of Nurse-Led Home Visits on Foot Ulcer Prevention in Elderly Type 2 Diabetics: A Cluster Randomized Trial

Foot ulcers are a prevalent and debilitating complication among elderly individuals with type 2 diabetes mellitus (T2DM), often resulting in increased morbidity, reduced mobility, and a heightened risk of lower limb amputation. As traditional outpatient models may fall short in addressing the preventive needs of this high-risk population, nurse-led home visits have emerged as a promising alternative. This review evaluated the impact of such interventions on foot ulcer prevention in elderly T2DM patients, synthesizing evidence from cluster randomized trials (CRTs). A narrative review methodology was employed, drawing insights from peer-reviewed CRTs that investigated clinical efficacy, behavioral outcomes, and implementation challenges associated with nurse-led home care models. Key components of these interventions include foot risk assessment, individualized education, self-care reinforcement, environmental hazard evaluation, and early referral for advanced care. Findings from CRTs consistently demonstrate a significant reduction in foot ulcer incidence and improvement in foot care practices among patients receiving home-based nursing care. Moreover, these interventions prove feasible and cost-effective, although challenges such as staffing limitations and reimbursement barriers persist. Nurse-led home visits not only enhance clinical outcomes but also align with broader goals of aging-in-place and chronic disease management. They represent a scalable and patient-centered strategy with substantial implications for geriatric diabetes care. Keywords: Type 2 Diabetes Mellitus, Foot Ulcer Prevention, Nurse-Led Home Visits, Elderly Patients, Cluster Randomized Trials.

Association of peripheral inflammatory cytokines with motor and non-motor symptoms in patients with Parkinson’s disease and type 2 diabetes mellitus

ObjectiveThis pilot study aims to investigate the association between peripheral inflammatory cytokines and motor and non-motor symptoms in patients with both Parkinson’s disease (PD) and type 2 diabetes mellitus (T2DM) and the underlying mechanisms.MethodsSixty patients with PD were divided into two groups depending on whether they also had T2DM, resulting in a PD group (21 cases) and a PD–T2DM group (39 cases). Thirty healthy volunteers from the physical examination centre were enrolled as the control group. Peripheral blood was collected from all patients.ResultsPatients with PD–T2DM had higher Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) III scores; total MDS-UPDRS scores; Parkinson’s Disease Questionnaire-39 (PDQ-39) scores; and interleukin (IL)-6, IL-1β, tumour necrosis factor alpha (TNF-α) and IL-4 levels than patients with PD (p &amp;lt; 0.05). In the PD group, IL-4 levels correlated with UPDRS II (r = 0.337), Non-Motor Symptom Scale (r = 0.354), Hamilton Depression Scale (r = 0.420) and PDQ-39 (r = 0.423) scores (p &amp;lt; 0.05). A multivariate regression revealed IL-6 independently predicted lower UPDRS III scores (β = −0.497, p = 0.018), TNF-α correlated with PD duration (β = 0.689, p &amp;lt; 0.001) and IL-1β correlated with PDQ-39 scores (β = 0.462, p = 0.002) in patients with PD–T2DM. Adjusted models explained up to 52.3% of variance (adjusted R2). In the PD group, age-adjusted correlations confirmed IL-4 was associated with UPDRS II (r = 0.321, p = 0.047) and PDQ-39 (r = 0.418, p = 0.009), and interferon gamma (IFN-γ) was associated with Scales for Outcomes in Parkinson’s Disease-Autonomic Questionnaire (SCOPA-AUT; r = −0.564, p = 0.001). Negative correlations were identified between IL-6 and UPDRS III scores (r = −0.497) and IFN-γ and SCOPA-AUT scores (r = −0.588; p &amp;lt; 0.05).ConclusionThese pilot findings suggest peripheral inflammatory cytokines can be considered biomarkers in patients with PD–T2DM. The underlying mechanism by which T2DM worsens the motor and non-motor symptoms of PD may involve increased inflammation.