Purpose: Given the substantial damage to visual function caused by diabetic retinopathy, this study explored the changes in the fundus microcirculation of diabetic patients without diabetic retinopathy to provide a basis for the prevention and early detection of diabetic retinopathy. Methods: This clinical observational study included 162 eyes of diabetic patients without clinical diabetic retinopathy and 108 healthy eyes. Retinal and choroidal parameters, namely, the foveal avascular zone (FAZ) and vessel density of the superficial capillary plexus (SCP), deep capillary plexus (DCP), full retina and large and middle choroidal vessel (LMCV) layers, were measured in the central and peripheral areas of 24 × 20 mm2 ultrawide-field swept-source optical coherence tomography angiography (UWF-SS-OCTA) images. The Mann‒Whitney U test or Wilcoxon signed-rank test was used for comparisons between groups, and the Kruskal‒Wallis H test was used for comparisons among multiple groups, followed by Bonferroni correction for multiple comparisons. Results: The FAZ in the diabetic group was greater than that of the control group. The diabetic group had lower vessel densities in the SCP (0–3, 4–6, and 13–24 mm diameter ranges), DCP (0–3, 4–6 and 7–12 mm diameter ranges), full retina (0–3 and 4–6 mm diameter ranges), and LMCV layers (4–6 and 13–24 mm diameter ranges) (p < 0.05). Significant differences (p < 0.05) were observed between the vascular density of the SCP (diameter ranges 0–3 and 7–12 mm), DCP, full retina, and LMCV layers (4–6 mm range) in all disease duration groups and those in the control group. Pairwise comparison showed that the vascular density decreased more significantly in the group > 15 y group (p < 0.05). Conclusion: Decreased retinal choroidal microcirculation occurs in diabetic patients before clinical retinopathy develops and becomes more pronounced with increasing disease duration, suggesting that diabetic patients should undergo regular fundus examinations to detect and potentially prevent diabetic retinopathy as early as possible.

Background The Triglyceride-Glucose (TyG) index, a surrogate marker of insulin resistance, is associated with increased cardiovascular risk. However, its relationship with subclinical atherosclerosis in diabetic patients with early-stage kidney injury, characterized by an elevated urinary albumin-to-creatinine ratio (ACR), remains unclear. This study examined the association between carotid intima-media thickness (IMT) and the TyG index, specifically investigating how this association is modified by albuminuria status. Methods This cross-sectional study included 507 patients with type 2 diabetes and preserved kidney function who had ACR values of 0–300 mg/g. Participants were stratified into quartiles based on ACR levels. IMT was measured using high-resolution B-mode ultrasonography. The relationship between the TyG index and IMT was evaluated using partial correlation and multivariate linear regression analyses, with emphasis on assessing this relationship across ACR-based strata. Result A weak positive correlation was observed between the TyG index and IMT overall ( r = 0.12, P = 0.035), with a significant interaction effect of ACR ( p = 0.008). Stratification by ACR showed that for patients with ACR ≤ 30 mg/g, each unit increase in the TyG index was associated with a 0.038 mm increase in IMT (95% CI: 0.015–0.061, p = 0.002), while for those with ACR &amp;gt; 30 mg/g, the increase was 0.071 mm per unit (95% CI: 0.036–0.106, p &amp;lt; 0.001). Furthermore, a graded pattern was observed across ACR quartiles, with the positive correlation between TyG and IMT showing graded strengthening ( β values increased from 0.022 to 0.078, p for trend &amp;lt;0.001;). Finally, the TyG–IMT correlation exhibited age specificity, being significant in patients under 50 years (&amp;lt;40 years: β = 0.085, p = 0.002; 40–49 years: β = 0.051, p = 0.015) and diminishing in older age groups. Conclusions The association between the TyG index and IMT exhibits stage-specific and population-heterogeneous patterns. A significant, ACR-dependent positive correlation was observed, with the association being pronounced in patients with elevated ACR (&amp;gt;30 mg/g) and in those younger than 50 years. These findings suggest that the pro-atherogenic effect of insulin resistance is more pronounced in diabetic patients with early albuminuria or in younger individuals, underscoring the need for enhanced vascular management to reduce insulin resistance in these high-risk populations.

Diabetic patients undergoing percutaneous coronary intervention (PCI) frequently have complex coronary artery disease (CAD) and suboptimal outcomes with drug-eluting stents (DES). Sirolimus-coated balloons (SCB) have recently been introduced, but comparative data versus DES in diabetic patients with de novo CAD are lacking. The SIMPLE-DM study is a pooled analysis of five observational registries including all-comer diabetic patients undergoing PCI for de novo CAD. Patients in the SCB cohort were treated with the phospholipid nanocarrier Magic Touch SCB, while those in the DES cohort received current-generation DES. Propensity score (PS) adjustment was used to balance clinical and angiographic characteristics. The primary endpoint was the 2-year cumulative incidence of target lesion failure (TLF), defined as the composite of cardiac death, target vessel MI (TV-MI), or target lesion revascularization (TLR). A total of 1838 patients were included, 599 treated with SCB-based PCI and 1239 with DES-only PCI. At 2 years, TLF occurred in 9.1% of SCB and 9.9% of DES patients (adj. hazard ratio HR 0.88, 95% confidence interval CI 0.43-1.81, p = 0.736). No significant differences were found in cardiac death, TV-MI or TLR. SCB-based PCI was associated with more favourable outcomes in patients with chronic kidney disease (p for interaction = 0.042) and long lesions (p for interaction = 0.003), whereas DES-only PCI performed better in those with short lesions. In diabetic patients undergoing PCI for de novo CAD, an SCB-based strategy was associated with comparable 2-year outcomes to DES-only PCI, with signals of potential benefit in the highest clinical and anatomical risk subsets.

Objective: To evaluate transfusion and chelation status among thalassemia patients, determine the prevalence of hyperglycemia, and assess whether adherence to chelation therapy is associated with differences in hyperglycemia severity. Study Design: Descriptive cross-sectional study Place and Duration of Study: This study was conducted at the Department of Pathology (Hematology) in collaboration with the Department of Pediatrics, Pakistan Railways Hospital (PRH), and the Thalassemia Center, Rawalpindi from September 2023 to September 2024. Methods: A total of 137 patients with thalassemia major were assessed. Patients were categorized into three management groups: well transfused and adequately chelated (12.4%), well transfused but inadequately chelated (29.9%), and irregularly transfused with inadequate chelation (57.7%). Glycemic status was classified as normal, impaired glucose regulation, or diabetes mellitus. Results: Among the 137 patients, 55.5% had normal glucose levels, 32.8% had impaired glucose regulation, and 11.7% were diabetic. Diabetes showed a significant association with irregular transfusion and inadequate chelation (p &lt; 0.001). Of the diabetic patients, 78.5% were irregularly transfused and inadequately chelated, while 21.5% were well transfused but inadequately chelated. Importantly, none of the well transfused and adequately chelated patients were diabetic. Conclusion: Effective transfusion schedules combined with adequate chelation therapy appear protective against the development of diabetes in thalassemia major. Poor adherence to transfusion and chelation regimens is strongly linked with hyperglycemia and diabetes, underscoring the need for strengthened patient education, monitoring, and early intervention strategies to prevent iron-related endocrine complications.

Association of HbA1c with renal markers and lipid profile in Type 2 diabetic patients

INTRODUCTION: Diabetic patients are exposed to information regarding diabetic eye complications and may therefore be aware of visual function problems even when diabetic retinopathy (DR) is absent or minimal. Hence, it is important to assess vision-related quality of life (VRQL) even in patients with no orminimal DR and preserved visual acuity. MATERIAL AND METHODS: This observational, matched case-control study involved diabetic patients aged above 45 years. The VRQL was measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25, version 2000). Multiple linear regression analysis was performed to compare VRQL between cases and controls after adjusting for age and gender. RESULTS: After adjustment for age and gender, cases had a significantly lower general health score than controls (mean difference -16.33; 95% CI -19.99 to -13.45; p&lt;0.001). Near-activity scores were also significantly lower among cases (mean difference -5.32; 95% CI -8.23 to -2.41;) p&lt;0.001). Although cases demonstrated a lower composite VRQL score, the difference was not statistically significant (b -0.71, 95% CI -3.57 to 2.15;p&gt;0.05). CONCLUSION: This study showed VRQL is more strongly associated with visual acuity than with the stage of diabetic retinopathy. Hence, we recommend comprehensive counselling regarding vision-related issues to all patients with diabetes.

Diabetes mellitus (DM) is a multifactorial disease driven by genetic and environmental factors, with type 2 diabetes mellitus (T2DM) constituting the majority of cases. A major cause of morbidity and mortality in diabetic patients is cardiovascular disease (CVD), which is closely linked to epigenetic mechanisms such as microRNA (miRNA) regulation. MiRNAs are small, non-coding RNA molecules that modulate gene expression at the post-transcriptional level, influencing key metabolic and inflammatory pathways. In T2DM, dysregulated miRNA expression contributes to insulin resistance, beta cell dysfunction, endothelial impairment, and vascular complications. Specific miRNAs, including miR-126, miR-375, and miR-21, have been identified as biomarkers for early diagnosis and disease progression. Moreover, miRNA-targeted therapies hold potential for novel therapeutic interventions in T2DM and associated CVD. This review explores the role of miRNAs in T2DM pathogenesis and their implications for cardiovascular complications, emphasizing their potential as biomarkers and therapeutic targets for precision medicine.

Objective: To compare the clinical features and acoustic characteristics of native arteriovenous fistulas (AVF) between maintenance hemodialysis (MHD) patients with and without diabetes mellitus. Methods: In this cross-sectional study, MHD patients using AVF from the Blood Purification Center of Northern Jiangsu People's Hospital Affiliated to Yangzhou University between March and August 2024 were enrolled. AVF morphology and hemodynamics were assessed via ultrasonography, while concomitant audio recordings were obtained for acoustic analysis. Participants were stratified by diabetes status, and differences in clinical, ultrasonographic, and acoustic features were analyzed. Results: A total of 192 patients (119 males and 73 females) aged (58.6±12.7) years were enrolled. Those with diabetes had greater height, weight, and body surface area but shorter dialysis duration and lower albumin, prealbumin, and hemoglobin levels (all P<0.05). Ultrasonography revealed smaller vascular diameters at the anastomosis, within 3 cm proximally, at the puncture site, and in the radial artery 2 cm from the brachial artery bifurcation in the diabetic group (all P<0.05). Resistive indices (at the anastomosis and within 3 cm proximally) and puncture depth were higher in diabetic patients (all P<0.05). The multiple linear regression analysis indicated that diabetes mellitus (β=0.102, 95%CI: 0.051-0.153, P<0.001) was associated with an increased anastomosis resistive index. The diabetic group demonstrated a significantly higher zero-crossing rate [0.011 (0.009, 0.012) vs 0.008 (0.007, 0.011), P<0.001], but lower acoustic wave amplitude [-13.2 (-20.6, -10.6) dB vs -11.5 (-14.3, -10.3) dB, P=0.049], mean mel-frequency cepstral coefficients (MFCC) [7.6 (0.4, 10.2) vs 10.4 (7.2, 12.2), P<0.001], and mean extended Geneva minimalistic acoustic parameter set (eGEmaps) values [112 (109, 114) vs 113 (112, 115), P=0.011] compared to the non-diabetic group. Conclusions: MHD patients with diabetes exhibit distinct AVF profiles characterized by smaller vascular diameters, greater puncture depth and resistance indices, higher acoustic zero-crossing rates, and lower mean MFCC and eGEMAPS values compared to non-diabetic patients.

Background/Objectives: Deep neck space abscesses (DNSAs), representing severe suppurative infections, continue to pose a significant global health challenge due to their morbidity, mortality, and evolving epidemiology. This review synthesizes existing knowledge regarding DNSA definitions, anatomic basis, epidemiological trends, microbiology, clinical presentation, diagnostic strategies, treatment paradigms, outcomes, health system challenges, and disparities to guide global efforts in DNSA prevention, management, and research. Methods: A structured narrative review was performed following SANRA guidelines. PubMed/MEDLINE and the Cochrane Library were searched from January 2000 to May 2025, retrieving 1102 records. After screening, 49 studies met the inclusion criteria. Data were extracted using standardized templates and synthesized thematically. Results: During the period 2004–2015, annual case increases were reported in a Finnish population-based retrospective cohort (n = 277), going from 14 to 24 subjects, and for a UK tertiary center retrospective series, going from 1 to 15 cases annually (2006–2015) (Pearson’s correlation, r = 0.9; p = 0.00019). The microbiological environment is mostly polymicrobial, composed of group streptococci and staphylococcus strains and anaerobes. Factors associated with poor outcomes include diabetes mellitus (adjusted hazard ratio of 10.7 [95% CI 6.0–19.1] in a retrospective, population-based cohort of 12,738 diabetic patients compared to 50,952 individuals without diabetes), immunosuppressed state, elderly age, and multispace involvement. Diagnosis relies on contrast-enhanced CT imaging (sensitivity &gt; 90%), and treatment consists of early multidisciplinary intervention combining empiric broad-spectrum antibiotics with surgical drainage in 60–97% of cases. Mortality ranges from 1.6% to 7.6%, with higher rates in cases complicated by mediastinitis (up to 40%). Conclusions: DNSAs demonstrate a clear upward incidence trend across high-income and resource-limited settings. Establishing standardized DNSA registries, validating risk-stratification tools, reinforcing antimicrobial stewardship to address rising resistance, and implementing early detection protocols in primary care remain critical priorities. While emerging technologies, including rapid molecular diagnostics and AI-based decision support, represent promising research directions, current DNSA management relies fundamentally on conventional clinical assessment, prompt imaging, and coordinated multidisciplinary care.

Practices for glucose measurement with a glucometer in a population of diabetic patients. An observational study.

Background Diabetic retinopathy (DR) is a common chronic complication of diabetes mellitus. Endothelin-1 (ET-1) has been identified as a key regulator of various ocular functions, including vascular perfusion, aqueous humor dynamics, and retinal ganglion cell survival. Substantial evidence further underscores the critical involvement of ET-1 in the pathogenesis and progression of DR. Elevated ET-1 levels have been reported in patients with DR; however, findings across studies are inconsistent. Aim This meta-analysis aimed to statistically evaluate the level of ET-1 in patients with DR. Methods A systematic literature search was conducted across five electronic databases (PubMed, Web of Science, OVID, Elsevier Science Direct, and Wiley Online Library). The search strategy targeted the terms “Endothelin-1” or “ET-1” in conjunction with “Diabetic retinopathy” or “DR” in title and abstract fields. Results are presented as standardized mean differences (SMD) with 95% confidence intervals (CI). Results Ten articles (346 cases and 425 controls) were included in the meta-analysis. The results of the meta-analysis indicated that the circulating ET-1 in patients with DR was significantly higher than that of the controls (SMD: 1.73, 95% CI: 0.90, 2.56). Furthermore, circulating ET-1 in patients with DR was also significantly higher than those in healthy individuals or diabetic patients without retinopathy, respectively. Conclusions This meta-analysis is the first to systematically assess ET-1 levels in patients with DR. The findings of this study indicate the potential application of ET-1 as a biomarker for monitoring DR progression. Systematic Review Registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420251156225.

Genome-wide transcriptional analysis of tendon tissue-related genes and pathways in the torn rotator cuff of diabetes patients.

Chronotherapy optimises the management of hypertension by synchronising medication with circadian rhythms. When taken in accordance with biological patterns, the long-acting angiotensin II receptor blocker telmisartan may provide extra advantages, particularly for patients with diabetes mellitus who have hypertension. The purpose of this study is to compare the effects of telmisartan 40 mg taken in the morning versus at bedtime on the mean blood pressure (BP) during the day and at night, as well as the BP response to exercise, in patients with diabetes mellitus. Forty diabetic hypertensive patients were given telmisartan either in the morning or at bedtime for 8 weeks, followed by a 1-week washout and cross-over in a cross-over randomised controlled trial. In addition to treadmill exercise testing (Bruce protocol), ambulatory BP was measured. Bedtime dosing considerably reduced the systolic and diastolic BP at night when compared to morning dosing. Morning dosing was especially successful in lowering BP increases brought on by exercise. No noteworthy adverse events were observed. Bedtime telmisartan dosage improves nocturnal BP control, but morning dosage more successfully lowers exercise-induced BP spikes. Individualised chronotherapy may improve outcomes and control hypertension in diabetic patients.

ObjectivesLimited evidence exists regarding the association of vitamin D status with lower extremity arterial plaque progression and diabetic foot ulcer outcomes. This study investigated the relationship between vitamin D status and the risk of lower extremity arterial plaque progression and diabetic foot ulcer development.MethodsIn this cross-sectional analysis of 7476 consecutively hospitalized type 2 diabetes patients (2018-2024), serum 25-hydroxyvitamin D level was measured using the electrochemiluminescence method. Vitamin D deficiency (<20 ng/mL) and insufficiency (20-30 ng/mL) were defined per the Endocrine Society guidelines. Lower extremity arterial plaque was identified using arterial Doppler ultrasonography, and diabetic foot ulcer was diagnosed using the International Working Group on the Diabetic Foot 2019 criteria. Multivariate logistic regression and receiver operating characteristic analyses were used to evaluate associations between parameters.ResultsDecreased 25-hydroxyvitamin D levels were correlated with adverse lipid profiles (high-density lipoprotein cholesterol: r = 0.152, P < 0.001) and elevated inflammatory markers (high-sensitivity C-reactive protein: r = -0.086, P < 0.001). Lower extremity arterial plaque patients (n = 4622) exhibited longer diabetes duration, higher glycosylated hemoglobin levels, and reduced 25-hydroxyvitamin D levels compared with those without lower extremity arterial plaque (19.98 vs. 23.41 ng/mL, P < 0.001). The prevalence of diabetic foot ulcer in lower extremity arterial plaque patients was 2.8%, and the levels of 25-hydroxyvitamin D were significantly lower in diabetic foot ulcer patients than in nondiabetic foot ulcer patients (14.77 vs. 19.98 ng/mL, P < 0.001). Adjusted models revealed that 25-hydroxyvitamin D level was an independent protective factor against lower extremity arterial plaque (odds ratio = 0.938, 95% confidence interval: 0.914-0.963) and diabetic foot ulcer (odds ratio = 0.938, 95% confidence interval: 0.932-0.944). Receiver operating characteristic curve analysis demonstrated that a 25-hydroxyvitamin D level ≤18.94 ng/mL predicted lower extremity arterial plaque, with an area under the curve value of 0.651, which improved to 0.703 when combined with the duration of diabetes and white blood cell count. For diabetic foot ulcer prediction, a 25-hydroxyvitamin D level ≤17.11 ng/mL achieved an area under the curve value of 0.674, which increased to 0.764 after adjusting for covariates.ConclusionVitamin D insufficiency is independently associated with lower extremity arterial plaque severity and incident diabetic foot ulcer in type 2 diabetes. Therapeutic implications of vitamin D supplementation warrant prospective investigation.

Molecular hydrogen mitigates acetaminophen-induced liver injury and enhances the effects of N-acetylcysteine in diabetic mice.

The prothrombotic potential of diabetic patients with ischemic heart failure is associated with impaired left ventricular contractility and endothelial dysfunction.

Odontogenic cervical necrotizing fasciitis in diabetic patients – A case series highlighting critical complications and surgical management

Emerging therapies such as autologous platelet-rich plasma (PRP), which delivers a supraphysiological concentration of growth factors including but not limited to PDGF, VEGF, and TGF-β have shown promise in enhancing tissue regeneration and healing. This study compares two treatments for diabetic foot ulcers: the standard method (normal saline washing and routine debridement) and the PRP method (autologous platelet-rich plasma). It evaluates PRP's effectiveness in accelerating healing compared to standard care in diabetic patients, specifically in terms of wound area reduction over a 6-week period, the proportion of patients achieving complete healing, and the average time to healing. In this double-blind randomized clinical trial conducted on patients referred to Velayat Hospital, 50 eligible type I and II diabetic patients aged 40-70 were randomly allocated to two groups using color-coded sealed envelopes, ensuring allocation concealment. One group received PRP and the other standard treatment. Double-blinding was maintained by using identical syringes for both treatments, and independent assessors unaware of group assignments evaluated wound healing weekly. There was no significant difference between the two groups regarding gender and HbA1c levels. However, a significant difference was observed in wound healing rates between the PRP method and the standard method across the two groups. Additionally, a meaningful relationship was found when comparing the average age of patients treated with both methods. There was no significant difference between the two groups regarding gender and HbA1c levels. Ultimately, our research indicates that the PRP method is a more effective alternative to the standard method alone for the treatment of diabetic foot ulcers. Additionally, younger patients demonstrated a faster rate of diabetic foot ulcer healing. PRP's superior efficacy may justify its moderate upfront costs given potential long-term savings from reduced complications.

A systematic review and meta-analysis on partial foot amputation in diabetic foot ulcers.

Introduction: The simultaneous rise of hypertension and diabetes in Indian patients necessitates effective management strategies to prevent severe complications. The study addresses the limited understanding of hypertension management in diabetic patients within the Indian clinical context, highlighting gaps in regionspecific data on expert perceptions and preferred strategies. Aim: To assess Indian physicians’ perceptions and practices regarding the impact of hypertension in patients with diabetes and the most appropriate strategies for managing it. Materials and Methods: The present study was a cross-sectional, questionnaire based electronic survey. A total of 1618 physicians throughout India were invited to participate in an online survey and virtual meetings. The study questionnaire had two sections. Section 1 consisted of four questions focusing on the detrimental effects of hypertension on diabetes. Section 2 included seven questions regarding appropriate management approaches for hypertension. The data collected was analysed using Microsoft Excel 2019 and presented as frequency. Results: Majority of the physicians (39.9%) were from Western region. The majority of participants in this survey had 10-20 years of experience (n=504, 41.2%) and practiced in their clinic (n=541, 44.3%). The expert panel reported that cardiac events (48.22%) were the most common consequence of hypertension in diabetic patients. They recommended telmisartan (85.9%), amlodipine (64.7%), and metoprolol (76.0%) as preferred treatments for managing diabetes with hypertension and cardiovascular Co-morbidities. For patients with diabetes, hypertension, and Chronic Kidney Disease (CKD), telmisartan (84.0%), amlodipine (63.4%), and hydrochlorothiazide (63.1%) were favoured. Additionally, 51.3% of diabetologists did not recommend the use of dual RAAS inhibitors (ACE inhibitors+ARB). In a patient with diabetes, hypertension and a history of stroke, if Blood Pressure (BP) remains uncontrolled on an optimal ARB dose, Calcium Channel Blockers (CCBs) should be added as a second-line therapy. Conclusion: Appropriate management strategies, such as enhancing medication adherence, patient education, and selecting effective treatments, can prevent the detrimental effects of hypertension in patients with diabetes and Co-morbidities. Indian diabetologists typically prefer ARBs as the first-line therapy and CCBs, beta-blockers, or diuretics as second-line options. The most commonly chosen medications include telmisartan, amlodipine, metoprolol, and hydrochlorothiazide. As a secondline treatment, CCBs are particularly preferred for patients who have both diabetes and CKD.