Exploring the association between prophylaxis and diabetic complications among adults with diabetes and periodontal disease.

Background: Stigma experiences challenge Type 1 Diabetes Mellitus (T1DM) adolescents. Such an impact causes complications in their self-management behaviour and identity formation. Aim: To critically synthesise, analyse, interpret and reflect on research regarding the experiences of T1DM adolescents and stigma through identifying the types of stigma experienced and the impact they have on T1DM adolescents. Method: Three scholarly databases were used to identify scientific data, which was subjected to a screening process using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method of extraction and analysis. One hundred and nine articles were scanned, yet 14 eligible articles were included in the review. Using thematic analysis, the experiences of T1DM adolescents and stigma were consolidated, improving our understanding of the interactive nature of stigma. Results: T1DM adolescents experience social, enacted, internal and self-stigma. These experiences result in suboptimal T1DM self-management and the non-disclosure of a T1DM diagnosis. Negative effects associated with stigma experiences are linked to challenges in T1DM identity integration and decreased wellness. A diagram was developed to explain the continuous interactive nature of stigma. Conclusion: Stigma experiences may have a negative impact on adolescents in the absence of support structures and appraisal strategies. Contribution: Within a primary care setting, practitioners are empowered to comprehend the stigmas experienced by T1DM adolescents. Through this knowledge, adolescents may be educated to cope with such experiences without compromising their T1DM self-management or their psychosocial development. Academically, the model can assist future researchers in understanding the relationships that exist between stigmas while informing opportunities for interventions in curbing the effects of stigma.

IntroductionWhile previous studies have examined the link between Type 2 Diabetes Mellitus (T2DM) and cognitive function in middle-aged adults, no review has explored the long-term effects on cognition of T2DM when diagnosed at midlife. This review aims to investigate any association between T2DM and its metabolic correlates during midlife and measures of cognitive function, spanning from midlife into later life.MethodsElectronic databases (EMBASE, Medline, CINAHL, Web of Science) were explored from their establishment until December 2023 to identify studies exploring the link between T2DM in midlife (40–65 years) and cognitive function. T2DM was defined based on ESC and AHA criteria, encompassing diabetes status, FBG, HbA1c levels, and MetS presence. Cognitive function in mid and/or later life was categorised into functioning sub-domains, with tests selected to reflect predominant cognitive functions utilised. A random-effects meta-analysis was performed, and study quality assessed using the AXIS tool.ResultsWe included 151 studies of moderate to high quality. Studies were independently screened in a step-by-step process, with a subset of studies that met the criteria selected for inclusion in a meta-analysis. Due to limited availability of raw data for cognitive measures at later life, meta-analysis was conducted on studies assessing cognitive function at midlife only. In the case of later life, the majority of longitudinal studies reported negative relationships between midlife T2DM and cognitive function, specifically in the modalities of executive function and global cognition; findings for memory were conflicting. Qualitive assessment of 107 studies where cognitive function was assessed at midlife found no association between it and midlife T2DM. However, meta-analysis of 10 studies revealed a negative impact of T2DM on memory (MD = −0.19; 95% CI = −0.26 to −0.11; I2 = 25%), executive function (MD = −0.14; 95% CI = −0.25 to −0.04; I2 = 0%), and global cognition (MD = −0.26; 95% CI = −0.34 to −0.17; I2 = 0%).DiscussionThis study highlights the impact of midlife T2DM on a variety of cognitive domains from midlife onwards, suggesting that timely diagnosis of T2DM and its careful management may be an important strategy in preserving cognitive function through the lifespan. Given the contrast in results from qualitative and quantitative analysis that we report in the case of midlife cognitive function, we also emphasise the value of combining both methodological approaches where possible.

Effects of Health Qigong Walking Practice on anxiety and serum metabolites in patients with Type 2 Diabetes Mellitus: A randomized controlled trial.

Background. Cardiovascular-kidney-metabolic syndrome (CKMS) is a multifactorial pathological condition, the pathogenesis of which combines mutually reinforcing mechanisms of cardiovascular, renal and metabolic disorders that significantly increases the risk of progression of coronary heart disease (CHD), type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). The aim of the study was to compare blood lipids in patients with cardiovascular-kidney-metabolic syndrome depending on its stage and the presence of type 2 diabetes mellitus. Materials and methods. All patients with CKMS underwent a general clinical examination with confirmation of the diagnosis of T2DM and CHD. They were divided into six main clinical groups depending on the presence/absence of CHD and T2DM (taking into account the degree of compensation), as well as a control group. The study was conducted in four stages: analysis of lipid metabolism in patients with CKMS without CHD and T2DM, study of blood lipids in patients with CKMS in the presence of CHD, assessment of lipid profile in patients with CKMS and T2DM, analysis of changes in lipid metabolism in CKMS in the presence of CHD and T2DM. Results. In patients with CKMS without CHD and T2DM, there was a significant increase in triglycerides (TG), very low-density lipoprotein (VLDL) cholesterol, indicating an early activation of atherogenesis. In the combination of CKMS with CHD, changes in lipid metabolism are more pronounced — total and low-density lipoprotein (LDL) cholesterol increases, and high-density lipoprotein (HDL) cholesterol decreases. In patients with CKMS with T2DM, regardless of the level of compensation, there was an increase in TG, total and VLDL cholesterol compared to the control group, with the highest values of these parameters noted in T2DM decompensation combined with CHD. In the presence of CKMS, nonspecific atherogenic changes in the lipid levels occur, which progress with the addition of CHD and/or T2DM that creates a high proatherosclerotic threat. Conclusions. In patients with CKMS without CHD and T2DM, lipid disorders are detected in the form of a significant increase in TG, VLDL cholesterol and atherogenic index, which indicates the activation of atherogenesis. In patients with CKMS and CHD, the progression of insulin resistance is accompanied by more pronounced disorders of lipid metabolism — a significant increase in TG and VLDL cholesterol, as well as an increase in total cholesterol by 12.7 % (p = 0.001), LDL cholesterol by 20.37 % (p = 0.002) and a decrease in HDL cholesterol by 28.8 % (p = 0.0009). The presence of T2DM in patients with CRMS, regardless of the degree of its compensation, is associated with a probable increase in TG, total and VLDL cholesterol, and atherogenic index. Patients with CKMS are characterized by the dependence of the degree of atherogenic changes in lipoproteins on the presence and severity of CHD, as well as on the state of T2DM compensation.

The health of patients with type 2 diabetes mellitus (T2DM) may be adversely affected by microplastics (MPs) that are present in the environment. However, most toxicity studies of MPs are conducted on healthy models, which may not accurately reflect the exposure risks for diabetic individuals. Dipeptidyl peptidase IV (DPP4/CD26) is a multifunctional transmembrane glycoprotein with a broad spectrum of biological functions, and its abnormal activity is intimately associated with the development of T2DM. Therefore, noninvasive detection techniques for DPP4 have wide-ranging applications in disease diagnosis and MPs toxicity research. Here, we developed an enzyme-activatable near-infrared fluorescent probe, Cy-DPP, to monitor DPP4 activity in cells and mice exposed to MPs. Using this probe, we detected changes in DPP4 levels in healthy model mice and T2DM mouse models after exposure to MPs, respectively. Our results revealed a differential upregulation of DPP4, with varying degrees of increase observed between T2DM cells and mouse models. This study not only offers a new approach for the early diagnosis of T2DM but also highlights the significant impact of MPs on the diabetic condition.

BackgroundLimited data are available on the risk of pancreatic adverse events among people with obesity or type 2 diabetes mellitus (T2DM) initiating glucagon-like peptide-1 receptor agonist (GLP-1 RA).MethodsRetrospective study utilizing data from a federated research network (TriNetX). Adult people (≥ 18 years) with a diagnosis of obesity (body mass index ≥ 30 kg/m2) or T2DM (ICD-10-CM: E11) between 2018 and 2024 were subdivided in two mutually exclusive cohorts: (1) GLP-1 RA Users; and (2) Non–GLP-1 RA Users. Primary outcomes were 1-year risk of all-cause death and a composite outcome (acute pancreatitis, chronic pancreatitis). Secondary outcomes included the individual components of the composite outcome and pancreatic cancer. Cox regression analyses were employed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) before and after 1:1 propensity score matching (PSM). Sensitivity analyses stratified follow-up into early (first 6 months) and late (last 6 months) phases. Subgroup analyses were performed based on age (≥ 65 or < 65 years), sex, and the history of smoking and alcohol use, hypertriglyceridemia, cholelithiasis, heart failure, and chronic kidney disease.ResultsWe identified 1,562,626 people who initiated treatment with GLP-1 RA (mean age 55.3 ± 14.0 years; 59.2% female) and 18,652,572 those who did not (mean age 50.6 ± 18.7 years; 54.5% female). Before PSM, GLP-1 RA Users were older, more frequently female, and exhibited a higher burden of endocrine, metabolic and gastrointestinal disorders. After PSM, GLP-1 RA use was associated with a substantially lower risk of all-cause death (HR 0.554, 95% CI 0.542–0.566), and small increased risk of the composite outcome (HR 1.062, 95% CI 1.023–1.102) and acute pancreatitis (HR 1.058, 95% CI 1.015–1.103), with no differences in chronic pancreatitis or pancreatic cancer. The excess risk of acute pancreatitis was more pronounced during the early phase of follow-up (first 6 months). Subgroup analyses showed a higher reduction in death and composite outcome among people aged < 65 years. Additional significant interactions were observed for all-cause death in females and in people with a history of smoking, alcohol use, heart failure, chronic kidney disease, or cholelithiasis.ConclusionGLP-1 RA use was associated with substantially reduced all-cause death but a small increased risk of acute pancreatitis, particularly during early treatment. The survival benefit was more pronounced in younger people and those with cardiometabolic comorbidities, highlighting the need for a careful risk–benefit evaluation when prescribing GLP-1 RAs in high-risk individuals.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12933-025-02986-0.

Intestinal dysbiosis has been linked to metabolic disorders, including insulin resistance and type 2 diabetes mellitus (T2DM). T2DM typically follows a prediabetic stage, during which insulin resistance develops. During the early stages of T2DM, its development can be corrected, thus potentially preventing or delaying the onset of the disease. This secondary, exploratory, cross-sectional comparison study aimed to contrast the gut microbiome of individuals with elevated fasting blood glucose to that of individuals with glucose levels within the normal range. This study involved 65 older adults (ages 76–83 years) enrolled from the randomized controlled trial entitled the “Generation 100 Study”, all of whom consented to provide their gut microbiome samples. We employed a high-throughput sequencing of the bacterial 16S rRNA gene to obtain metagenomic microbial profiles for all participants. These profiles were then correlated with clinical measures. Overall, microbial alpha diversity was significantly reduced in the high glucose group. We have also observed distinct patterns of microbial beta diversity between high and normal glucose groups. At the phylum level, we found that Synergistes, Elusimicobia, Euryarchaeota, Verrucomicrobia, and Proteobacteria were all significantly decreased in participants with high blood glucose. Additionally, P. copri (ASV 909561) was significantly elevated (10-fold increase) in the high glucose groups, suggesting that it may serve as an early T2DM marker. In contrast to prior reports on the Fusobacterium genus, we found that it was significantly increased in the normal glucose group, with a significant 151-fold increase compared to the high glucose group. Directly linking gut microbiota profiles with clinical indicators such as fasting blood glucose and T2DM diagnosis allows the identification of specific microbial features associated with glucose dysregulation, providing preliminary population-level evidence to guide future translational research. Our results indicate significant changes in the microbiome that may provide valuable insights for early intervention in pre-diabetic states.

Type-1 diabetes (T1D) pathogenesis is either initiated or accelerated by human enteroviruses, particularly Coxsackie viruses. Because the structural makeup of the virus's viral protein 2 C (P2-C) and the glutamic acid decarboxylase (GAD65) autoantigen in human beta-cells is similar, Coxsackie B viruses are one of the primary causes of type 1 diabetes. The study identified the molecular presence of the Coxsackie B virus and ascertained its seroprevalence in patients with type 1 diabetes mellitus. From March 2023 to January 2024, a hospital-based cross-sectional study was conducted in three hospitals in Jigawa State: Dutse General Hospital, Hadejia General Hospital, and Ringim General Hospital. Ninety blood samples from diabetes patients who gave their consent were collected from the research facilities. Blood sugar levels exceeding 200 mg/dL or 11.1mmol/L were used to diagnose type-1 diabetes mellitus (T1DM) in patients based on clinical characteristics. IgM indirect ELISA detection against the GAD65 autoantibody in the patients' serum was used to confirm the diagnosis of T1DM. The virus was also detected by IgM detection and molecular technique (RT-PCR). Out of 90 blood samples, 52% of all samples of T1D patients were positive for Anti-GAD65. 11 were positive for the CBV IgM antibody, indicating a prevalence of 12.2% of T1D patients across all patient groups. The RT-PCR results indicated the presence of the RNA genome of Coxsackie B virus in the serum of some T1DM patients, with a prevalence of 2.2% (2/90), as indicated by the detection of the VP1 gene. The findings demonstrated that in Jigawa state, CBV is not the most likely causative agent of T1D; rather, risk variables for the disease include sex, age, educational attainment, parental status, and the mechanism of disease acquisition and residency. However, other factors may be taken into consideration in future research. To lower the prevalence or eradicate the disease, it may be advisable to conduct more studies on the various causative agents of T1D and to provide early treatment for affected individuals. Additionally, relevant agencies should establish public awareness campaigns on the impacts of the disease.

Recommendations for the evaluation and treatment of patients with diabetes and albuminuria. Role of non-steroidal mineralocorticoid antagonism.

The objective of this study was to examine how diabetes-related emotional distress and depressive symptoms are uniquely related to objective measures of glycemic outcomes in people with Type 2 diabetes mellitus (T2DM). Existing research demonstrates that diabetes distress is better able to account for glycemic outcomes when compared to depressive symptoms. However, few studies have focused on this comparison when assessing glycemic outcomes using continuous glucose monitoring (CGM) indices specifically in T2DM populations. Sixty-three adults diagnosed with T2DM were recruited from an outpatient endocrinology clinic. Diabetes-related emotional distress and depressive symptoms were assessed via self-report measures. Glycemic outcomes were measured using the gold standard hemoglobin A1c and 7 days of CGM data (measuring both glucose concentration levels and variation). The relationship between diabetes-related emotional distress (operationalized as a latent factor), depressive symptomatology, and glycemic outcome metrics (i.e., hemoglobin A1c and CGM-based) was evaluated using structural equation modeling. Moderate-sized associations were observed between diabetes-related emotional distress and a majority of the glycemic outcome metrics when controlling for depressive symptoms. No associations were observed between depressive symptoms and glycemic outcome metrics when controlling for diabetes-related emotional distress. The findings suggest that following a T2DM diagnosis, diabetes-related emotional distress is better able to account for variance in glycemic outcomes when compared to depressive symptoms. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Metabolic dysfunction-associated steatotic liver disease (MASLD) and diabetes independently contribute to increased gut permeability. Whether metabolic alterations of type 2 diabetes mellitus (T2DM) are further increased by the concomitant presence of MASLD and may explain cardiovascular risk is unknown. We analyzed differences in biomarkers of gut permeability alteration related low-grade endotoxemia and oxidative stress in T2DM with or without MASLD. Enrolled patients were included if they had a diagnosis of T2DM. In the presence of hepatic steatosis, the finding of any cardiometabolic risk factors would confer a diagnosis of MASLD if there are no other causes of hepatic steatosis. Blood samples were collected for oxidative stress and gut permeability evaluation. Overall, 190 patients were included, of which 95 had concomitant MASLD and 95 had no concomitant MASLD. Patients with MASLD had significantly higher values of lipopolysaccharide (LPS) and zonulin compared with patients without MASLD. Patients with MASLD have significantly higher values of NOX-2 activity and hydrogen peroxide compared with patients without MASLD. Linear correlation analysis demonstrated a significant and direct correlation between LPS and zonulin ( R = 0.47, p = 1.3e-11). These results support the hypothesis that patients with MASLD exhibit an increase in gut permeability alteration related low-grade endotoxemia and oxidative stress compared with patients without MASLD. Antioxid. Redox Signal. 00, 000–000.

Disclosure: L. Abdul Jabbar: None. B. Ataallah: None.Introduction: Type 1 diabetes mellitus (T1DM) is typically diagnosed in childhood, with a late-onset diagnosis being extremely rare. However, autoimmune diabetes can occur later in life, especially in the context of dysregulation of the immune system. Immune checkpoint inhibitors (ICIs), used for malignancies like triple-negative breast cancer (TNBC), have been linked to developing T1DM. This case highlights the importance of recognizing autoimmune diabetes in middle-aged adults undergoing ICI therapy. Case Report: A 46-year-old female with a past medical history of TNBC presented to clinic with pre-diabetic symtoms and A1c of 7% that was found incidently while receiving chemotherapy and steroids. She was initially, started on basal-bolus insulin with continuous glucose monitoring (CGM). Despite steroid discontinuation, her blood glucose remained uncontrolled. This prompted further testing for T1DM which showed a low C-peptide (<0.1 ng/mL), elevated glutamic acid decarboxylase (GAD) antibodies (>250 IU/mL), and Islet antigen 2 (IA-2) antibodies (8.7 IU/mL), confirming autoimmune T1DM. The patient was also found to have pembrolizumab-induced hypothyroidism (TSH:13.70 μIU/mL). Throughout her course of treatment, no adrenal insufficiency (AI) was noted, and her blood glucose level were later controlled with an insulin pump. Discussion: Late-onset T1DM is rare and may present with prior episodes of ketoacidosis. Autoantibodies, including GAD, IA-2, and C-peptide levels, help distinguish T1DM from type 2 diabetes and steroid-induced hyperglycemia. ICIs, such as pembrolizumab, are increasingly linked to endocrine-immune-mediated adverse effects, including thyroiditis and insulin-dependent diabetes. While ICIs enhance immune responses against tumors, they may also trigger pancreatic beta-cell destruction. However, it is unclear if this new-onset diabetes is related to the use of ICI as in this case. The incidence of ICI-induced diabetes is rare (∼1%) but is a critical consideration in oncology patients. In previous studies, it was found that 21% of individuals diagnosed with late-onset T1DM had a rapid insulin requirement over the first 3 years, due to severe endogenous insulin deficiency, confirming the diagnosis of T1DM. Treatment is similar to traditional T1DM, including insulin therapy and CGM. Early identification and genetic testing may help distinguish between autoimmune-mediated diabetes and monogenic diabetes. It can also prevent complications like ketoacidosis. Thus, screening for hyperglycemia, thyroid dysfunction, and AI is a crucial part of the initial workup.Presentation: Saturday, July 12, 2025

Abstract Disclosure: J. Tamayo Acosta: None. G. Rivera Rodriguez: None. R. Trinidad-Hernandez: None. High-titer anti-glutamic acid decarboxylase 65 (anti-GAD65) autoimmunity is emerging as a dual-threat phenomenon that challenges conventional diabetes classification and portends multisystem involvement. When anti-GAD65 titers exceed 25,000 IU/mL, they may unmask latent autoimmune diabetes in adults (LADA) and signal potential central nervous system (CNS) involvement. We present two illustrative cases of older adults originally managed as type 2 diabetes mellitus (T2DM) who were reclassified as LADA after the detection of anti-GAD65 titers &amp;gt;25,000 IU/mL.In the first case, a 61-year-old man with a decade-long presumed T2DM diagnosis and well-controlled hypothyroidism experienced recurrent, severe hypoglycemic episodes despite acceptable self-monitored glucose readings. Paradoxically low HbA1c values, combined with markedly elevated anti-GAD65 titers and positive thyroid autoantibodies, prompted reclassification to LADA. Subsequent neurological evaluation revealed subtle cognitive deficits and neuroimaging abnormalities—including cortical microhemorrhages and cerebellar lesions—raising concerns for CNS involvement and a broader multisystem autoimmune process.In the second case, a 69-year-old woman with historically stable glycemic control underwent abrupt metabolic decompensation, with her HbA1c rising to 12.5%. Further investigation confirmed anti-GAD65 titers exceeding 25,000 IU/mL with preserved C-peptide levels, establishing the diagnosis of LADA. Although overt neurological symptoms were minimal, cognitive screening and neuroimaging suggested early neurocognitive impairment consistent with subclinical CNS involvement. These cases provide critical teaching points: LADA may masquerade as T2DM in older adults, and unexpected hypoglycemia or sudden glycemic deterioration should prompt evaluation for autoimmune markers such as anti-GAD65. Exceptionally high anti-GAD65 titers may signal multisystem autoimmune involvement, including subtle neurological dysfunction. Comprehensive metabolic and neurological assessments, coupled with early interdisciplinary intervention, are essential to optimize outcomes and mitigate long-term complications. Recognizing high-titer anti-GAD65 autoimmunity as a dual threat to metabolic and neural health carries significant implications for contemporary clinical practice in endocrinology. Presentation: Monday, July 14, 2025

Disclosure: M. Murugesh: None. S. Nair: None. B. Simon: None.Glucokinase (GCK) maturity-onset diabetes of the young (MODY) is often misdiagnosed as Type 1 or Type 2 diabetes mellitus (T2DM). The first detection of hyperglycemia can also occur during pregnancy. It often presents with mild fasting hyperglycemia, is not associated with typical vascular complications and can often be managed with diet alone. Accurate diagnosis can be elusive since it requires a high clinical suspicion, thorough patient and family history, and ultimately, genetic testing. This is not only crucial for treatment decisions but also for tailoring management for pregnant patients based on fetal genotype. Despite its clinical relevance, MODY remains underdiagnosed, partly due to underutilization of genetic testing. We present a case of an Asian American female, initially diagnosed with prediabetes at age 30 by hemoglobin A1c (HbA1c) of 6.0%. Family history was significant for presumed T2DM in her father and paternal grandfather. During her first pregnancy at age 34, she was started on insulin and had an uncomplicated delivery (baby weight 7 pounds (lbs.) 14 ounces (oz)). HbA1c increased to 7% one year later, leading to a T2DM diagnosis. Due to metformin intolerance, she resumed insulin. During her second pregnancy at age 35, she continued insulin and had another uncomplicated delivery. When she established care at our institution at age 37, she remained on 15 units of intermediate-acting insulin nightly, reporting hypoglycemia at least once monthly. On physical exam, she was well-appearing with normal vitals, weight 137 lbs., and body mass index (BMI) 22.8. Labs showed HbA1c 6.2%, C-peptide 1.8, glucose 108 mg/dL and negative T1DM associated antibodies. Given her labs, young age at diagnosis, low BMI and family history, genetic testing for MODY was performed and returned positive for GCK MODY. Insulin was stopped, and her HbA1c remained controlled at 6.2% 5 months later. She was referred to medical genetics, with plans to test her children. This patient was treated for gestational DM, subsequently for T2DM, and remained on insulin for 2 years before her MODY diagnosis. Her history, lack of T2DM features, normal C-peptide, negative T1DM antibodies and the non-progressive nature of hyperglycemia prompted the MODY evaluation. The correct diagnosis led to discontinuation of insulin, reduction of hypoglycemia risk, and reassurance of the low risk of diabetic complications over time. Further, treatment during pregnancy may not have been warranted if fetal testing was also positive for the GCK variant.Presentation: Sunday, July 13, 2025

Abstract Background Diabetic nephropathy (DN) is one of the most common microvascular complications of type 2 diabetes mellitus (T2DM) that can develop in the short few years after the diagnosis. As a frequent comorbidity in T2DM, hypothyroidism could also cause renal impairment by metabolic and hemodynamic mechanisms. The current research is designed to assess the role of concomitant hypothyroidism in the development of diabetic nephropathy on an early stage in the treatment of patients with newly diagnosed T2DM. Methods The sample consisted of 80 middle-aged patients with (T2DM) duration of five years or less. The involved participants were separated into two equal pools of study and reported to one of two groups, Group 1 (n = 40) that comprised patients with both T2DM and with a hypothyroidism diagnosis, and Group 2 (n = 40) comprising patients with T2DM diagnosis only. Comparison by Group: Demographic, metabolic parameters, markers of renal functions and such microvascular complications as nephropathy, retinopathy, and hypertension were compared. Results Significantly more participants in Group 1 were females (p &lt; 0.001), had a far higher body weight (p = 0.044) and a higher BMI (p = 0.009). Although the HbA1c levels were similar, Group 1 had attained much lower fasting blood glucose (p = 0.042), postprandial glucose (p = 0.002), and total cholesterol (p = 0.023). Nephropathy was more frequent in Hypothyroid group though statistically insignificant (30% vs. 17.5% p = 0.189). Disease durations and albumin/creatinine ratio were also increased in patients with nephropathy. There were no important correlations in albuminuria duration on diabetes duration and hypothyroidism duration. Conclusion Although the existence of hypothyroidism among patients with early T2DM did not show a significant linkage of diabetic nephropathy, observed trends indicate the possibility of an additive effect on the renal risk. As these findings show, close attention to the performance of the thyroid should be paid, and early renal examination done in patients with diabetes.

AimsThe precise differentiation between Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM) can be challenging in clinical practice, particularly in adults. We aimed to validate the diagnostic accuracy and performance of urinary C-peptide creatinine ratio (UCPCR) for distinguishing T1DM from T2DM in the Emirati population.MethodsThis prospective cross-sectional study included 79 patients with diabetes (19 T1DM, 60 T2DM) from Tawam Hospital Diabetes Center, UAE. Post-prandial urine samples were collected for UCPCR measurement using chemiluminescent immunoassay. Receiver operating characteristic (ROC) analysis determined optimal cut-offs. Multivariable logistic regression and cost-comparison analyses were performed.ResultsMean UCPCR was significantly lower in T1DM compared to T2DM (0.29 ± 0.64 vs 1.44 ± 1.82 nmol/mmol, p<0.001). ROC analysis revealed that a UCPCR cut-off of <0.25 nmol/mmol achieved 100% sensitivity and 91.7% specificity for T1DM diagnosis (AUC 0.991, 95% CI: 0.978-1.000). In patients with diabetes duration <5 years, UCPCR maintained excellent discrimination (AUC 0.988, sensitivity 100%, specificity 91.7%). However, specificity declined in patients with a diabetes duration of >10 years (82.4%), with 15% of these longstanding T2DM patients exhibiting UCPCR values <0.25 nmol/mmol, reflecting progressive beta-cell decline. Multivariable regression identified UCPCR (OR 0.001; 95% CI: 0.000–0.012; p<0.001) as the strongest independent predictor of T1DM. Cost-comparison analysis demonstrated ≥ 90% cost reduction when compared with serum C-peptide or autoantibody panels.ConclusionsUCPCR < 0.25 nmol/mmol accurately identifies T1DM in the Emirati population. This cost-effective, non-invasive test could improve clinical practice through enhanced diagnostic accuracy and reduced healthcare costs.

BackgroundPatients with type 2 diabetes mellitus (T2DM) exhibit a heightened susceptibility to developing dementia, especially those who already present with mild cognitive impairment (MCI). Nevertheless, the fundamental etiology remains elusive, underscoring the pressing need for an objective and precise diagnostic approach in clinical settings. This study investigates the utilization of machine learning algorithms in conjunction with high-resolution sagittal T1-weighted structural imaging to facilitate automated diagnosis of T2DM patients with MCI, differentiating them from both T2DM patients without MCI and healthy controls (HCs).MethodsThirty patients with T2DM and MCI, thirty T2DM patients without MCI, and thirty matched healthy controls (HCs) were enrolled to identify independent biomarkers and develop a diagnostic model for early cognitive impairment in T2DM. Whole-brain structural features-including cortical surface area, volume, thickness, curvature index, folding index, Gaussian curvature, mean curvature, thickness standard deviation, nuclear volume, hippocampal volume, and white matter volume-were extracted from the images of brains using automated segmentation methods. The minimum redundancy maximum relevance (MRMR) method was employed to filter out irrelevant and redundant features, reducing the dimensionality of the dataset. Subsequently, the least absolute shrinkage and selection operator (LASSO) algorithm was applied for further feature selection, ensuring the retention of only the most diagnostic features. The Random Forest (RF) classifier, a powerful machine learning model within the realm of artificial intelligence, was meticulously trained utilizing a curated feature set that had undergone rigorous refinement. To ensure the robust diagnostic performance and generalizability of the established random forest model, a 5-fold cross-validation was employed, providing a dependable estimation of the model’s effectiveness.ResultsThe FreeSurfer software automatically segmented the cerebral imaging data into up to 70 regions. For model establishment, a comprehensive set of 705 structural features, a series of neuropsychological tests, and standard laboratory tests were utilized. Ultimately, 8 features were selected through two feature selection strategies aimed at refining the optimal features. These included bilateral brainstem volume, left hippocampus volume, left transverse temporal gyrus volume, bilateral posterior corpus callosum volume, left medial orbitofrontal cortex Gaussian curvature, glycosylated hemoglobin, blood sugar levels, and the Digit Span Test (DST) backward score. The Random Forest (RF) model, based on the combined features, exhibited the excellent performance, with mean AUCs of 0.959 (95% CI, 0.940–0.997, mean specificity = 94.2%, mean sensitivity = 88.3%, mean accuracy = 88.3% and mean precision = 88.3%) for the training dataset and mean AUCs of 0.887 (95% CI, 0.746–0.992, mean specificity = 85.0%, mean sensitivity = 70.0%, mean accuracy = 70.0% and mean precision = 69.6%) for the testing dataset, based on 5-fold cross-validation.ConclusionThe RF model, leveraging a combination of features, demonstrates high accuracy in diagnosing T2DM with MCI. The exclusion of T2DM patients with complications may limit generalizability to the broader T2DM population, potentially inflating performance estimates. Among these features, 8 optimal indicators comprising 5 structural features, 1 neuropsychological test feature, and 2 standard laboratory test features emerge as the potential independent biomarkers for detecting early-stage cognitive impairment in T2DM patients. These features hold significant importance in understanding the pathophysiological mechanisms of T2DM-related cognitive impairment. Our fully automated model is capable of swiftly processing MRI data, enabling precise and objective differentiation of T2DM with MCI. This model significantly enhances diagnostic efficiency and holds considerable value in clinical practice, facilitating early diagnosis of T2DM with MCI.

AimColorectal cancer (CRC) is one of the most prevalent cancers worldwide. Epidemiological evidence has identified Type 2 Diabetes Mellitus (T2DM) as a risk factor for CRC. This study aimed to evaluate the impact of T2DM, along with clinicopathological and socio‐demographic factors, on long‐term overall survival in a large, nationally representative cohort of CRC patients with T2DM.MethodA prospective cohort of 1186 CRC patients was analysed, approximately 20% of whom had a diagnosis of T2DM. Kaplan–Meier estimates and multivariable Cox proportional hazards models were used to assess overall survival.ResultsCRC patients with T2DM were more often older, had lower educational attainment, were former smokers, and presented higher comorbidity, right‐sided tumours, prior symptoms, depressive symptoms, elevated Body Mass Index (BMI) and lower baseline quality of life (EORTC QLQ‐C30 < 75). In multivariable analysis, the co‐occurrence of T2DM and depression (p = 0.007; HR 1.77; 95% CI: 1.17–2.68) and low quality of life (p = 0.04; HR 1.42; 95% CI: 1.02–1.97) emerged as independent predictors of poorer long‐term survival.ConclusionOur findings highlight the compounded negative impact of T2DM and depression on overall survival in CRC patients. Their combined presence significantly worsens prognosis, underscoring the need for integrated care approaches that address both physical and mental health. Future research should explore targeted interventions for these comorbidities to improve long‐term outcomes and quality of life in this high‐risk population.

To examine (1) the mediating roles of self-efficacy and future-oriented time perspective (FTP) in the association between workplace culture of health (COH) and diabetes self-management and (2) the moderating effect of diabetes distress on the relationship between self-efficacy and FTP among employees with type 2 diabetes mellitus (T2DM). A cross-sectional survey. This study was conducted among employees with T2DM recruited from the Endocrinology Outpatient Departments at three tertiary hospitals in Taiyuan City, Shanxi Province, China, between March and October 2024. The participants were 462 employees with T2DM who had been employed at their current organisations for at least 3 months following their T2DM diagnosis. Data on demographics, diabetes-related and work-related factors, workplace COH, self-efficacy, time perspective, diabetes distress and self-management performance were collected via a survey. The moderated mediation effects were examined using Hayes's PROCESS macro. Workplace COH was associated with diabetes self-management both directly (β=0.251, 95% CI 0.080 to 0.422, p<0.01) and indirectly (indirect effect=0.303, 95% CI 0.190 to 0.419). Two significant indirect pathways were identified: (1) workplace COH → self-efficacy → diabetes self-management (indirect effect=0.207, 95% CI 0.110 to 0.308); (2) workplace COH → self-efficacy → FTP → diabetes self-management (indirect effect=0.093, 95% CI 0.051 to 0.144). However, the indirect pathway: workplace COH → FTP → diabetes self-management was not significant (indirect effect=0.004, 95% CI -0.055 to 0.063). Additionally, a significant interaction (β=-0.356, 95% CI -0.566 to -0.146, p<0.01) indicated that diabetes distress moderated the relationship between self-efficacy and FTP. This study demonstrated that workplace COH was associated with diabetes self-management both directly and indirectly, specifically through self-efficacy alone and serially through self-efficacy and FTP; it also confirmed that diabetes distress weakens the effect of self-efficacy on FTP, thereby providing a basis for developing interventions to improve self-management among employees with T2DM.