To investigate the synergistic interaction between fasting plasma glucose (FPG) and serum uric acid (SUA) on the severity of peripheral diabetic retinopathy (DR) and to develop a predictive nomogram for severe non-proliferative DR (S-NPDR) in type 2 diabetes mellitus (T2DM) patients. This retrospective, single-center study included 900 T2DM patients admitted between January 2018 and December 2023. Patients were categorized into groups of No-DR (n = 300), mild to moderate NPDR (n = 350), and S-NPDR (n = 250). S-NPDR was compared against the combined No-DR and mild to moderate NPDR groups (n = 650). Independent predictors were identified via multivariable logistic regression. Additive interaction analysis assessed the synergistic effect of FPG and SUA. A predictive nomogram was developed and internally validated using 1000 bootstrap resamples. Seven independent predictors of S-NPDR were identified in the final model: higher FPG (odds ratio [OR] = 1.701), SUA (OR = 1.062 per 10 µmol/L), urinary albumin-to-creatinine ratio (UACR; OR = 1.046 per 10 mg/g), high-sensitivity C-reactive protein (hs-CRP; OR = 1.191), lower subfoveal choroidal thickness (SFCT; OR = 1.330 per 10-µm decrease), lower serum albumin (ALB; OR = 1.153 per 1-g/L decrease), and the interaction between FPG and SUA (OR = 2.710, P < 0.001). A strong synergistic interaction was confirmed (adjusted OR for high FPG/high SUA = 17.56; relative excess risk due to interaction [RERI] = 12.58). The nomogram demonstrated excellent discrimination (area under the receiver operating characteristic curve [AUC] = 0.925) and good calibration (Hosmer-Lemeshow P = 0.418). Concurrent elevations of FPG and SUA are strongly associated with an increased likelihood of S-NPDR. Patients with both markers elevated represent a high-risk group requiring intensive monitoring. The validated nomogram enables personalized risk stratification, guiding targeted clinical management to prevent vision-threatening DR complications.

Body balance is maintained thanks to the coordinated work of the proprioceptive, visual and vestibular systems. Diabetes mellitus affects each of these systems, leading to the development of postural instability and an increased risk of falls in this group of patients. The high incidence of diabetic peripheral neuropathy and retinopathy has prompted detailed study of these conditions. It has been established that these conditions, leading to reduced visual acuity, sensory deficits and sensory ataxia, impair stability and increase the frequency of falls. At the same time, there is evidence of the potentially damaging effect of diabetes mellitus on the vestibular system with the development of subclinical vestibulopathy. Since the vestibular system plays an essential role in maintaining balance, timely detection of relevant disorders can be of considerable value in developing measures to prevent falls in this group of patients. Meanwhile, the prevalence and precise mechanisms of damage to the vestibular system in diabetes remain unclear, and the results of studies conducted in this area are characterised by high methodological and statistical heterogeneity, which makes it difficult to draw a single conclusion.

Background: Glycated hemoglobin (HbA1c) is widely used for the diagnosis and monitoring of diabetes mellitus. However, its potential role as a marker of metabolic stratification and early complication risk beyond diagnostic thresholds remains insufficiently explored. Prediabetes is often considered a transitional state, although growing evidence suggests the presence of early metabolic and microvascular alterations. Methods: In this cross-sectional observational study, adult subjects were stratified into three groups based on HbA1c levels: normoglycemic (HbA1c < 5.7%), prediabetic (HbA1c 5.7-6.4%), and diabetic (HbA1c ≥ 6.5%). Demographic data, metabolic parameters, cardiometabolic comorbidities, and diabetes-related complications were analyzed. Group differences were assessed using appropriate statistical tests. Cumulative complication burden was evaluated, and risk estimation was performed using univariate logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results: A total of 839 subjects were included in the analysis. HbA1c and fasting glucose levels increased progressively across groups (p < 0.001). Prediabetic individuals already exhibited a higher prevalence of peripheral neuropathy and retinopathy compared to normoglycemic subjects, while diabetic patients showed the highest overall complication burden. The cumulative number of complications increased significantly across HbA1c-based groups (p = 0.033). Risk estimation analyses revealed increased odds for presenting at least one complication and for peripheral neuropathy in diabetic subjects, with intermediate risk levels observed in the prediabetic group. Conclusions: HbA1c-based stratification captures meaningful differences in metabolic status, complication burden, and estimated risk across normoglycemic, prediabetic, and diabetic individuals. Prediabetes is associated with detectable microvascular involvement and higher complication risk. Given the cross-sectional design, these findings reflect associations rather than causal relationships. These findings highlight the potential clinical value of HbA1c for early risk assessment and targeted preventive strategies.

Background: Type 1 diabetes mellitus (T1DM) is associated with an increased risk of fragility fractures that cannot be fully explained by reduced bone mineral density (BMD), highlighting a potential role for bone quality impairment. The purpose of this study was to evaluate the prevalence of altered bone density and microarchitecture and to identify their main clinical correlates in adults with T1DM and seemingly adequate glycemic control at the time of assessment. Methods: Sixty-eight adults aged 18-69 years with T1DM attending a diabetes technology outpatient clinic were enrolled in this single-center, cross-sectional study. BMD at the lumbar spine, femoral neck, and total hip was assessed by dual-energy X-ray absorptiometry (DXA) and classified as reduced based on age and sex: Z-score < -2.0 SD for premenopausal women and men < 50 years, and T-score ≤ -2.5 SD for postmenopausal women and men ≥ 50 years. Bone microarchitecture was evaluated using trabecular bone score (TBS). Clinical, metabolic, and lifestyle variables were collected, including glycated hemoglobin (HbA1c; good control ≈ 7.0%/53 mmol/mol), diabetes duration, microvascular complications, and physical activity (PA) assessed by the International PA Questionnaire (IPAQ; moderate-high PA defined according to combined high and moderate IPAQ categories). Results: Reduced BMD was observed in 35.3% of patients and was associated with older age (p < 0.001), longer disease duration (p = 0.044), lower body mass index (p = 0.031), poorer glycemic control (p = 0.03), microvascular complications such as diabetic peripheral neuropathy (p = 0.028) and retinopathy (p = 0.045), and low PA (p = 0.012). Altered TBS was present in 45.6% of patients and was associated with older age (p < 0.001), longer diabetes duration (p = 0.011), higher HbA1c levels (p < 0.001), diabetic peripheral neuropathy (p = 0.002), retinopathy (p = 0.007), cardiovascular risk factors (dyslipidemia p = 0.002, hypertension p = 0.002), and low PA (p < 0.001). In multivariable analyses, older age and higher HbA1c were independently associated with reduced TBS, whereas moderate-high PA was associated with a lower likelihood of impaired bone microarchitecture. Conclusions: Impaired bone density and bone quality are highly prevalent in adults with T1DM and are frequently associated with longer disease duration, poorer metabolic control, and chronic complications. Our findings support the potential value of a combined assessment of BMD and TBS in fracture risk evaluation, together with strategies aimed at preventing diabetes-related complications and promoting healthy lifestyle behaviors.

Pathogenic variants in the HADHA and HADHB genes are associated with impairment of mitochondrial trifunctional protein. Mitochondrial trifunctional protein deficiency is a disorder of long-chain fatty acid oxidation with different clinical presentations: the neonatal-onset form expressing with severe cardiac phenotype, the infantile-onset form with intermediate hepatic phenotype with metabolic crises, and the late-onset form with mild neuromyopathic phenotype. Long-term complications in patients with the intermediate and late-onset phenotypes include peripheral neuropathy and retinopathy. We report a patient harboring 2 compound heterozygous variants in the HADHA gene (p.Tyr724* and p.Gly319Ser) and presenting with an early-onset, progressive sensorimotor axonal polyneuropathy, without any other systemic manifestations typical of mitochondrial trifunctional protein deficiency. We also provide a literature review of HADHA mutated patients presenting with early-onset isolated neuropathy phenotype.

Alport syndrome is a hereditary nephritis caused by mutations in the gene encoding type IV collagen, which presents with progressive kidney disease, sensorineural hearing loss, and eye abnormalities. We report a 20-year-old male who presented with acute kidney injury requiring hemodialysis, accompanied by progressive sensorineural hearing loss since age 8 and visual impairment requiring lens implantation. Family history revealed a deceased elder brother with renal failure. Clinical examination showed hypertension, bilateral pitting edema, bilateral sensorineural hearing loss, and ophthalmoscopic findings of pseudophakia, peripheral fleck retinopathy, and pale optic disc. Genetic analysis revealed a hemizygous COL4A5 c.1708G&gt;C (p.Gly570Arg) mutation, classified as likely pathogenic according to ACMG guidelines.This case highlights the importance of comprehensive genetic testing in young patients with unexplained nephritis and its associated extra renal manifestations. Early diagnosis allows appropriate genetic counseling, family screening, and optimal therapeutic interventions including ACE inhibitors and renal replacement therapy. Bangladesh J Medicine 2026; 37(1): 68-71

ABSTRACTMitochondrial trifunctional protein (TFP) deficiency is an inherited disorder of long‐chain fatty acid β‐oxidation (FAO). TFP is a heteromeric enzyme composed of two α and two β‐subunits. Despite early detection and dietary treatment, TFP deficiency patients often develop hypoglycemia, rhabdomyolysis, cardiomyopathy, and peripheral neuropathy. Degenerative retinopathy and milder peripheral neuropathy occur in patients with an isolated deficiency of the αTFP subunit of long‐chain 3‐hydroxyacyl‐CoA dehydrogenase (LCHAD) activity. Triheptanoin treatment improves most complications, but not peripheral neuropathy and retinopathy. Notably, TFP also carries a fourth enzymatic function involved in cardiolipin remodeling, which we previously found to be impaired in TFP/LCHAD deficiency. We therefore tested whether elamipretide, a synthetic cardiolipin‐binding peptide, could improve mitochondrial function and cardiolipin levels in βTFP‐deficient mice and patient‐derived fibroblasts. Mice were treated with elamipretide delivered by osmotic minipump and challenged with treadmill exercise or cold stress after fasting. βTFP‐deficient mice treated with elamipretide showed improved exercise endurance, but cold tolerance was not altered. Liver mitochondria from male βTFP‐deficient mice demonstrated improved FAO‐ETC enzyme activities. However, cardiolipin content and composition were unchanged. In patient fibroblasts, elamipretide produced a possible genotype‐dependent increase in mitochondrial bioenergetics and a reduction in ROS. These results support a mechanism in which elamipretide stabilizes between FAO enzymes and ETC complexes, thereby improving mitochondrial function independently of changes in cardiolipin levels. Elamipretide thus emerges as a potential therapeutic agent for TFP/LCHAD deficiency, warranting further preclinical studies.

Diabetes mellitus, a notorious global health concern, presents with a broad spectrum of microvascular and macrovascular complications, of which peripheral neuropathy and diabetic retinopathy are well known however, isolated sixth nerve palsy is a rare entity noticed in the diabetic population.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic illness characterized by persistent hyperglycemia, which raises the chance of macrovascular and microvascular complications. These issues are linked to increased platelet activation, aggregation, and thromboxane production.Objective: This study sought to assess the use of Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) as possible hematologic indicators for detecting vascular complications in people with T2DM. Methods: A retrospective cross-sectional research was conducted using the medical records of 141 T2DM patients treated at Sanjiwani Gianyar Hospital in 2023. Patients were split into two groups based on the presence or absence of vascular complications such as coronary artery disease, cerebrovascular disease, peripheral arterial disease, diabetic nephropathy, and diabetic retinopathy. MPV and PDW values were derived from routine Complete Blood Count (CBC) testing. The data were tested for normality, and any changes between groups were calculated using an independent samples t-test.Results: Patients with vascular complications had significantly higher MPV values (9.53 ± 1.30 fL) than those without complications (8.99 ± 0.96 fL), with a statistically significant p-value of 0. 018. However, the two groups' PDW values did not differ significantly (15.95 ± 0.44 vs. 15.91 ± 0.36; p = 0.582).Conclusions: MPV may be a useful and cost-effective hematological parameter associated with vascular complications in T2DM patients, but the clinical relevance of PDW is unclear and requires more research.

Physical Therapy Reduced the Risk of Microvascular Complications in the Musculoskeletal Disorders Population With Type 2 Diabetes Mellitus.

To investigate the interrelationships between peripheral neuropathy, diabetic retinopathy (DR), and nephropathy in patients with type 2 diabetes mellitus (T2DM), with a specific focus on how DR severity correlates with the presence and severity of diabetic neuropathy and nephropathy. In this cross-sectional study, adult patients with at least five years’ duration of T2DM and preserved renal function (eGFR ≥ 60 mL/min/1.73 m²) were evaluated. DR was graded using the International Clinical Diabetic Retinopathy Severity Scale, and DME was assessed by spectral-domain optical coherence tomography. Peripheral neuropathy was quantified via nerve conduction studies (NCS), specifically sural sensory nerve action potential (SNAP) amplitude, while nephropathy was evaluated by urinary albumin-to-creatinine ratio (UACR) and eGFR. A total of 155, 138, and 94 patients completed neuropathy, retinopathy, and nephropathy assessments, respectively. Among the 138 participants who underwent fundus examination, 60% had proliferative diabetic retinopathy (PDR) and 32% had diabetic macular edema (DME). A significant inverse correlation was found between SNAP amplitude and both DR severity (p = 0.001) and DME presence (p = 0.001), indicating worse nerve conduction in advanced retinal disease. Patients with DME had a fourfold higher likelihood of impaired SNAP values (OR = 4.0; 95% CI: 1.849–8.653). Additionally, DME presence was associated with significantly higher UACR (p = 0.011), and nephropathy severity showed a mild but significant association with DR stage (p = 0.047). The severity of DR and the presence of DME correlate strongly with peripheral neuropathy and increased albuminuria in T2DM patients, reflecting shared microvascular pathology. Retinal findings, particularly DME, may serve as accessible clinical markers for identifying individuals at elevated risk of systemic microvascular complications.

Disclosure: S.B. Karatela: None. J.M. Pathak: None. N.B. Trivedi: None. K.P. Shah: None. D.J. Shah: None. A.G. Patel: None. A. Parikh: None. A.J. Rajani: None. A. Patel: None.Type 2 diabetes mellitus (T2DM) is a growing global health concern, with complications like peripheral neuropathy (PN), retinopathy, and nephropathy affecting patients' quality of life. Metformin, the first-line oral treatment, is linked to vitamin B12 deficiency, which can cause hematologic abnormalities and worsen diabetic PN. While well-documented, this association remains underexplored in India, particularly regarding neuropathy severity and metformin dosage/duration. Given the high cost of serum vitamin B12 testing, we also aimed to evaluate hematologic (mean corpuscular volume, MCV) and clinical (Toronto clinical neuropathy score, TCNS) parameters as cost-effective screening tools. 92 T2DM patients (46 metformin users and 46 non-users) were assessed. Primary outcomes included vitamin B12 deficiency and PN, while secondary outcomes evaluated MCV and clinical PN as screening tools. Neuropathy was staged using TCNS. Statistical analysis was conducted using MedCalc version 20.210, with two-tailed p<0.05 considered significant. Results showed no significant difference in mean vitamin B12 levels between metformin users (410.78±558.86) and non-users (479.84±618.85), p=0.61. However, metformin users were 1.6 times more likely to develop PN (RR=1.6, 95% CI=1.09-2.34, p=0.015), with significantly higher rates of severe neuropathy (X2(3, N=92)=8.334, p=0.039). No significant correlation was found between metformin duration and vitamin B12 levels or neuropathy severity, but metformin dose significantly correlated with TCNS scores, explaining 9.9% of the variation (R2=0.099, F(1,44)=4.86, p=0.03). MCV as a screening tool for vitamin B12 deficiency showed sensitivity (2.2%, 95% CI: 0.1-11.5), specificity (100%, 95% CI: 92.3-100), and an overall accuracy of 51.1%. TCNS demonstrated sensitivity (56.5%, 95% CI: 41.1-71.1), specificity (43.5%, 95% CI: 28.9-58.9), and an overall accuracy of 50%. While metformin did not significantly lower vitamin B12 levels, this may be due to the study’s limited power. However, metformin use was significantly associated with PN development and severity in a dose-dependent manner. The low sensitivity of MCV and TCNS limits their utility as screening tools for B12 deficiency. A larger trial or meta-analysis is needed to confirm these findings and assess causality. Clinicians should monitor vitamin B12 levels to prevent PN progression in diabetic patients on long-term metformin therapy.Presentation: Saturday, July 12, 2025

Objectives: Studying the prevalence of sensorineural hearing loss in patients with diabetes mellitus (DM) and to find the relationship between the severity of Sensorineural hearing loss (SNHL) with microvascular complications according to age, sexual predominance, duration of disease, and glycemic control (HbA1C) in diabetic patients. Methods: The study population comprised 101 type 2 DM (T2DM) patients as cases, and 101 non-diabetics as controls from the P.G. Department of Medicine, SCB Medical College, Cuttack, from July 2022 to January 2023, and were included in the study after considering the inclusion and exclusion criteria. Results: Among 68 diabetic patients with SNHL, most had a mild degree of 30.7%, followed by a moderate degree of 27.7%, severe and profound being 6.9% and 2%, respectively. Overall, the prevalence of SNHL is 67.3% among cases compared to 21.8% among controls (p&lt;0.001). The proportion of SNHL among diabetes patients with a duration of diabetes of more than 10 years is the highest. The table shows that the proportion of SNHL among diabetes patients with HbA1C between 9.1 and 11 is highest (p=0.025). In our study, as the age of the cases advances, the prevalence of SNHL increases (p=0.013). Conclusion: SNHL is common in T2DM, with a high association with microvascular complications such as diabetic peripheral neuropathy, nephropathy, and retinopathy. As the duration of diabetes and the level of HbA1C progress, the prevalence of hearing loss is found to worsen. Routine audiological evaluation may be carried out to help in the early diagnosis of SNHL.

Diabetes imposes a substantial economic burden on patients worldwide, and various national healthcare insurance systems adopt different payment methods to mitigate medical costs. However, the impact of insurance payment methods on patient health remains unclear. This study uses the reform of per capita payment for diabetes in Tianjin, China, as a quasi-experiment to investigate the effects of insurance payment methods on diabetes complications. The results indicate that the experimental group exhibited a significant reduction in vascular complications compared to the control group. The incidence of peripheral neuropathy, peripheral vascular disease, diabetic nephropathy, retinopathy, cardiovascular disease, and diabetic foot decreased significantly, with these effects becoming more pronounced over time. Moreover, compared to the control group, the incidence rates of complications in retired individuals were lower than those in employees within the experimental group.

Diabetic kidney disease (DKD) is the most serious microvascular complication of diabetes mellitus (DM), responsible for significant morbidity and mortality. Its incidence is increasing in parallel with the epidemiological evolution of DM. Its management is primarily preventive, with specific attention paid to the identification and management of associated risk factors. The study’s objectives were to determine the prevalences and risk factors of DKD and glomerular hyperfiltration (GHF) in Malagasy patients with DM. This cross-sectional study was conducted on 248 patients with DKD seen in the Cardiovascular Diseases and Internal Medicine departments of the Soavinandriana Hospital Center in Antananarivo over a 2-year period. The diagnosis of DKD was confirmed by an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m² and/or albuminuria ≥ 30 mg/24 h. GHF was defined as a value ≥ 100 mL/min/1.73 m². The prevalence of DKD was 36.3% and GHF was 31.0%. In bivariate analysis, risk factors for DKD included age ≥ 60 years (aOR 2.08 [1.14–3.88]), hypertension (aOR 2.21 [1.07–4.78]), dyslipidemia (aOR 2.91 [1.53–5.77]), smoking (aOR 1.94 [1.09–3.49]) and DM duration ≥ 10 years (aOR 2.99 [1.64–5.53]). After multivariate analysis, the independent risk factors for DKD were dyslipidemia (aOR 2.23 [1.11–4.46]) and duration of diabetes ≥ 10 years (aOR 2.82 [1.55–5.14]). Peripheral neuropathy (aOR 4.93 [2.67–9.11]), retinopathy (aOR 28.3 [12.0-66.8]) and carotid atherosclerosis (aOR 1.86 [1.00-3.51]) were significantly associated with DKD. Independent risk factors for GHF were age ≤ 50 years (aOR 5.48 [2.37–12.7]) and glycated hemoglobin ≥ 10% (aOR 1.89 [1.01–3.21]). DKD and GHF were common among Malagasy diabetics. Their management should primarily focus on prevention by achieving optimal control of blood glucose levels and other risk factors, using cardioprotective and renoprotective medications. The presence of DKD should prompt a search for other diabetic complications, and vice versa.

To identify and validate subgroups of type 2 diabetes in Chinese populations using clustering analysis and assess their complication risks. Data from 5653 type 2 diabetes patients in the Shanghai Suburban Adult Cohort and Biobank (SSACB) and 6384 in the Southwest China Diabetic Chronic Complications Study were integrated. Using body mass index, fasting blood glucose, age at diabetes diagnosis, and triglycerides to high-density lipoprotein cholesterol ratio, k-means clustering was performed by sex in SSACB and validated in Southwest China Diabetic Chronic Complications Study. Cox and logistic regression models compared complication risks. Five type 2 diabetes subgroups were identified: Hyperglycaemic Diabetes (HGD), Obesity-Related Diabetes (ORD), Young-Onset Diabetes (YOD), Insulin Resistance Diabetes (IRD), and Elderly-Onset Diabetes (EOD). Verification in an external validation cohort confirmed the robustness and reproducibility of the identified subgroups. In SSACB, distinct subgroup-specific complication risks were observed. Specifically, the HGD subgroup showed the highest risks for stroke (HR = 1.37, 95% CI: 1.10-1.70), peripheral vascular disease (HR = 1.66, 95% CI: 1.36-2.03), retinopathy (HR = 3.53, 95% CI: 2.53-4.90), peripheral neuropathy (HR = 1.89, 95% CI: 1.56-2.30), and nephropathy (HR = 1.81, 95% CI: 1.41-2.34). The IRD subgroup had the highest risk for coronary heart disease (HR = 1.20, 95% CI: 1.01-1.43). Similar risk patterns were observed in the validation cohort. We identified five clinically distinct type 2 diabetes subgroups with differential complication risks in the Chinese population, providing a basis for precision diabetes management.

Graphical Introduction and aimsThe prevalence of T2DM is rising among young people, placing them at greater risk for complications. We studied the prevalence and predictors of micro- and macrovascular complications in early-onset diabetes subjects (EOD, <40 years) and compared them with late-onset T2DM (LOD, ≥40 years).MethodsA total of 800 subjects (400 EOD, 400 LOD), matched for gender and diabetes duration, were prospectively recruited and assessed for the prevalence of peripheral neuropathy, retinopathy, nephropathy, and ASCVD. Multivariate logistic regression analyzed predictors of diabetes complications.ResultsThe median age at diagnosis of diabetes was 35 years in EOD and 48 years in LOD. Hypertension was more common in LOD (73.8 vs 58.8%, P < 0.001). EOD patients had higher HbA1c (7.9 vs 7.7%, P < 0.05) and worse lipid profiles (non-HDL-C 129 vs 118 mg/dL, P < 0.05; triglycerides 146 vs 130 mg/dL, P < 0.001; HDL-C 36 vs 38 mg/dL, P < 0.01). The prevalence of retinopathy and nephropathy was similar between groups, while peripheral neuropathy and ASCVD were more prevalent in LOD. Increasing diabetes duration was associated with higher risk of all microvascular complications (P < 0.01–0.001), while the age at onset of T2DM predicted peripheral neuropathy, nephropathy, and ASCVD (P < 0.05–0.001). Retinopathy (P < 0.001) and female gender (P < 0.05) increased peripheral neuropathy risk. Nephropathy (P < 0.05) and smoking (P < 0.01) were major ASCVD predictors.ConclusionEOD patients had worse glycemic and lipid profiles, but similar frequency of retinopathy and nephropathy as LOD. The high prevalence of microvascular complications in EOD may reduce productivity, highlighting the importance of early screening, better glycemic control, and timely complication management.

ABSTRACTAim:This research examines the clinical characteristics and complications associated with type 2 diabetes mellitus (T2DM) among patients at a tertiary hospital in India.Materials and Methods:Fifty patients were analyzed for demographic data, glycemic control, lipid profile, and complications.Results:The study demonstrated a significant correlation between poor glycemic control, as evidenced by elevated HbA1c levels, and a heightened risk of microvascular complications, such as peripheral neuropathy, retinopathy, and nephropathy. The prevalence of autonomic neuropathy was notably high, with 78% of patients testing positive.Conclusion:These findings underscore the significance of early diagnosis and proactive management of glycemic control to avert complications in patients with T2DM.

We aimed to systematically review and quantify risk factors for first-ever diabetes-related foot ulcer (DFU). Four English and three Chinese electronic databases were searched for cohort and case-control studies reporting risk factors for first-ever DFU. Two researchers independently screened titles, abstracts and full text, extracted data and assessed the quality of included studies. Meta-analyses were performed for risk factors reported in at least two studies, using unadjusted odds ratios and standardised mean differences for dichotomous and continuous variables. Of 6736 potential studies screened, 23 were included in the meta-analysis and 24 in the systematic review. Twenty-eight significant risk factors for first-ever DFU were identified, including older age, obesity, male gender, unmarried status, alcohol consumption, current smoking, insufficient physical activity, longer diabetes duration, increased HbA1c, fasting plasma glucose, creatinine and triglyceride, decreased eGFR and high-density lipoprotein, high vibration perception threshold, albuminuria, low ankle-brachial pressure index ratio, cardiovascular, cerebrovascular and peripheral artery disease, retinopathy, nephropathy, neuropathy, myocardial infarction, foot deformity, skin dryness, insulin treatment and anti-hypertensive treatment. This study provides the first comprehensive synthesis of risk factors for first-ever DFU. Identifying high-risk individuals based on these factors can enhance early intervention strategies, reducing the burden of DFU in diabetes management.

Introduction: Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes, affecting up to 50%. DPN is associated with foot ulcers which can result in amputations. Early diagnosis is the key strategy to prevent foot ulcers.Objective: This study aimed to determine the prevalence of DPN and its associated factors among patients with Diabetes mellitus (DM) registered in medical clinics at the National Hospital of Sri Lanka.Methodology: This was a descriptive cross-sectional clinic-based study. We randomly selected 280 participants with diabetes. Michigan Neuropathy Screening Instrument (MNSI) was used to screen for DPN. MNSI is a simple validated clinical tool consisting of two parts: MNSI symptom score and MNSI examination score. An MNSI examination score of &gt; 2 was taken as the cut-off point for defining DPN, which was 80% sensitive and 95% specific.Results: Females were the majority (62.5%, n= 280). The mean age was 58.6 years, and the mean duration of diabetes was 8.6 years. Type 2 diabetes was the vast majority (96.1%). 120 patients (42.9%) had DPN according to the MNSI examination score. However, only 59 patients (21.1%) were diagnosed as having DPN. There was no significant difference in the incidence of DPN among different ethnic groups. However, the duration of diabetes was very significantly associated with DPN (p =0.001). Only 14 patients (5%) had an MNSI symptom score of 7 or more, but all of them had DPN (MNSI examination score &gt; 2). The most common symptom was numbness of the feet (n=95); the sign was reduced vibration sensation (n=101, 36.07%). Nevertheless, a significant number of patients (26.3%) with feet numbness,36.7% with burning pain in the feet, and 26.7% with prickling sensation in the leg did not have DPN (MNSI examination score &lt; 2). Conversely, 34 patients (28.3%) with DPN were asymptomatic There were 8 (0.03%) patients with leg ulcers, 7 of whom had DPN. The most common comorbidity in this study group was hypertension (n=205, 73.2%). Peripheral vascular disease (p=0.011) and retinopathy (p=0.016) were significantly associated with DPN.Conclusion: DPN is a common and important complication of diabetes, however, a significant percentage of patients with DPN were not diagnosed at clinics. Many patients with DPN had no symptoms, therefore symptomatology in DPN is not a reliable clue to the diagnosis. Consequently, we reiterate the importance of annual assessment using a simple screening tool such as the MNSI examination score in patients with diabetes.