We evaluated the potential of the Finnish Diabetes Risk Score questionnaire to screen for undiagnosed hyperglycemia in patients with periodontitis, comparing its performance with that of glycated hemoglobin (HbA1c).

In this cross-sectional pilot study, we included 21 adults (22-64 years) diagnosed with periodontitis. Demographic data, periodontal status, HbA1c levels, and Finnish Diabetes Risk Scores were collected. Based on HbA1c levels, participants were classified as normoglycemic (<5.7%), prediabetic (5.7-6.4%), or diabetic (≥6.5%) according to established diagnostic criteria. Finnish Diabetes Risk Scores ≥12 indicated moderate-to-very-high diabetes risk. Associations between the Finnish Diabetes Risk Score, HbA1c, and periodontal parameters were assessed using Friedman's test and multinomial logistic regression. Diagnostic validity indices and receiver operating characteristic (ROC) curves were calculated.

Most participants were women (71.4%) and had advanced disease (71.4% stage IV; 71.4% generalized periodontitis). According to the Finnish Diabetes Risk Score, 71.5% of patients had a high or very high risk of developing type 2 diabetes within 10 years. Mean HbA1c was 5.8±0.4%, ranging from normoglycemic to diabetic levels (≥6.5%). Finnish Diabetes Risk Scores ≥12 were significantly associated with HbA1c-defined prediabetes/diabetes and generalized periodontitis (p<0.001). In the multinomial logistic regression analysis, age, sex, periodontal extent, and HbA1c were identified as independent predictors of higher Finnish Diabetes Risk Scores. Finnish Diabetes Risk Scores ≥12 showed high sensitivity (92-100%) and negative predictive value (80-100%), but low specificity (26-44%); ROC analysis demonstrated acceptable diagnostic performance, particularly for identifying combined prediabetes and diabetes.

The Finnish Diabetes Risk Score is a practical, non-invasive screening tool for predicting the risk of undiagnosed dysglycemia in patients with periodontitis in dental settings. Its high sensitivity supports its use for risk stratification; however, positive findings require biochemical confirmation. These findings underscore the role of dental professionals in early disease detection.

This study aimed to explore perceived barriers and facilitators to healthy eating among individuals with type 2 diabetes mellitus and community health workers (CHWs) in primary health care in the Brazilian Amazon. This qualitative study used a participatory approach. Data were collected by World Café discussion groups and semi-structured interviews with type 2 diabetes mellitus patients and CHWs. Thematic network analysis was used to find intrapersonal, interpersonal, and environmental factors influencing dietary behaviors. This study included 64 participants - 47 type 2 diabetes mellitus patients and 17 CHWs in the Brazilian Amazon. Key barriers to healthy eating included financial constraints, lack of family support, and limited access to qualified health professionals such as nutritionists. Additional environmental challenges included seasonal food shortages and poor access to markets. Facilitators included personal motivation, dietary awareness, family support, and local food cultivation. Although the Amazon has a rich biodiversity conducive to healthy eating, socioeconomic and environmental conditions often prevent people with diabetes from accessing healthy food. The findings underscore the need for culturally appropriate, community-based strategies involving multidisciplinary teams to improve dietary adherence in low-resource settings.

Carpal tunnel syndrome (CTS) is a common and disabling condition of the hand, affecting up to 10% of the population, caused by compression of the median nerve at the wrist. Conventional observational epidemiological studies have demonstrated associations between CTS and elevated plasma insulin-like growth factor 1 (IGF-1), as well as several metabolic factors, such as obesity and type 2 diabetes (T2DM).

Here, we use two-sample univariable and multivariable Mendelian randomization to investigate causality in the relationships between IGF-1, metabolic factors related to IGF-1, and CTS.

We replicate the result that increases in measures of obesity (body mass index (BMI), waist-hip ratio (WHR), and waist circumference (WC)) are causal for CTS, and show that the effect of elevated childhood BMI on increasing risk of CTS is mediated mostly by elevated adult BMI. Furthermore, we demonstrate that T2DM and raised fasting plasma glucose are also causal for CTS. Finally, we show that increased IGF-1 signalling is also causally related to CTS risk, and the effect is likely mediated by its effects on both BMI and T2DM. The IGF-1 pathway merits further investigation as a potential therapeutic target for CTS.

We provide genetic epidemiological evidence to support obesity, T2DM, and elevated plasma IGF-1 concentrations playing a causal role in increasing the risk of CTS. These findings suggest that pharmacological management of the metabolic risk factors may also decrease the risk of CTS, with the IGF-1 pathway as a potential therapeutic target.

We examined the association of peripubertal pregnancies with long-term health and developmental outcomes in adult offspring and strengthened causal inference using sibling-comparison methods.

Using linked Swedish register data from 1964 to 2018, we conducted a cohort study to estimate associations of pregnancies before age 16 years compared with pregnancies between ages 16 and 25 years, with body mass index (BMI), systolic blood pressure (SBP), cognitive function, and stress resilience among 943 444 male offspring aged 17-21 years in the Military Conscription Register. We further assessed associations with type 2 diabetes (T2D), depression, and anxiety among 2 461 510 male and female offspring aged 18-73 years using population-wide registers. Linear, multinomial, and survival models were used. Sibling fixed-effect models were used to account for unmeasured confounding shared among siblings.

Offspring from pregnancies before age 16 years compared with pregnancies between ages 16 and 25 years had lower SBP (β - 1.12; 95% confidence interval [CI] - 1.97 to -0.26), poorer cognitive function (β  - 0.54; 95% CI -0.67 to -0.40), and poorer stress resilience (β -0.24; 95% CI -0.38, -0.10). There was no increased risk of being underweight or overweight compared with normal weight. There was a lower risk of anxiety (hazard ratio 0.87; 95% CI 0.80 to 0.95) and no increased risk of T2D or depression. Sibling-comparison analyses attenuated deleterious associations to null or reversed them and amplified associations with markers of better health.

Pregnancies before age 16 years may not be causally associated with adverse long-term health and developmental outcomes in adolescent and adult offspring. The adverse associations in conventional analyses appear attributable to shared familial characteristics.

To examine trends in type 2 diabetes mellitus (T2DM) burden among adults aged ≥ 55 years in Mexico from 1990 to 2021, disaggregated by sex, quinquennial age groups, and subnational level.

We conducted a secondary analysis of Global Burden of Disease (GBD) 2021 data. Age-specific and age-standardized rates (ASR) were estimated for each year and metric, including mortality, years lived with disability (YLD), years of life lost (YLL), and disability-adjusted life years (DALY). We applied Joinpoint regression to assess ASR-DALY trends, and associations with the Sociodemographic Index (SDI) and Healthcare Access and Quality Index (HAQI) were evaluated.

From 1990 to 2021, the number of T2DM deaths among adults aged ≥ 55 years increased by 104.3%, although the overall age-standardized mortality rate showed a nonsignificant decline of 1.8%. Mortality rates decreased significantly among females by 15.6%, whereas they increased nonsignificantly among males by 18.0%, with significant increases observed in the 80-84 and ≥ 85 age groups. The ASR DALY remained relatively stable, changing from 9629.0 per 100,000 in 1990 to 9649.2 per 100,000 in 2021. In 2021, YLL accounted for 73.5% of DALY among males, whereas YLD accounted for 34.2% among females. Subnational differences were substantial: Tabasco, Guanajuato, and Puebla had the highest DALY rates in 2021, whereas Sinaloa and Nuevo León reported the lowest. Joinpoint analyses identified significant increases in 13 states and significant decreases in 13 states. Nationally, ASR DALY were negatively correlated with the SDI (-0.43) and HAQI -0.56), although state-level associations were heterogeneous.

The burden of T2DM among Mexican adults aged ≥ 55 years shifted from higher rates among women in 1990 to slightly higher rates among men in 2021. In 2021, women experienced a greater disability burden, whereas men had higher premature mortality. Marked subnational disparities and heterogeneous state-level trends suggest uneven epidemiological and health system transitions, underscoring the need for targeted, sex-sensitive, and region-specific strategies for chronic disease prevention and management.

Delegating tasks from the general practitioners (GPs) to practice nurses (PNs) may support healthcare challenges. While PN-led care is well accepted in countries with established models, transferability to Germany remains unclear. Qualitative data suggest openness towards PN-led consultations (PNLC), but quantitative evidence is scarce.

To assess willingness, condition-specific preferences, and influencing factors towards PNLC in general population.

We conducted a cross-sectional online survey within the HeReCa-Study panel between July to September 2023 using a pretested questionnaire. Participants were randomly selected from five German states, stratified by urbanity and age. Analyses included descriptive statistics, bivariate and multivariable logistic regression (IBM SPSS 25.0; R 4.5.2).

The response was 50.0% (1,532/3,066). Approximately 39.7% received care in single-handed practices (SHP). Among included participants without prior PNLC experience (n = 1,419), willingness to accept PNLC was 83.6%. Willingness was highest for superficial wounds, respiratory infections, and chronic conditions and lowest for new-onset back pain. Higher trust in PNs' professional (OR 2.46; 95% CI 1.60-3.82) and communication skills (OR 1.80; 1.18-2.75) increased willingness. Older age (OR 0.32; 0.10-0.90 in 74-83 versus 22-33-year-olds) and treatment in SHP vs. no (OR 0.69; 0.48-0.99) were associated with lower willingness. Sex, regional variables and population density showed no relevant associations.

Acceptability of PNLC among the German general population is high. Trust in PNs' professional and communication skills, and younger age, are associated with increased willingness for PNLC, while treatment in SHP showed a negative association. Our findings may inform implementation of PNLC in other countries.

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors improve kidney and cardiovascular outcomes in type 2 diabetes, chronic kidney disease, and heart failure, but optimal initiation timing after dialysis-requiring acute kidney injury (AKI-D) is uncertain.

To compare outcomes associated with SGLT-2 inhibitor prescription within 30 days vs 31 to 90 days after discharge among adults with type 2 diabetes recovering from AKI-D.

This cohort study using a target trial emulation design used TriNetX Global Collaborative Network electronic health records from January 1, 2015, to September 1, 2024. Eligible adults had type 2 diabetes, were hospitalized for AKI-D, had dialysis discontinued after discharge, and had no SGLT-2 inhibitor prescription in the prior year.

First documented SGLT-2 inhibitor prescription within 30 days after discharge vs 31 to 90 days after discharge.

Primary outcomes were adverse kidney events, all-cause mortality, and major adverse cardiovascular events. Adverse kidney events included dialysis reinitiation, incident end-stage kidney disease, or recorded estimated glomerular filtration rate less than 15 mL/min/1.73 m2. Selected 6-month safety outcomes were also assessed. A 90-day landmark design and 1:1 propensity score matching were used.

Among 4406 eligible patients before propensity score matching, 2268 initiated SGLT-2 inhibitors within 30 days (mean [SD] age, 63.5 [12.9] years; 1336 male [58.9%]), and 2138 initiated SGLT-2 inhibitors between 31 and 90 days (mean [SD] age, 62.7 [13.5] years; 1210 male [56.6%]). After 1:1 propensity score matching, 1912 patients remained in each group (mean [SD] age, 63.0 [13.0] vs 62.8 [13.5] years; 1102 [57.6%] vs 1112 [58.2%] male, in the early vs late SGLT-2 initiation groups, respectively). During a mean follow-up of 3.4 years (IQR, 1.1-3.3 years), early prescription was associated with a lower risk of adverse kidney events compared with late prescription in 74 patients (3.9%) vs 119 patients (6.2%) (adjusted hazard ratio [AHR], 0.62; 95% CI, 0.46-0.83). All-cause mortality (AHR, 1.06; 95% CI, 0.84-1.35; P = .63) and major adverse cardiovascular events (AHR, 1.03; 95% CI, 0.80-1.34; P = .81) did not differ significantly. Recorded 6-month safety outcomes were also similar.

In adults with type 2 diabetes recovering from AKI-D, SGLT-2 inhibitor prescription within 30 days after discharge was associated with fewer adverse kidney events than prescription at 31 to 90 days, without significant differences in mortality, cardiovascular events, or recorded short-term safety outcomes. These findings support timely initiation of SGLT-2 inhibitors during the post-AKI recovery period and provide a rationale for prospective randomized clinical trials.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare, severe hypersensitivity reaction characterized by rash, hematologic abnormalities, and multiorgan involvement. Although DRESS is typically triggered by medications, interindividual variability suggests a role for host-related factors. This study investigated whether underlying autoimmune diseases increase susceptibility to DRESS.

A retrospective, propensity score-matched case-control analysis was conducted using a large multicenter database, comparing 1128 patients with DRESS to 1128 controls matched by age, sex, and race. Autoimmune comorbidities were identified through ICD-10 codes encompassing systemic and organ-specific conditions.

Several autoimmune diseases were significantly more prevalent in patients with DRESS, including hypothyroidism (odds ratio [OR] 1.56; 95% confidence interval [CI] 1.24-1.96; P < 0.001), type 2 diabetes mellitus (OR 1.58; 95% CI 1.31-1.91; P < 0.001), rheumatoid arthritis (OR 2.17; 95% CI 1.36-3.46; P < 0.001), psoriasis (OR 2.28; 95% CI 1.28-4.06; P = 0.004), inflammatory bowel disease (OR 1.81; 95% CI 1.08-3.04; P = 0.02), and mixed connective tissue disease (OR 2.59; 95% CI 1.52-4.44; P < 0.001).

These findings highlight the importance of heightened vigilance when prescribing high-risk medications to patients with autoimmune diseases and underscore the need for prospective studies exploring genetic and immunologic mechanisms linking autoimmunity and drug hypersensitivity.

Background and Objectives: To determine whether continuous glucose monitoring (CGM)-derived metrics can differentiate between normoglycemia, increased diabetes risk (FINDRISC+) and prediabetes and to assess whether CGM-derived metrics provide additional discriminatory information beyond conventional laboratory markers. Materials and Methods: In this cross-sectional study, 41 adults without diabetes were classified as normoglycemic controls (HbA1c < 5.7%, FINDRISC < 12), individuals at increased diabetes risk (HbA1c < 5.7%, FINDRISC ≥ 12), or individuals with prediabetes (HbA1c 5.7-6.49%). All participants underwent 14-day CGM. Mean interstitial glucose, glycemic variability (SD, CV) and time in, above and below range (TIR, TAR, TBR) were analyzed. Group differences were assessed using ANOVA or non-parametric tests; correlations were evaluated using Pearson analysis. Results: HbA1c differed significantly across groups (F = 17.62; p < 0.001). Among CGM metrics, only mean interstitial glucose differed (F = 3.54; p = 0.039), driven by higher values in the prediabetes group. Glycemic variability and time-based metrics did not differ significantly. Substantial overlap was observed between the increased risk and prediabetes groups. No significant correlation was found between HbA1c and mean CGM glucose (r = 0.164; p = 0.30). Conclusions: In this exploratory cohort, short-term CGM-derived metrics provided limited additional discriminatory information beyond conventional laboratory markers and clinical risk assessment. Larger prospective studies are needed to determine the discriminatory and predictive value of CGM in early metabolic risk states.

Background and Objectives: Sodium-glucose cotransporter-2 (SGLT2) inhibitors provide cardio-renal protection in type 2 diabetes, but tolerability-related discontinuation is common, creating a need for effective replacement therapy. Dipeptidyl peptidase-4 (DPP-4) inhibitors are widely used as follow-on agents, yet the clinical course after such a switch has not been systematically characterized, and whether individual DPP-4 inhibitors differ in efficacy in this setting is unknown. Materials and Methods: We conducted a single-center retrospective cohort study at Chungnam National University Hospital (Daejeon, Republic of Korea) between January 2013 and January 2025, including 117 adults with type 2 diabetes who switched from an SGLT2 inhibitor to a DPP-4 inhibitor and met pre-specified criteria for medication stability and follow-up. The primary outcome was the change in glycated hemoglobin (HbA1c) from baseline to 3 months; secondary outcomes were changes in body weight, body mass index, blood pressure, and renal parameters. A pre-specified subgroup analysis compared teneligliptin (n = 60) with other DPP-4 inhibitors as a class (n = 57). Results: In the overall cohort, body weight rose by 0.7 kg and systolic blood pressure by 4.3 mmHg at 3 months (both p < 0.05), whereas HbA1c was unchanged (p = 0.157). In the subgroup analysis, HbA1c fell significantly with teneligliptin (-0.36%; 95% confidence interval, -0.62 to -0.10; p = 0.009) but not with other DPP-4 inhibitors (+0.13%). The between-group difference was -0.49% (95% confidence interval, -0.83 to -0.15; p = 0.005) and persisted after adjustment for baseline HbA1c and estimated glomerular filtration rate (p = 0.007). Conclusions: Switching preserved overall glycemic control at 3 months but produced modest, anticipated increases in body weight and blood pressure. Teneligliptin was associated with a greater HbA1c reduction than the pooled group of other DPP-4 inhibitors; this association persisted after adjustment for the two available baseline covariates but could not be adjusted for diabetes duration, medication adherence, diabetic complications, or other unmeasured factors. Because confounding by indication and other residual confounding cannot be excluded in this short-term, single-center analysis, this finding is hypothesis-generating only and requires confirmation in adequately powered prospective head-to-head trials. Importantly, this study evaluated only the glucose-lowering effect of the switch; because the cardio-renal protection of SGLT2 inhibition is not reproduced by DPP-4 inhibitors, a DPP-4 inhibitor should be regarded as an unavoidable substitute when an SGLT2 inhibitor cannot be maintained rather than a therapeutically equivalent replacement, and preserved HbA1c at 3 months does not establish clinical equivalence between the two strategies.