Youth with type 1 diabetes face demanding daily self-management requirements. Mobile health interventions are a promising approach for supporting diabetes self-management both within clinical care and in everyday contexts. This review synthesizes recent evidence published between 2018 and 2024 on mobile health interventions designed to support self-management in children and adolescents with type 1 diabetes.

Forty-four studies met inclusion criteria. Most were early-phase evaluations emphasizing feasibility, usability, and engagement. Across modalities, mHealth interventions were most successful at lowering hemoglobin A1c when they provided real-time, actionable support during insulin dosing or carbohydrate estimation. Engagement trajectory emerged as an important determinant of clinical benefit, suggesting that initial usability alone are insufficient to produce meaningful clinical impact. Mobile health interventions for youth with type 1 diabetes are feasible, acceptable, and effective for improving self-management processes and psychosocial outcomes. Glycemic improvements occur selectively when interventions provide point-of-need decision support and when engagement is sustained. Future research should prioritize mechanisms of action, strategies to support long-term engagement, and rigorous effectiveness-implementation trials to support scalable clinical impact.

To characterize the spatial pattern of cortical magnetic susceptibility alterations in Type 2 diabetes mellitus (T2DM) and to determine whether hyperglycemia moderates the association between regional cortical QSM values and cognitive performance.

In this cross-sectional study, 145 patients with T2DM and 182 healthy controls underwent 3 T MRI. Cortical gray matter magnetic susceptibility was quantified using quantitative susceptibility mapping (QSM). Cognitive function was assessed with a multidomain neuropsychological battery. Partial correlation, general linear models, and moderation analyses examined associations among cortical susceptibility, glycemic indices, and cognitive performance. Support vector regression (SVR) with nested cross-validation evaluated the predictive value of limbic subregional QSM values for information processing speed.

Whole-cortex analyses showed nominally higher QSM values in the bilateral limbic cortices of patients with T2DM, while post hoc analyses identified significantly higher QSM values in the left cingulate cortex and right parahippocampal gyrus after FDR correction. QSM values in selected limbic cortical regions at both the lobar and subregional levels were positively correlated with FPG and HbA1c. Covariate-adjusted analyses further indicated associations between higher QSM values in frontal, parietal, and limbic regions and poorer episodic memory and executive function. Moderation analyses suggested that higher HbA1c levels strengthened the inverse associations between QSM values in selected limbic cortical regions and cognitive performance on the MMSE, MoCA, and CDT. Within the T2DM group, SVR models based on limbic subregional QSM values showed cross-validated predictive performance for TMT-A scores.

Patients with T2DM showed a limbic-predominant pattern of cortical magnetic susceptibility alterations, with higher QSM values in selected regions associated with poorer performance across multiple cognitive domains. HbA1c moderated the associations between regional QSM values and cognitive performance. These findings suggest that limbic cortical susceptibility alterations may be relevant to metabolic dysregulation and cognitive vulnerability in T2DM.

Individuals deprived of liberty exhibit high health vulnerability due to limited access to medical services and insufficient health promotion efforts. Implementing education and self-care programs constitutes an essential strategy to improve their wellbeing. The objective of this study was to evaluate changes in clinical parameters following the implementation of health promotion programs among incarcerated individuals.

A prospective pre-post intervention study was conducted between February 2023 and July 2024 at the Male Social Reintegration Center No. 1 in Aquiles Serdán, Chihuahua, Mexico. Fifteen male inmates with type 2 diabetes mellitus and arterial hypertension participated in a structured health promotion program that included educational workshops on nutrition, physical activity, and chronic disease self-management. Anthropometric and biochemical data were collected before and after the intervention. Statistical analysis included paired Student's t-test and McNemar's test (P < 0.05).

Significant reductions were observed in blood glucose (174.1 ± 123.2 vs. 111.1 ± 57.4 mg/dL; P = 0.0017), systolic blood pressure (140.7 ± 18.3 vs. 117.3 ± 9.6 mmHg; P < 0.001), diastolic blood pressure (92.0 ± 10.8 vs. 84.0 ± 7.4 mmHg; P = 0.0013), and waist circumference (83.6 ± 37.6 vs. 80.3 ± 35.7 cm; P = 0.0005), with a favorable trend in body mass index (P = 0.065).

Health promotion programs had a positive impact on the control of chronic diseases among the incarcerated population studied. These findings highlight the need to strengthen sustainable interdisciplinary strategies that uphold the right to health in prison settings.

To compare clinical characteristics, microbiology, treatment burden and outcomes between lower-extremity necrotising soft tissue infections associated with diabetic foot ulcers (DFU) and lower-extremity necrotising soft tissue infections not associated with DFU. We retrospectively reviewed 86 surgically treated patients at a single tertiary hospital from 2015 to 2025. Twenty patients had diabetic foot ulcer-associated infections and 66 had infections from other causes. Baseline characteristics, laboratory findings, microbiology, resource utilisation, wound healing, amputation and mortality were compared between the cohorts. The diabetic foot ulcer-associated group had a longer diabetes duration, higher glycated haemoglobin and a greater prevalence of hypertension, coronary heart disease and chronic kidney disease. Microbiological profiles showed overlapping distributions of major pathogens. The proportion of patients who were alive with a healed wound at 90 days was lower in the DFU-associated group (35.0% vs. 80.3%), and overall amputation was more frequent (55.0% vs. 15.2%), primarily driven by minor amputation (40.0% vs. 1.5%). Major amputation (15.0% vs. 13.6%) and mortality (10.0% vs. 4.5%) did not differ statistically, although estimates were imprecise. Lower-extremity necrotising soft tissue infections associated with DFU were associated with greater comorbidity, resource utilisation, minor amputation and a lower proportion of patients alive with a healed wound at 90 days. This retrospective study cannot determine whether minor amputation improves survival or prevents major amputation.

Background Cardiovascular disease (CVD) remains the leading cause of premature morbidity and mortality among individuals living with type 1 diabetes mellitus (T1DM). Although overt cardiovascular events are uncommon during childhood, endothelial dysfunction and subclinical atherosclerosis develop early, making timely cardiovascular risk assessment essential. Plasma homocysteine has emerged as a potential biomarker of vascular injury; however, its clinical value in pediatric T1DM remains controversial, and evidence from African populations is scarce. This study aimed to evaluate plasma homocysteine concentrations in children and adolescents with T1DM and to investigate their relationship with cardiovascular risk profiles and diabetes-related complications. Methods A cross-sectional observational study was conducted at the Department of Pediatrics B, in the university hospital center of Oran, Algeria. A total of 50 children and adolescents aged 5-19 years with confirmed T1DM were included. Demographic, anthropometric, clinical, and laboratory data were retrospectively collected from medical records. Plasma total homocysteine (tHcy) concentrations, glycemic control, lipid profile, diabetes duration, insulin therapy, nephropathy, and cardiovascular risk factors were analyzed. Hyperhomocysteinemia prevalence was determined, and its association with cardiovascular risk stratification was assessed using descriptive and inferential statistical analyses. Results The study included 27 male (54%) and 23 female patients (46%), and hyperhomocysteinemia was identified in 17 of 50 participants (34%). Plasma tHcy concentrations were significantly higher in participants with HbA1c >7.5% than in those with HbA1c ≤7.5% (18.9 ± 5.8 vs. 11.8 ± 3.9 μmol/L; Student's t-test, t = 4.44, p < 0.001). Plasma tHcy concentrations were positively correlated with HbA1c (r = 0.61, p < 0.001), diabetes duration (r = 0.49, p = 0.001), LDL cholesterol (r = 0.42, p = 0.004), and triglycerides (r = 0.35, p = 0.015). Participants with diabetic nephropathy had significantly higher plasma tHcy concentrations than those without nephropathy (21.1 ± 5.9 vs. 15.2 ± 5.3 μmol/L; Student's t-test, t = 2.53, p = 0.015). In exploratory multivariable analysis, poor glycemic control (HbA1c >7.5%; aOR = 3.26, 95% CI: 1.18-9.02; p = 0.021) and diabetes duration ≥5 years (aOR = 2.54, 95% CI: 1.01-6.42; p = 0.047) were independently associated with hyperhomocysteinemia. Plasma tHcy showed good discriminative ability for the study-specific moderate-to-high cardiovascular risk classification (AUC = 0.82, 95% CI: 0.69-0.94; p < 0.001). Conclusion Hyperhomocysteinemia was prevalent among children and adolescents with T1DM in our cohort and was associated with an unfavorable cardiovascular risk-factor profile. These findings suggest that plasma homocysteine may represent a potential investigational adjunctive marker of cardiovascular risk-factor burden in pediatric T1DM. Prospective multicenter studies are warranted to validate these associations and determine their incremental clinical value beyond established cardiovascular risk factors.

 Onychomycosis is a common fungal nail infection among individuals with diabetes mellitus and may contribute to diabetic foot complications by altering the local microbial environment and increasing the risk of secondary bacterial infection. This study aimed to determine the prevalence of onychomycosis and evaluate its association with clinical and microbiological characteristics among patients with diabetic foot ulcers.

 This retrospective observational study included 226 adult patients with diabetic foot ulcers treated at a tertiary referral center in South Kerala, India. Clinical records were reviewed to obtain demographic, clinical, and microbiological data. Onychomycosis was diagnosed based on compatible clinical findings with microbiological confirmation using potassium hydroxide microscopy and/or fungal culture. Categorical variables were summarized using frequencies and percentages. Univariate binary logistic regression was performed to identify factors associated with onychomycosis.

 Of the 226 patients included in the study, 85 (37.6%) had confirmed onychomycosis. Among patients with onychomycosis, 35 (41.2%) were aged 61-70 years, 54 (63.5%) were male, and 60 (70.6%) had diabetes duration >10 years. Poor glycemic control (HbA1c >9%) was observed in 43 (50.6%) patients, while peripheral neuropathy was present in 73 (85.9%). Polymicrobial ulcer cultures were identified in 44 (51.8%) patients with onychomycosis. Gram-negative bacilli were isolated in 49 (57.6%) patients, Pseudomonas aeruginosa in 30 (35.3%), and osteomyelitis was present in 35 (41.2%). On univariate binary logistic regression analysis, diabetes duration >10 years (OR: 2.30, 95% CI: 1.24-4.28; p=0.008), peripheral neuropathy (OR: 2.67, 95% CI: 1.33-5.34; p=0.005), polymicrobial infection (OR: 2.26, 95% CI: 1.30-3.91; p=0.004), Pseudomonas aeruginosa isolation (OR: 2.10, 95% CI: 1.14-3.86; p=0.017), and osteomyelitis (OR: 2.38, 95% CI: 1.33-4.26; p=0.003) were significantly associated with onychomycosis.

 More than one-third of patients with diabetic foot ulcers had concomitant onychomycosis. Longer duration of diabetes, peripheral neuropathy, polymicrobial infection, Pseudomonas aeruginosa isolation, and osteomyelitis were significantly associated with onychomycosis. Routine nail examination and timely identification of fungal nail infection may complement comprehensive diabetic foot assessment and help identify patients at increased risk of complicated foot infections.

Type 2 diabetes (T2D) has become increasingly prevalent among young adults in their prime working years. This study aimed to estimate the productivity-adjusted life years (PALYs) loss associated with T2D among working-age Chinese adults from 1990 to 2021, with projections to 2050.

Leveraging data from the Global Burden of Disease (GBD) 2021 database, the United Nations, and the China Chronic Disease and Risk Factors Surveillance study, we quantified individual- and population-level PALYs loss associated with T2D between 1990 and 2021 and projected trends through 2050 using a projection model. Loss of PALYs was calculated by combining productivity losses from excess mortality (years of life lost, YLL) with reductions in labour force participation, presenteeism, and absenteeism (years of productivity lost, YPL). Gross domestic product (GDP) loss was estimated by valuing each lost PALY using China's annual GDP per worker.

In 2021, 39.8 million working-age Chinese men and 23.3 million women had T2D. Over their working lifetime, T2D was associated with 53.42 (95% uncertainty interval (UI) = 51.25-55.59) million PALYs loss in men and 33.56 (95% UI = 31.59-35.52) million in women, equivalent to 1.34 (95% UI = 1.29-1.40) and 1.44 (95% UI = 1.36-1.53) PALYs loss per man and woman, respectively. Loss of GDP reached USD 1035.31 billion for men and USD 650.38 billion for women. Total PALYs loss is projected to increase from 1990 to 2050, although per-person losses decline in both sexes. Women with T2D experience greater per-person PALYs loss than men in 2030 and 2050.

T2D among working-age population is associated with substantial PALY and economic losses, underscoring urgent need for targeted interventions.

Type 2 diabetes mellitus (T2DM) is a major global health problem for which a wide range of antidiabetic medications are available. Adverse effects of antidiabetic medications may negatively affect patients' health and treatment adherence. In Egypt, limited data are available regarding the adverse-effect profiles of antidiabetic agents.

This study aimed to compare safety profiles, treatment-related adverse effects, and diabetes-related complications associated with commonly prescribed antidiabetic medications.

A multicenter, cross-sectional observational study was conducted across diabetes outpatient clinics in Egypt from February 2024 to May 2024. Adult patients with type 2 diabetes on antidiabetic regimens were enrolled. Data was collected through medical records and patient interviews, including demographics, clinical history, laboratory results, diabetes complications, and treatment-related adverse events. Univariate logistic regression analyses were performed to assess the associations between antidiabetic medications and diabetes-related complications and adverse outcomes. Unadjusted odds ratios (ORs) with 95% confidence intervals were reported. Statistical significance was set at p-value ≤ 0.05.

Several statistically significant associations were observed between the use of different antidiabetic medications and the prevalance of side effects and diabetes-related complications. Among 1,534 participants, insulin was associated with increased odds of cardiovascular, renal, and peripheral complications. Metformin, liraglutide, and empagliflozin were linked to gastrointestinal issues. Various mental disorders were notably associated with insulin. Empagliflozin and sitagliptin showed higher infection risks, while insulin and sulphonylureas were linked to some organ damage and retinopathy.

Understanding the safety profiles of antidiabetic drugs is essential for optimizing treatment. The observed associations may help inform clinical decision-making and improve patient outcomes. However, they should be interpreted as associations rather than causal relationships and warrant further investigation in well-designed prospective studies.

The co-occurrence of type 2 diabetes mellitus (T2DM) and dementia represents a major public health challenge in Spain, where prevalence among hospitalized patients rose from 6.9% in 2011 to 10.6% in 2020. However, post-pandemic trends and sex-specific clinical outcomes remain under-characterized. We aimed to evaluate the frequency and temporal trends of dementia subtypes, clinical profiles, and predictors of in-hospital mortality (IHM) among T2DM-related hospitalizations in Spain (2021-2024).

We conducted a nationwide retrospective observational study using the Spanish National Hospital Discharge Database (RAE-CMBD) and analyzed 2,786,184 T2DM-related hospital discharge episodes recorded between 2021 and 2024. The unit of analysis was the hospitalization episode rather than the unique individual; therefore, recurrent admissions for the same person could be included as separate observations. Multivariable logistic regression identified independent predictors of dementia presence and IHM.

All-cause dementia was coded in 180,623 hospital episodes, corresponding to 6.48% of T2DM-related hospitalizations. This proportion was higher among hospitalizations involving women than among those involving men. Regarding specific subtypes, AD was the most frequent diagnosis with 80,174 cases (2.88% prevalence), presenting an IHM of 16.3% across the study period. VaD affected 1.44% of the sample. A remarkably strong association was found between prior stroke/TIA and the presence of VaD (aOR 5.89; 95% CI 5.69-6.09). Hospitalizations involving all-cause dementia had higher in-hospital mortality (17.06% vs. 7.22%), lower ICU admission rates (1.33% vs. 7.58%), and higher frequencies of palliative-care coding (3.76% vs. 1.65%) than hospitalizations without dementia (Table 3). They also had shorter hospital stays and lower median estimated hospitalization costs (€6,129.3 vs. €8,602.94). A comprehensive breakdown of in-hospital mortality according to specific concomitant conditions and dementia status is available in S3 Table.

Among T2DM-related hospitalizations with dementia, female sex was associated with lower adjusted odds of in-hospital mortality. Prior stroke or transient ischemic attack was strongly associated with vascular dementia coding. Lower ICU admission and higher palliative-care coding were observed among hospitalizations involving dementia; however, the clinical reasons underlying these patterns cannot be determined from administrative discharge data.

Patients with end-stage kidney disease (ESKD) and diabetes undergoing maintenance hemodialysis (HD) may be at increased risk of metabolic disturbances and intradialytic complications during Ramadan fasting. However, evidence regarding the safety of fasting in this population remains limited. This study evaluated the association between Ramadan fasting and intradialytic hypoglycemia and other clinical outcomes.

This multicenter prospective cohort study included 153 patients with ESKD and diabetes undergoing maintenance HD at four centers in Thailand during the pre-Ramadan and Ramadan periods in 2024. Participants were categorized as non-fasting, partial fasting, or full fasting. All underwent HD using glucose-containing dialysate (100 mg/dL) and received standardized pre-Ramadan medication adjustments, including insulin dose reduction and oral glucose-lowering medication modification. The primary outcome was intradialytic hypoglycemia, defined as a blood glucose level <70 mg/dL. Secondary outcomes included HD-related complications, blood pressure, interdialytic weight gain (IDWG), dialysis adequacy, and laboratory parameters.

Among 153 participants, 73 were non-fasting, 44 were partial fasting, and 36 were full fasting. No intradialytic hypoglycemia occurred in the full- or non-fasting groups, whereas one episode (0.2%) occurred in the partial-fasting group. HD-related complications, blood pressure, IDWG, and dialysis adequacy (Kt/V) were comparable across groups. Serum potassium and parathyroid hormone levels increased during Ramadan in the full- and non-fasting groups without reported clinical events. Overall, participants remained clinically stable under the standardized protocol.

In this cohort, Ramadan fasting was not associated with an observed increase in major intradialytic hypoglycemic events and hemodialysis-related complications, indicating that the practice is clinically feasible and well-tolerated under strictly supervised protocols. Therefore, fasting may be considered for carefully selected patients with ESKD and diabetes receiving maintenance hemodialysis, provided it is accompanied by individualized medication adjustments, meticulous monitoring, and shared decision-making.