Living with Type 1 diabetes (T1D) requires multiple daily self-care behaviours. Identifying important self-care behaviours associated with health and wellbeing has the potential to support a goal-focussed and person-centred consultation. We describe diabetes self-care behaviours and their associations with clinical outcomes including glycated haemoglobin (HbA1C) and diabetes distress, and characterise key behavioural measures associated with poorer outcomes that could be targeted via behavioural intervention.

Cross-sectional study involving 105 adults with T1D attending a tertiary diabetes outpatient clinic. Self-report questionnaires administered during routine appointments assessed diabetes self-care behaviours, measures of distress and psychological flexibility. Associations between behaviours, HbA1C and distress were examined. Cluster analysis identified subgroups of participants with similar profiles, providing insights into frequency of self-care behaviours, HbA1C and distress.

Half the participants reported lower frequencies of some key behaviours than generally considered necessary to manage day-to-day glucose variations. HbA1C less than 64 mmol/mol (< 8%) was associated with higher frequency of glucose checks, frequency of insulin administration, less prandial insulin omission, and days having hypoglycaemia treatment food available. Clinically significant distress was associated with less frequent insulin administration and less frequent glucose checks before administering insulin. Higher perceived attainment of diabetes self-care goals and psychological flexibility were associated with lower HbA1C and distress.

A point of care self-reported questionnaire can identify the frequency of clinically meaningful self-care behaviours, particularly those most strongly associated with glycaemia and/or distress. This could inform targeted strategies to enhance health outcomes. A prospective study is necessary to test whether routine collection of behavioural information would enhance personalised approaches to diabetes care.

Objectives Macular edema after cataract surgery is known as pseudophakic cystoid macular edema or Irvine-Gass syndrome. The aim of this study was to determine the incidence and time to onset of cystoid macular edema after uncomplicated cataract surgery. Methods  A retrospective review was conducted of 1,325 consecutive cataract surgeries performed by a single surgeon at a single institution over four years, from January 2022 to December 2025. Results Among 1,325 eyes, one or more macular cysts were detected by optical coherence tomography in 27 eyes (2.0%) of 22 patients who complained of blurred vision or decreased visual acuity after having no symptoms immediately after surgery. The 22 patients (27 eyes: 12 right and 15 left) comprised 12 men and 10 women. Their ages at the time of surgery ranged from 57 to 82 years, with a median of 75.5 years. Of the 27 eyes that developed macular cysts, 13 eyes with no preoperative or intraoperative risk factors for inflammation received topical 0.1% bromfenac twice daily as the only postoperative anti-inflammatory treatment, together with topical antibacterial 0.5% moxifloxacin four times daily. In contrast, the remaining 14 eyes, which had risk factors for inflammation, such as exfoliation, floppy iris, poor mydriasis, extracapsular cataract extraction, or diabetes mellitus, received topical bromfenac twice daily and 0.1% betamethasone (or 0.1% fluorometholone in two eyes) four times daily, as well as topical moxifloxacin. The time from surgery to the diagnosis of macular cysts ranged from one week to eight months, with a median of two weeks, in the 13 eyes treated with topical bromfenac only. In the 14 eyes treated with the combination of topical bromfenac and betamethasone, the time to diagnosis ranged from two weeks to 13 months, with a median of two months. In 26 of the 27 eyes, the macular cysts disappeared and visual acuity returned to normal without residual symptoms within two weeks to seven months, with a median of one month, after topical betamethasone four times daily was initiated or resumed. Conclusions  Pseudophakic macular cysts developed during the postoperative course in eyes with no preoperative or intraoperative risk factors that received topical bromfenac alone. They also developed later in the postoperative course after the combination of topical bromfenac and betamethasone was discontinued in eyes with risk factors for inflammation. The macular cysts disappeared following the initiation or resumption of topical betamethasone, accompanied by recovery of visual acuity and resolution of symptoms.

Background Anorectal abscess and fistula-in-ano represent acute and chronic manifestations of cryptoglandular anorectal sepsis. Fistula formation after incision and drainage remains an important cause of morbidity and recurrent sepsis. Evidence regarding demographic, socioeconomic, dietary, hydration, bowel habit, and clinical factors associated with fistula formation is limited, particularly in the Indian population. This study assessed the six-month incidence of fistula-in-ano following abscess drainage and factors associated with its development. Methods A prospective observational study was conducted among 65 adults undergoing incision and drainage of anorectal abscess at JSS Medical College and Hospital, Karnataka, India. Patients were followed for six months. Demographic, socioeconomic, comorbidity, dietary, lifestyle, bowel habit, abscess, and microbiological variables were recorded. Associations with fistula formation were assessed using Pearson chi-square, Fisher's exact, or Fisher-Freeman-Halton exact tests, as appropriate. Significant variables were further assessed using univariate binary logistic regression. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. A two-sided p <0.05 was considered significant. Results Fistula-in-ano developed in 22/65 patients (33.8%); of the remaining, 39 (60.0%) achieved complete healing without fistula and four (6.2%) developed recurrent abscess without fistula. Male sex (OR 7.20, 95% CI 1.36-38.20; p=0.014), age 61-70 years (OR 6.60, 95% CI 1.23-35.44; p=0.028), abscess size >3 cm (OR 6.88, 95% CI 1.98-23.88; p=0.002), mixed diet (OR 2.99, 95% CI 1.03-8.66; p=0.043), constipation (OR 6.64, 95% CI 1.71-25.76; p=0.006), diabetes mellitus (OR 4.28, 95% CI 1.33-13.75; p=0.014), and water intake <1.5 L/day (OR 3.40, 95% CI 1.01-11.45; p=0.048) were associated with higher odds of fistula formation. Abscess type was significantly associated with fistula formation (p=0.007). After recoding, patients with ischiorectal, submucosal, or supralevator abscesses had higher odds than perianal abscesses (OR 19.20, 95% CI 2.06-179.08; p=0.009). Lower socioeconomic status was significantly associated with fistula formation on Fisher-Freeman-Halton exact testing (p=0.003) but was not included in logistic regression because no fistula events occurred in the upper socioeconomic group, resulting in complete separation and unstable parameter estimates. Abscess position was significant on categorical analysis (p=0.013), although posterior location was not significant on regression (p=0.113). Among the 22 patients who developed fistula-in-ano, 13 (59.1%) had posterior internal openings and 16 (72.7%) had intersphincteric fistulas. Conclusion One-third of patients developed fistula-in-ano within six months following drainage of anorectal abscess. Male sex, older age, larger abscesses, diabetes, constipation, mixed dietary pattern, low water intake, and non-perianal abscess type were associated with increased odds of fistula formation. These findings identify potentially high-risk clinical and modifiable characteristics that may help guide closer follow-up and patient counselling after abscess drainage. However, the associations should not be interpreted as independent predictors because multivariable analysis was not performed. Larger multicentre prospective studies with longer follow-up and multivariable modelling are required to validate these findings and establish independent risk factors.

Shared Medical Appointments (SMAs) have recently emerged as a novel tool in weight management as they are efficient, bypass logistic barriers to physical attendance, decrease attrition, and are cost-effective. This study aimed to observe outcomes among patients enrolled in an insurance-based weight loss program, called Program for Reducing Obesity (PRO), utilizing telemedicine SMAs during a 12 month period of chronic weight management.

Patients of age ≥ 18 years with BMI ≥ 30 kg/m² were enrolled in the program, consisting of telemedicine SMAs with an obesity medicine board-certified physician and a registered dietitian. The primary outcome was the change in body weight at 6 and 12 months. Secondary outcomes were changes in glycated hemoglobin (HgbA1c) and triglyceride (TG) levels.

One hundred and nine patients, who had been enrolled in the program for about 18 months, were included in the study. The mean age was 62.40 ± 12.5 years. 73% were treated with obesity management medications. Patients attended an average of 10 classes through SMAs. 51% of patients had prediabetes, and 25% had Type 2 Diabetes Mellitus (DM). The mean weight of patients at baseline was 97.54 ± 19 kg, with an average weight loss of 2.38 ± 4.78 kg (2.43%) and 4.47 ± 7.77 kg (4.55%) at 6 and 12 months (p < 0.001). The mean baseline HgbA1c and TG levels were 5.96 ± 0.8% and 137.43 ± 112.4 mg/dL, respectively. HgbA1c levels decreased by 0.11 ± 0.65 (2.19%) and 0.20 ± 0.50 (3.70%) at 6 and 12 months, and TG levels decreased by 25.19 ± 104.60 mg/dL (33.60%) at 6 months and 35.83 ± 112.08 mg/dL (41.14%) at 12 months (p < 0.05). There were no statistically significant differences in weight loss between sexes, and regardless of the presence of DM, use of obesity management medications, or the number of classes attended.

This study showed that telemedicine SMAs are an effective and efficient method for promoting weight loss, even in the ongoing maintenance phase.

The integration of digital twins (DT) and artificial intelligence (AI) is driving a paradigm shift in diabetes mellitus (DM) care from traditional population-based, symptomatic intervention to a lifecycle-oriented precision management approach. This review systematically elaborates on the cross-disciplinary integration mechanisms of the two technologies. By integrating multimodal data and constructing physiologically constrained hybrid models, it achieves multi-scale mechanistic analyses ranging from single-cell β-cell protection to multi-organ complications at the basic research level. On the clinical application front, it not only significantly enhances the early screening sensitivity for diabetic retinopathy and the accuracy of blood glucose prediction, but also optimizes insulin dosing, personalized nutritional plans, and exercise decision support through virtual trials. In the field of drug development, virtual clinical trials accelerate target discovery and drug repurposing. Although substantial technical, regulatory, and ethical challenges remain unresolved, ongoing progress in hybrid modeling, federated learning, explainable AI, and evolving regulatory frameworks provides a plausible pathway toward individualized prediction and proactive management, provided that claims of clinical readiness are matched by rigorous prospective validation.

Diabetic foot is a serious and largely preventable complication of diabetes. Patient knowledge, attitudes, and practices (KAP) regarding foot care are central to early prevention, yet the overall distribution of KAP levels among patients with diabetes in China remains unclear. This systematic review and meta-analysis aimed to estimate the pooled proportions of different levels of diabetic foot care-related KAP among patients with diabetes in China.

The review was registered in PROSPERO (CRD420261328954) and followed PRISMA 2020 reporting guidance. PubMed, Embase, Scopus, the Cochrane Library, Web of Science, CINAHL Complete, SinoMed, CNKI, Wanfang, and VIP were searched from inception to March 2, 2026. Cross-sectional studies reporting extractable diabetic foot-care KAP data among Chinese adults with diabetes were included. Study quality was assessed using the 11-item Agency for Healthcare Research and Quality checklist. Random-effects proportion meta-analyses used the Freeman-Tukey double arcsine transformation. Subgroup, sensitivity, and small-study effect analyses were conducted where data allowed.

Twenty-four cross-sectional studies involving 6,124 participants across 13 Chinese provinces or municipalities were included. Fourteen studies contributed to the meta-analysis of knowledge, five to attitudes, and seventeen to practices. The pooled proportions of poor, satisfactory, and good knowledge were 33% (95% CI: 19-48%), 43% (95% CI: 33-54%), and 26% (95% CI: 17-37%), respectively. For attitudes, 33% (95% CI: 10-62%) of participants had unfavorable attitudes and 67% (95% CI: 38-90%) had favorable attitudes. For practices, the pooled proportions of poor, satisfactory, and good foot care practices were 45% (95% CI: 35-55%), 45% (95% CI: 38-53%), and 10% (95% CI: 6-14%), respectively. Substantial heterogeneity was observed across most outcomes, and subgroup analyses did not identify statistically significant differences by study region, diabetic foot status, or publication period.

Chinese patients with diabetes generally showed favorable attitudes toward diabetic foot care, but knowledge remained insufficient and good foot-care practices were uncommon. Because all included studies were cross-sectional, the pooled estimates primarily characterize the distribution of KAP levels and should be interpreted descriptively. When considered alongside existing guidelines and intervention evidence, these findings may inform the development of risk-stratified, behavior-oriented, and system-supported strategies for diabetic foot prevention.

Publicly accessible record: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261328954. PROSPERO registration: CRD420261328954.

Melioidosis is a tropical infectious disease caused by Burkholderia pseudomallei. Although vascular involvement is rare, melioidosis-associated abdominal aortic pseudoaneurysm can rapidly progress and carries a high risk of rupture and mortality. Due to nonspecific early symptoms and the lack of specific guidelines, the optimal timing of surgery remains unclear.

A 62-year-old female farmer from Hainan Province, China, presented with persistent lower abdominal pain for over 10 days, followed by low back pain and fever (maximum 38.0 °C). She was diagnosed with type 2 diabetes mellitus based on persistent hyperglycemia and an HbA1c level of 14.8%. Emergency CTA revealed a focal pseudoaneurysmal lesion of the abdominal aorta at the L3 level, with periaortic inflammatory changes and suspected contained rupture, but no active contrast extravasation. As the patient was hemodynamically stable, empirical piperacillin/tazobactam therapy was initiated with close monitoring. Blood cultures on hospital day 5 suggested gram-negative bacilli, prompting a switch to imipenem/cilastatin. On day 6, cultures confirmed B. pseudomallei, susceptible to imipenem, ceftazidime, and TMP-SMX. Targeted antimicrobial therapy was continued with addition of TMP-SMX. The patient's fever, pain, and inflammatory markers improved significantly. Follow-up CTA on day 21 showed marked resolution of periaortic inflammation, and blood cultures became negative on day 28. Antimicrobial therapy was switched to ceftazidime on day 30, and open vascular reconstruction was performed on day 38.

In melioidosis-endemic regions, aortic infection should be considered in diabetic patients with fever and abdominal or back pain. For carefully selected patients with suspected contained rupture, hemodynamic stability, and good response to targeted antimicrobial therapy, delayed elective open reconstruction under strict surveillance and with emergency intervention capability may be a feasible strategy. However, this single case cannot establish the superiority of delayed surgery or define the optimal timing of intervention.

Objective: To explore the role and mechanism of G-protein coupled receptor kinase 2 (GRK2)-mediated phosphorylation of adiponectin receptor 1 (AdipoR1) in diabetic cardiomyopathy (DCM), and to verify the therapeutic effect of site-directed mutagenesis targeting serine at position 205 (Ser205) of AdipoR1. Methods: Twenty 4-week-old C57BL/6J mice were randomly assigned to the normal control (NC) group and the DCM model group using a random-number table, with 10 mice per group. The DCM model was established in the DCM group by high-fat diet (HFD) feeding combined with intraperitoneal injection of streptozotocin (STZ). After 21-week intervention, 6 mice from each group were selected using a random-number table for measurements of serum biochemical parameters, adiponectin (APN) levels and cardiac diastolic function. Following euthanasia, myocardial tissues were harvested for Masson's trichrome staining to evaluate the degree of myocardial fibrosis. Co-immunoprecipitation and Western blot (WB) assays were performed to determine GRK2 expression, phosphorylated serine (p-Ser) levels, and the binding capacity between AdipoR1 and adaptor protein, phosphotyrosine-binding domain and leucine zipper motif 1 (APPL1). The remaining 4 mice per group were used for isolation of primary adult cardiomyocytes, which were treated with exogenous APN or phosphate-buffered saline (PBS). Phosphorylation status of the downstream adenosine monophosphate-activated protein kinase (AMPK)/protein kinase B (Akt) signaling pathway was subsequently detected. Twenty-eight 3-day-old AdipoR1-knockout neonatal mice were included in further experiments. Four of these AdipoR1-knockout neonatal mice were randomly selected by a random-number table to isolate primary cardiomyocytes. Plasmid co-transfection was conducted to assess AdipoR1-APPL1 interaction and downstream AMPK/Akt phosphorylation upon GRK2 overexpression. Four experimental subgroups were set: Adenovirus-empty(Ad-empty)+3×Flag-AdipoR1^WT, Ad-empty+3×Flag-AdipoR1^S205A, adenovirus-mediated GRK2(Ad-GRK2)+3×Flag-AdipoR1^WT, and Ad-GRK2+3×Flag-AdipoR1^S205A. This experiment aimed to identify whether Ser205 phosphorylation serves as the key molecular event whereby GRK2 blocks APN signaling. From the remaining 24 AdipoR1-knockout neonatal mice, 12 were randomly allocated into two groups (6 mice per group) using a random-number table. On postnatal day 3, mice received an injection of either adeno-associated virus serotype 9 (AAV9)-AdipoR1^WT or AAV9-AdipoR1^S205A. Ten weeks later, primary adult cardiomyocytes were isolated and divided into 4 subgroups: AAV9-AdipoR1^WT+Ad-empty, AAV9-AdipoR1^WT+Ad-GRK2, AAV9-AdipoR1^S205A+Ad-empty, and AAV9-AdipoR1^S205A+Ad-GRK2. GRK2 was overexpressed in vitro, and immunofluorescence co-localization was applied to quantify the co-localization of AdipoR1 and APPL1. The leftover 12 AdipoR1-knockout neonatal mice were randomized into two groups (6 mice per group) with a random-number table, and injected with the aforementioned viruses on postnatal day 3. Four weeks after virus injection, DCM was induced by HFD plus STZ administration, yielding two in-vivo groups: AAV9-AdipoR1^WT+DCM (wild-type group) and AAV9-AdipoR1^S205A+DCM (point-mutation group). APN was continuously delivered via osmotic minipumps. Eight weeks after APN intervention, cardiac function and myocardial fibrosis were evaluated. Results: In C57BL/6J mice, the DCM group exhibited significantly higher levels of blood glucose, triglycerides, low-density lipoprotein-cholesteral and adiponectin (APN) compared with the NC group (all P<0.001). Statistically significant differences were observed between the two groups in the E/A ratio, radial strain rate, reverse radial strain rate (rRSR), longitudinal strain rate (LSR), and reverse longitudinal strain rate (rLSR) (all P<0.05). The fraction of myocardial fibrotic area was larger in the DCM group than in the NC group (9.20±1.66 vs 1.24±0.51, P<0.001). Myocardial protein levels of GRK2 (4.81±0.46 vs 1.03±0.09, P<0.001) and p-Ser (1.75±0.21 vs 0.98±0.05, P<0.001) were elevated in the DCM group relative to the NC group. The binding ratio of APPL1 to AdipoR1 in myocardial tissue was decreased in the DCM group versus the NC group (0.398±0.085 vs 0.978±0.088, P<0.001). APN-stimulated AMPK/Akt phosphorylation was blunted in primary adult cardiomyocytes isolated from DCM-model C57BL/6J mice. In-vitro experiments using AdipoR1-knockout neonatal mouse cardiomyocytes demonstrated that following AdipoR1 Ser205 site mutation, the ratios of p-AMPK/AMPK (4.025±0.767 vs 1.003±0.087, P<0.001) and p-Akt/Akt (4.125±0.544 vs 0.990±0.034, P<0.001) were markedly increased in the 3×Flag-AdipoR1^S205A+APN group compared with the 3×Flag-AdipoR1^S205A+PBS group. In primary adult cardiomyocytes derived from AdipoR1-knockout mice, the AAV9-AdipoR1^S205A+Ad-GRK2 group restored the AdipoR1-APPL1 interaction in the presence of GRK2 when compared with the AAV9-AdipoR1^WT+Ad-GRK2 group (P=0.014). In the in-vivo DCM model established in AdipoR1-knockout mice, the AAV9-AdipoR1^S205A+DCM group displayed higher E/A ratio, rRSR, LSR and rLSR values, together with a lower myocardial fibrotic area fraction (all P<0.05), relative to the AAV9-AdipoR1^WT+DCM group. Conclusions: GRK2-mediated phosphorylation of AdipoR1 at serine 205 triggers APN-AdipoR1 metabolic dysfunction, which represents a critical contributor to aggravated cardiac dysfunction in DCM. This mechanism is associated with the decoupling of AdipoR1 from APPL1. Targeted inhibition of AdipoR1 phosphorylation via site-directed mutagenesis restores APN-AdipoR1 signaling and ameliorates cardiac dysfunction in DCM.

The Diabetic Foot Group of the Chinese Diabetes Society, Chinese Medical Association was founded in 1995 and renamed the Diabetes Foot and Peripheral Vascular Disease Group (hereinafter referred to as the Group) in 2012. Over the past 30 years, through the persistent efforts of successive generations of specialists, the Group has achieved fruitful outcomes in clinical practice, scientific research, talent cultivation, international academic exchanges and other fields. This paper reviews the developmental course of the Group, summarizes the work accomplished by its seven successive committees, analyzes the gaps between domestic research on diabetic foot and peripheral vascular diseases in China and the advanced international standards, and puts forward proposals for the future development of the Group.

Cardiovascular-kidney-metabolic (CKM) syndrome is a recently defined clinical entity integrating metabolic risk factors, chronic kidney disease, and cardiovascular disease. Elevated body mass index (BMI) is a major modifiable risk factor for CKM syndrome, yet comprehensive long-term analyses of the high BMI-attributable burden in China remain scarce.

Using data from the Global Burden of Disease (GBD) 2023 study, we assessed the burden of eight selected CKM-related diseases attributable to high BMI (atrial fibrillation and flutter [AFF], chronic kidney disease due to hypertension [CKD-HTN] or diabetes mellitus type 2 [CKD-T2DM], diabetes mellitus type 2 [T2DM], hypertensive heart disease [HHD], ischemic heart disease [IHD], lower extremity peripheral arterial disease [LEPAD], and stroke) in China from 1990 to 2023. The primary outcomes were absolute deaths and DALYs and their age-standardized rates (ASRs) per 100,000 population. Joinpoint regression and ARIMA models were applied to analyze and project temporal trends in ASRs, age-period-cohort analysis was conducted using age-specific rates, and decomposition analysis quantified the contributions of population growth, population aging, and epidemiological change to changes in absolute deaths and DALYs.

From 1990 to 2023, absolute deaths and DALYs for all eight selected diseases relevant to the CKM framework increased. IHD had the highest burden in 2023 (114,980 deaths; 2,923,595 DALYs), whereas AFF showed the greatest relative increase (11.4-fold). Descriptively, men generally had higher point estimates of death and DALY counts, ASMRs, and ASDRs for CKD-T2DM, CKD-HTN, IHD, and HHD, whereas women had higher corresponding estimates for AFF. Joinpoint regression identified sustained increases in AFF, IHD, T2DM, and LEPAD, with several inflection points around 2005. APC analysis showed pronounced age-related gradients and variations in period and cohort rate ratios. Decomposition analysis indicated that population aging was the predominant contributor to increasing mortality for most outcomes, while epidemiological change had heterogeneous effects and partially offset increases in CKD-T2DM and HHD. Model-based projections suggested heterogeneous future trajectories: increasing mortality and DALY rates for AFF, IHD, and LEPAD; increasing DALYs but slightly declining mortality for T2DM; broadly stable or slightly declining rates for stroke, CKD-T2DM, and CKD-HTN; and declining point estimates for HHD, although with substantial long-term uncertainty.

High BMI-attributable stage 2-4 CKM burden has risen sharply in China and will continue to increase, driven mainly by worsening epidemiological risks. AFF, IHD, and LEPAD show the fastest growth. Men had higher age-standardized mortality and DALY rates for several selected diseases. Early-life obesity prevention and sex-tailored interventions are urgently needed.