Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among patients with type 2 diabetes mellitus (T2DM) but remains underdiagnosed in primary care despite clinical guidelines. We investigated whether a multicomponent workflow that included expanding the role of ambulatory pharmacists, who already manage T2DM under collaborative care agreements to include MASLD risk stratification, is associated with improved detection of liver fibrosis.

To evaluate the feasibility of a pharmacist-integrated, multicomponent intervention and its association with MASLD fibrosis risk stratification, vibration-controlled transient elastography (VCTE) referral and completion, and detection of clinically significant fibrosis among patients with T2DM in a safety net primary care setting.

We conducted a 6-month pre-post feasibility and implementation pilot in a safety net family medicine clinic, with the pre-period serving as a baseline of usual care. The multicomponent intervention expanded MASLD risk stratification to pharmacists comanaging T2DM and incorporated targeted education, co-location of VCTE, and internal facilitation. Pharmacists calculated Fibrosis-4 index (FIB-4) scores during T2DM visits and referred patients with FIB-4 greater than or equal to 1.3 for VCTE. Outcomes included VCTE referral among patients with elevated FIB-4 scores, VCTE completion, detection of clinically significant fibrosis (liver stiffness measurement ≥8 kPa) or possible cirrhosis (liver stiffness measurement ≥12 kPa), and hepatology referral.

In the pre-intervention period, 41% (52 of 127) of patients with available laboratory data had FIB-4 greater than or equal to 1.3, and none were referred for VCTE. In the post-intervention period, 45% (61 of 136) of such patients had FIB-4 greater than or equal to 1.3. Of these, 87% (53 of 61) were referred for VCTE, and 85% (45 of 53) completed testing. VCTE identified 8 new cases of clinically significant fibrosis, including 6 with possible cirrhosis, leading to 6 hepatology referrals.

A pharmacist-integrated, multicomponent workflow was associated with increased VCTE referrals and completion, enabled identification of fibrosis, and facilitated specialist referrals among patients with T2DM in a safety net primary care setting. These findings support this pharmacist-integrated workflow as a feasible, patient-centered strategy to enhance MASLD detection, warranting further evaluation of scalability, sustainability, and impact.

Although continuous glucose monitoring (CGM) is well established for insulin-treated diabetes, its utility in non-insulin-treated type 2 diabetes (T2D) remains less studied.

To evaluate the short-term clinical and economic outcomes following personal use of CGM in patients with T2D.

This prospective pre-post study enrolled adults with poorly controlled non-insulin-treated T2D (hemoglobin A1c ≥8%; target N = 200) initiating G7 CGM and observed them for 6 months. Primary endpoints were changes in A1c and Audit of Diabetes-Dependent Quality of Life (ADDQoL) scores. Glycemic events, health care utilization, and medication use were evaluated in a subgroup with claims data. Baseline was defined as the 3 months before CGM initiation. Changes at 3 and 6 months were assessed using the Wilcoxon signed-rank test. Multivariable analysis of covariance models evaluated A1c change, adjusting for baseline A1c and clinical covariates. ADDQoL was analyzed using linear mixed-effects models with random intercepts and fixed effects for time, whereas Cuzick's test assessed quality-of-life trends.

Of 217 enrolled patients, a subgroup of 76 had claims data. Most were White (75%) and male (58%), with mean age 58.3±11.5 years. Baseline median A1c was 8.60% (IQR = 8.20-9.10), and mean A1c was 8.96%±1.24%. Prevalent comorbidities included hyperlipidemia (73%), hypertension (70%), and obesity (44%). A1c significantly decreased at 3 and 6 months after CGM (median: -1.10%, -1.40%; mean: -1.28%, -1.42%; P < 0.001). In adjusted models, the adjusted mean change in A1c from baseline was -1.32 percentage points at 3 months (95% CI = -1.48 to -1.15; P < 0.001; n = 153) and -1.48 percentage points at 6 months (95% CI = -1.68 to -1.28; P < 0.001; n = 143). American Diabetes Association (ADA) (<7%) and Healthcare Effectiveness Data and Information Set (HEDIS) (<8%) target attainment improved from 0% at baseline to 26.4% and 50.9% at 6 months (both P < 0.001). Hyperglycemic events declined from 53.7% at baseline to 16.3% at 6 months, although not significantly. No significant changes were observed in health care utilization, medication adherence, or medication burden. Greater CGM use and higher time in range were associated with improved A1c and glucose management indicator outcomes. The proportion reporting good-to-excellent quality of life increased from 24.1% at baseline to 45.8% at 6 months, while weighted ADDQoL scores remained stable.

CGM use in non-insulin-treated patients with T2D was associated with significant improvements in glycemic control and perceived quality of life, with stable health care utilization and medication therapy. These findings support expanded implementation and reimbursement of CGM in this population, but further research is required to assess the long-term sustainability of these improvements and the specific roles of diet, medication, and adherence.

Older adults (≥65 years) make up a substantial portion of individuals with type 2 diabetes (T2D) and frequently experience multimorbidity requiring complex, costly medication regimens. Cost-related nonadherence is prevalent in this population because of fixed incomes, polypharmacy, and a historically complex Medicare Part D coverage structure with variable out-of-pocket expenses over the year, which saw significant changes in 2025. We hypothesized that, among Medicare beneficiaries, brand medication possession would decline more rapidly than generic possession over the calendar year and rebound in January of the subsequent year when coverage resets.

To examine comparative trends in medication possession for brand and generic classes of glucose-lowering medications among older adults over the calendar year stratified by insurance type.

We conducted a retrospective cohort study using electronic health record and claims data from 6 US health systems. For each year from 2015 through 2020, adults aged at least 65 years with T2D who possessed at least 1 glucose-lowering medication on January 1 (index), filled the medication at least once during the following year, and maintained continuous prescription insurance coverage for 15 months from index were included; individuals could contribute multiple observations across years and medications. Medication possession was determined on January 1 and, thereafter, based on dispense date and days supply for each glucose-lowering medication. We calculated the daily proportion of individuals in possession of each medication class over 15 months and compared trends by brand/generic classification, medication class, and insurance. Medications were classified into brand and generic status based on class availability and prescribing trends during the study period. Segmented linear regression estimated slope changes before and after day 365. Difference-in-differences-in-slope approach compared brand vs generic medications before and in the first month after the new year. Additional analyses compared individual branded classes with biguanides.

Among 88,060 older adults with T2D (240,542 medication observations), mean age for the population was 73.7 years, 46% were female, 60% were White, 83% of medications were covered by Medicare insurance, and 92% were generic classes of glucose-lowering medications. Medication possession declined uniformly during the first 3 months of each year across all insurance types, followed by steeper declines for brand vs generic classes of medications (slopes -19.6% and -7.9% per year) for the Medicare-insured cohort. Brand classes exhibited a more significant positive slope change compared with generics (18.2% and 1.3% per year; P < 0.001) in the first month of the new year (days 366-395) for Medicare-insured cohort, a pattern differing from the commercial and Medicaid cohorts. Individual brand medication possession differed significantly from biguanides. Sensitivity analyses using a 3-month post-new year segment yielded similar findings.

Older adults appear vulnerable to cost-related nonadherence, with lower year-end medication possession of brand classes of T2D medications than generics. The modest rebound in possession after coverage reset and similar end-of-year possession across insurance types suggest that the coverage gap is not the sole contributor to reduced brand medication possession.

The purpose of this study is to develop and establish content validity evidence for the Perceived Barriers to Diabetes Self-Management Scale (PB-DSMS) for adolescents and young adults (15-39 years) with type 1 diabetes mellitus (T1DM).

A methodological scale-development and content-validation study was conducted in June 2023. Item generation was guided by the social ecological model and informed by a synthesis of qualitative literature on barriers to diabetes self-management. An initial pool of 57 items was generated and subsequently refined to 47 items through internal review. Content validity was evaluated by a multidisciplinary panel of 6 experts using the item-level content validity index (I-CVI), scale-level content validity index, and modified kappa statistics. Cognitive interviews with 6 individuals with T1DM were conducted to evaluate item clarity, comprehensibility, and contextual relevance, and findings were incorporated into item refinement.

Eight domains of perceived barriers were identified: lack of knowledge and skills, psychological barriers, time constraints and competing life priorities, lack of family support, lack of community/peer support, health system-related barriers, availability and accessibility barriers, and digital barriers. Of the 47 preliminary items, 43 achieved an excellent I-CVI. Cognitive interviews supported the comprehensibility and contextual relevance of the instrument and informed item refinement. Following expert review and cognitive interviewing, 4 items were removed and 16 items were revised, resulting in a final 44-item scale.

The PB-DSMS is a comprehensive, patient-informed, and contextually relevant instrument for assessing perceived barriers to diabetes self-management among adolescents and young adults with T1DM. It has the potential to facilitate patient-centered assessment and support the development of targeted interventions to improve diabetes self-management in clinical practice and research.

Chronic comorbidities, including diabetes mellitus and hypertension, and gut microbial factors may influence chemotherapy response and survival in cancer patients. This study quantitatively evaluated their combined impact. The main objective of this study was to evaluate the impact of diabetes, hypertension, and gut microbial diversity on chemotherapy response and survival in cancer patients.

A prospective cohort study enrolled 250 adult cancer patients receiving chemotherapy at a tertiary care center in Bangladesh. Clinical, metabolic, and microbiome data were collected at baseline and during treatment. Chemotherapy response was assessed by RECIST 1.1 criteria, while progression-free survival (PFS) and overall survival (OS) were recorded. Gut microbial diversity was measured using 16S rRNA sequencing. Statistical analyses included chi-square tests, t-tests, Kaplan-Meier survival analysis, and multivariable Cox regression.

Among participants, 32.8% had diabetes and 38.4% had hypertension. Objective response rates (CR+PR) were lower in patients with diabetes (41.5%) and hypertension (45.8%) compared with non-diabetic (57.1%) and normotensive (55.8%) patients (p < 0.05). Responders exhibited significantly lower HbA1c, fasting glucose, and systolic blood pressure than non-responders (p < 0.01). Higher gut microbial alpha diversity was observed in responders (Shannon index 4.1 ± 0.6) versus non-responders (3.4 ± 0.7; p < 0.001). Median PFS and OS were shorter in patients with diabetes (8.6 and 18.4 months) and hypertension (9.1 and 20.2 months) compared with those without comorbidities (12.9 and 26.7 months; 13.4 and 27.9 months, respectively). Multivariable analysis confirmed diabetes (aHR 1.58), hypertension (aHR 1.41), low microbial diversity (aHR 1.76), and advanced tumor stage (aHR 2.34) as independent predictors of worse survival (all p < 0.05).

Diabetes, hypertension, and reduced gut microbial diversity are associated with poorer chemotherapy response and survival outcomes. Integrated management of metabolic and cardiovascular comorbidities, alongside microbiome-informed interventions, may enhance treatment efficacy and patient survival.

BackgroundType 2 diabetes mellitus (T2DM) increases the risk of cardiovascular and neurocognitive complications. GLP-1 receptor agonists (GLP-1 RAs) and SGLT2 inhibitors (SGLT2is) have pleiotropic effects beyond glycemic control, but comparative long-term data on dementia, cardiovascular events, and mortality in older adults are limited.MethodsThis retrospective cohort study used the TriNetX US Collaborative Network. Adults ≥60 years with T2DM on metformin plus either GLP-1 RAs or SGLT2is (n=56,211 per cohort after matching, 2014-2020) were propensity-score matched on demographic and clinical characteristics. Five-year outcomes included incident Alzheimer's disease, vascular dementia, other dementia, dementia-related medication use, NSTEMI, STEMI, and all-cause mortality.ResultsAfter propensity-score matching, GLP-1 RA use was associated with higher risks of Alzheimer's disease (RR 1.33, 95% CI 1.18-1.48), vascular dementia (RR 1.56, 95% CI 1.39-1.76), other dementia (RR 1.33, 95% CI 1.21-1.47), dementia-related medication initiation, and all-cause mortality (RR 1.11, 95% CI 1.08-1.15) compared with SGLT2is. NSTEMI and STEMI risks did not differ significantly between groups.ConclusionsIn older adults with T2DM, SGLT2is were associated with lower risks of dementia, dementia-related medication use, and all-cause mortality compared with GLP-1 RAs in propensity-score matched cohorts. These observational findings are hypothesis-generating and should be confirmed in prospective studies.

Youth-onset diabetes is a chronic condition requiring lifelong management, and achieving optimal glycemic control remains challenging. This study aimed to delineate etiologies of youth-onset diabetes among Thai patients. We further examined clinical characteristics, therapeutic outcomes, and factors associated with glycemic control in type 1 diabetes (T1D) and type 2 diabetes (T2D).

We conducted a prospective cross-sectional Pediatric Diabetes Registry Project in 2 phases: initial (March 2016-August 2018) and follow-up (March 2019-March 2020). Individuals diagnosed before age 18 years were recruited. Data on clinical profile, glycemic control, treatment, and complications were collected.

Three hundred participants were recruited at baseline. The majority (77%, n = 231) had T1D, and 15.3% (n = 46) had T2D. The mean HbA1c in T1D was 8.96% ± 1.98%, with 22.5% achieving good glycemic control. Multivariate analysis revealed that older age (OR 1.16, 95% CI 1.01-1.32, p = 0.031) and self-monitoring of blood glucose (SMBG) ≥ 4 times/day (OR 4.85, 95% CI 1.85-12.71, p = 0.001) were positively associated with good control. Among T2D patients, mean HbA1c was 7.55% ± 2.21%, and 56.5% achieved good control. Longer disease duration (OR 0.40, 95% CI 0.21-0.74, p = 0.003) predicted suboptimal control. At follow-up, the prevalence of diabetic nephropathy increased in T1D (from 3.4% to 5.8%) and T2D (from 9.1% to 17.4%).

Most T1D patients exhibited suboptimal glycemic control, while older age and frequent SMBG predicted better outcomes. In T2D, longer disease duration correlated inversely with glycemic control, highlighting the need for proactive interventions.

The COVID-19 pandemic revealed the importance of pre-existing conditions, or comorbidities, as major predictors of disease severity and mortality worldwide. In this context, the major goal of this study was to examine the impact of common comorbidities on the clinical outcomes of COVID-19 patients in Sétif, Algeria, as well as to evaluate the local epidemiological risk profile. We conducted a thorough analysis of 12,932 COVID-19 participants in the Sétif community, focusing on the prevalence and impact of many illnesses, most notably diabetes, cardiovascular disease (CVD), and hypertension. We also looked at geographical inequalities in comorbidity prevalence to help influence local patient care methods. Our data revealed a strong link between these comorbidities and poor COVID-19 outcomes. Patients with heart disease, hypertension, and diabetes had a considerably greater incidence of severe COVID-19, with computed odds ratios (ORs) of 1.50, 1.34, and 2.89, respectively, indicating that diabetes was the best predictor of severity in this cohort. This investigation demonstrated that the presence of comorbidities considerably exacerbated the severity and mortality rate of SARS-CoV-2 infection. These findings highlight the importance of establishing thorough, personalised techniques and more effective diagnostic and treatment approaches for COVID-19 patients that explicitly account for the varied prevalence of underlying health issues.

BACKGROUND Diabetes mellitus (DM) is increasingly prevalent among heart transplant candidates, but its long-term prognostic significance remains undefined. The impact of posttransplant DM (PTDM) and insulin-dependent PTDM on outcomes has not been fully characterized. This study evaluated associations of pretransplant DM, PTDM, and insulin-dependent PTDM with long-term outcomes after heart transplantation. MATERIAL AND METHODS Adult heart transplant recipients in the Scientific Registry of Transplant Recipients between December 2005 and December 2020, with no prior transplant, were included. Recipients were stratified by pretransplant DM status, PTDM development, and insulin dependence among PTDM patients. Overall survival (OS) was assessed using Kaplan-Meier analysis, and independent predictors of mortality and PTDM were evaluated using multivariable Cox and logistic regression. RESULTS A total of 30 430 recipients were analyzed, including 8361 with pretransplant DM. Pretransplant DM was associated with worse 10-year OS and independently predicted mortality (HR=1.39, 95% CI: 1.32-1.46; P<0.001). Recipients with pretransplant DM also had higher rates of acute drug-treated rejection, dialysis requirement, drug-treated infection, and infection- or pulmonary-related death. Among 21 121 recipients without pretransplant DM, 3003 developed PTDM. PTDM was independently associated with worse OS (HR=1.14; 95% CI, 1.06-1.22; P=0.001), acute rejection, and infection. Among patients with PTDM, insulin-dependent PTDM conferred greater mortality risk than non-insulin-dependent PTDM (HR=1.58; 95% CI, 1.38-1.80; P<0.001) and was associated with higher rates of rejection, dialysis, infection, and cardiovascular death. CONCLUSIONS Diabetes across the transplant continuum has distinct prognostic implications after heart transplantation. Pretransplant DM and PTDM are independently associated with worse long-term OS, while insulin-dependent PTDM identifies a particularly high-risk subgroup.

Based on the integrated metabolomics data of serum and vitreous humor from diabetic retinopathy, this study aimed to elucidate the inhibitory effects and underlying mechanisms of L-threonic acid (L-ThA) on retinal neovascularization.

Cross-tissue metabolomic analysis identified consistently altered metabolites in both biofluids. Candidates negatively associated with proliferative diabetic retinopathy (PDR) progression were then selected through mass spectrometry analysis and disease risk assessment. To validate the inhibitory effects of these metabolites on retinal neovascularization, an oxygen-induced retinopathy (OIR) mouse model was used, and compounds were delivered intravitreally. The downstream signaling mechanisms of these metabolites were further elucidated using transcriptome sequencing, western blotting, co-culture assays, and other complementary molecular techniques.

Intersection analysis of differential metabolites in serum and vitreous humor from patients with PDR revealed that L-ThA was significantly downregulated in both biofluids. The reduction in L-ThA levels was associated with disease progression. In a mouse model of OIR, intravitreal injection of L-ThA markedly reduced the retinal neovascular area from 12.34% to 1.67%, demonstrating potent anti-angiogenic effects approaching the efficacy of those anti-vascular endothelial growth factor therapies. Transcriptomic and molecular analyses further elucidated that L-ThA suppresses retinal neovascularization by inhibiting the expression and secretion of C-C motif chemokine ligand 3 (CCL3) in retinal microglia/macrophages, thereby reducing its interaction with the CCR5 receptor on vascular endothelial cells.

Cross-tissue metabolomics revealed L-ThA as a metabolite consistently downregulated in PDR; functional studies suggest it possesses anti-angiogenic effects by modulation of CCL3-CCR5 signaling, representing a potential biomarker and therapeutic target for PDR.