Diabetes is significantly associated with cognitive impairment, particularly the risk of developing dementia. However, the impact of antidiabetic drugs on dementia risk remains unclear. This study aims to comprehensively evaluate the effects of different antidiabetic drugs on dementia risk using Bayesian network analysis.

The study systematically searched databases including PubMed, Embase, and the Cochrane Library to identify relevant publications up to September 5, 2025. Eligible randomized controlled trials, cohort studies, and case-control studies were selected. We employed a Bayesian network meta-analysis model to quantitatively assess the relationship between antidiabetic drugs and dementia risk. Data analysis was performed using R version 4.4.1.

A total of 28 articles (involving 4,382,897 patients), network meta-analysis results indicates that compared with placebo, Insulin [OR = 0.11, 95% CrI (0.1, 0.12)], Metformin [OR = 0.79, 95% CrI (0.77, 0.81)], and Pioglitazone [OR = 0.69, 95% CrI (0.56, 0.86)] all reduced the incidence of dementia compared to placebo, a higher incidence of Alzheimer's dementia[OR = 1.78, 95% CrI (1.66, 1.91)] and Vascular dementia[OR = 2.59, 95% CrI (2.33, 2.88)] with DPP4i compared to SGLT_2i.

This study indicate that insulin demonstrates the most pronounced efficacy in reducing the incidence risk of dementia and vascular dementia. Furthermore, SGLT_2i and GLP1 exhibit certain therapeutic benefits in the management of Alzheimer's disease.

https://www.crd.york.ac.uk/prospero/, identifier CRD420251172386.

Type 2 diabetes mellitus (T2DM) and cancer are both major global public health concerns; however, their causal relationship remains unclear. This study aims to quantitatively investigate the potential causal associations between T2DM and 17 site-specific cancers through a systematic review and meta-analysis of Mendelian randomization (MR) studies.

We systematically searched Scopus, PubMed, the Cochrane Library, Web of Science, Embase, and Ovid MEDLINE to identify MR studies investigating the association between T2DM and cancer published up to June 2025. A meta-analysis was performed on extracted data, accompanied by heterogeneity testing, sensitivity analysis, and publication bias assessment.

The initial search yielded 1,143 articles. After multi-level screening, 44 articles were ultimately included, with 42 articles (comprising 131 MR studies) eligible for meta-analysis. The pooled results demonstrated that T2DM was significantly associated with an increased risk of pancreatic cancer (OR = 1.09, 95% CI: 1.04-1.15, P = 0.0007) and endometrial cancer (OR = 1.07, 95% CI: 1.04-1.09, P < 0.00001). Conversely, T2DM was significantly associated with a decreased risk of gastric cancer (OR = 0.90, 95% CI: 0.85-0.93, P < 0.00001), melanoma (OR = 0.97, 95% CI: 0.95-0.99, P = 0.009), and esophageal cancer (OR = 0.86, 95% CI: 0.79-0.93, P = 0.0002). The effect sizes for T2DM's associations with thyroid and breast cancers were modest, with no clinical significance. No significant causal association was identified between T2DM and the remaining ten cancer types.

The causal relationship between T2DM and cancer appears to be tissue-specific. T2DM significantly increases the risk of pancreatic and endometrial cancers while demonstrating a negative association with gastric cancer, melanoma, and esophageal cancer.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251066404.

To assess multimodal ultrasound technology in the biomechanical assessment of carotid intima-media thickness (cIMT) in patients with type 2 diabetes mellitus (T2DM), specifically focusing on those with increased cIMT but without atherosclerotic plaques or significant stenosis.

In this exploratory cross-sectional study, 65 T2DM patients (thickened vs. normal cIMT) and 27 controls were examined using color Doppler ultrasound flow imaging (CDFI), ultrasound vector flow imaging (V-Flow), and ultra-fast pulse wave velocity (UF-PWV). Measurements included peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), resistance index (RI), wall shear stress (WSS), pulse wave velocity at the beginning of systole (PWV-BS), and pulse wave velocity at the end of systole (PWV-ES). Differences across groups and independent factors associated with cIMT were analyzed via correlation and multivariable linear regression.

The T2DM group exhibited higher HbA1c levels than the control group (P < 0.001). The T2DM with thickened cIMT group exhibited significantly lower EDV (P = 0.005) and higher Body Mass Index (BMI) (P = 0.006) than the control group. Furthermore, the same group showed significantly lower mean WSS (WSSmean) than the control and T2DM with normal cIMT groups (P < 0.05). The T2DM with thickened and normal cIMT groups showed significantly higher PWV-ES than the control group (P < 0.05). A positive correlation was observed between cIMT and BMI (ρ = 0.392, P < 0.001), HbA1c (ρ = 0.425, P < 0.001), and PWV-ES (ρ = 0.506, P < 0.001). Both WSSmean (ρ = -0.365, P < 0.001) and EDV (ρ = -0.209, P < 0.05) were negatively correlated with cIMT. After adjustment for clinical covariates, BMI, WSSmean, and PWV-ES were identified as independent factors associated with cIMT in the overall cohort. In the T2DM group, PWV-ES (B = 0.034, P = 0.004) and WSSmean (B = -0.060, P = 0.039) remained independently associated with cIMT.

Preliminary findings suggest V-Flow and UF-PWV imaging may detect biomechanical alterations in T2DM patients. While these techniques may offer insights into subclinical vascular remodeling prior to plaque formation, this cross-sectional study should be cautiously interpreted as hypothesis-generating.

Background Aortic stenosis is a progressive valvular disease strongly associated with aging and high mortality once symptoms develop. Surgical aortic valve replacement has traditionally been the standard treatment for symptomatic severe disease; however, transcatheter aortic valve replacement (TAVR) has emerged as an effective, less invasive alternative for patients with increased surgical risk, supported by evidence from major clinical trials. Since its introduction in Nicaragua, procedural volume has steadily increased. This study aimed to describe the initial national experience with TAVR in patients with severe aortic stenosis in Nicaragua. Materials and methods This retrospective descriptive case series included 16 patients with confirmed severe aortic stenosis who underwent TAVR between July 2023 and March 2024 at a single center in Managua, Nicaragua. Baseline clinical and echocardiographic data were obtained from medical records. Outcomes were evaluated using Valve Academic Research Consortium-3 (VARC-3) criteria, including technical success, device success, and early safety at 30 days. Data were analyzed using IBM SPSS Statistics 25 (IBM Corp., Armonk, NY) with categorical variables reported as n (%), continuous variables as mean ± SD, and pre- versus post-procedural mean transaortic pressure gradients compared using the Wilcoxon signed-rank test. Statistical significance was defined as p ≤ 0.05, which was calculated through Fisher's exact test (dichotomous variables) and Fisher-Freeman-Halton exact test (polytomous variables). Institutional review board approval was obtained. Results The majority of participants were in the 61-70 year age group, accounting for 7 (43.8%) patients, with a mean age of 68.9 ± 8.7 years; 9 (56.3%) were male, and 9 (56.3%) were overweight. The most prevalent comorbidities were hypertension in 15 (93.8%) and diabetes mellitus in 6 (37.5%). Dyspnea was the most common symptom, reported in 15 (93.8%), followed by heart failure in 9 (56.3%) and angina in 8 (50%). Baseline hemodynamics showed a mean transaortic gradient of 55.7 ± 21.1 mmHg, with 14 (87.5%) presenting gradients >40 mmHg, and a mean aortic valve area of 0.68 ± 0.3 cm². Self-expanding valves were implanted in 15 (93.8%), predominantly Acurate Neo 2 in 13 (81.3%) (Boston Scientific Corp., Marlborough, MA). Overall, 13 (81.3%) procedures met VARC-3 criteria for technical success. No intraprocedural or 30-day deaths were recorded. At 30 days, device success was achieved in 12 (75%), early safety in 15 (93.8%), and intended valve performance was satisfactory in 14 (87.5%), with a post-procedural mean gradient of 9.08 ± 6.3 mmHg and no moderate-to-severe aortic regurgitation. The median transaortic pressure gradient decreased from baseline to 30 days after TAVR, from 52.5 (IQR 41.5-67.5) to 9.0 (IQR 3.47-11), with p<0.001 indicating a statistically significant change and a substantial clinical impact on patients' hemodynamic status. Permanent pacemaker implantation and paravalvular leak occurred in 1 (6.3%) patient each. Conclusion In this initial single-center experience in Nicaragua, TAVR was feasible and achieved favorable short-term outcomes, with significant improvement in transaortic hemodynamics at 30 days. These findings support the early safety and effectiveness of TAVR in this setting, although larger prospective studies are needed to confirm results and improve generalizability.

Background Type 2 diabetes mellitus (T2DM) is a chronic, non-communicable condition that causes insulin resistance and β-cell malfunction over time. The traditional food scene in India has changed dramatically as a result of rising urbanization and increased consumption of processed, Westernized diets heavy in refined carbs, saturated fats, and added sugars. These dietary changes have greatly contributed to the increased prevalence of type 2 diabetes. Medical nutrition therapy (MNT) is a systematic approach to nutrition management that aims to improve metabolic regulation and treatment results. MNT is often provided by a registered dietitian in collaboration with a diabetologist, and it focuses on personalized, evidence-based dietary guidelines. In this regard, NutroActive Industries Pvt. Ltd., India, has created a diabetic low glycemic load (GL) food product. The product kit contains Diabexy flour, Diabexy sugar substitute drops, Diabexy almond cookies, and Diabexy coconut burfi. These products are intended to provide a structured, low-GL meal plan that may support glycemic management. Although their formulation is nutritionally appropriate, clinical data for its effectiveness and safety are sparse. This randomized pilot trial sought to explore the potential effects of these products in improving glycemic parameters, such as fasting plasma glucose (FPG), postprandial glucose (PPG), and glycated hemoglobin (HbA1c), as well as their tolerance and safety. Method A total of 30 individuals with type 2 diabetes were randomly assigned to control and intervention groups. Baseline characteristics, including age, vital signs, and anthropometric parameters, were comparable between groups (p > 0.03), indicating adequate randomization. Ten participants demonstrated significantly lower postprandial glucose responses to Diabexy atta compared with glucose (iAUC: 52 vs. 241 mmol·min/L), corresponding to a low glycemic index (GI) of 22%. In the intervention group, the low-GL kit was associated with stable HbA1c, changes in fasting insulin that were interpreted alongside HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) to assess insulin dynamics, and improved quality-of-life scores. Safety assessments showed no adverse effects on liver, kidney, or lipid parameters. Indigestion was reported in one participant during the study period; however, it was transient and not considered related to the low-GL intervention kit. Overall, these findings suggest a potential metabolic benefit of Diabexy atta as part of a low-GL dietary approach, within the limitations of this pilot study. Conclusion In this randomized, open-label pilot study, the low-GL dietary intervention was associated with reductions in postprandial glucose levels, stabilization of HbA1c, and improvements in insulin resistance compared with standard care. No clinically significant safety concerns were observed over the study period based on clinical and laboratory assessments. While these findings suggest a potential metabolic benefit of the low-GL approach in individuals with T2DM, they should be interpreted cautiously given the small sample size, short duration, and exploratory nature of the study. Larger, well-controlled trials are warranted to confirm these preliminary observations.

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are serious metabolic disturbances that can occur in diabetes, and although they are often described separately, they can share features in clinical practice. This report describes the case of a 62-year-old male patient with type II diabetes mellitus and significant medication nonadherence who presented to the emergency department unresponsive with a Glasgow Coma Scale score of 3. Initial evaluation revealed profound hyperglycemia with a serum glucose level of 1,033 mg/dL, severe metabolic acidosis, an anion gap of 44, and positive ketones, consistent with a mixed DKA/HHS presentation. The patient required emergent intubation, aggressive intravenous fluid resuscitation, insulin therapy, and electrolyte correction. Despite extensive evaluation, no infectious source was identified, and medication nonadherence was determined to be the likely precipitating factor. This case underscores the clinical importance of recognizing overlapping features of DKA and HHS, as reliance on glucose thresholds alone may result in misclassification and delayed treatment. It reinforces the need for comprehensive metabolic assessment in severely hyperglycemic patients and supports viewing DKA and HHS as points along a continuum rather than isolated entities. Additionally, this case highlights the critical role of prevention through diabetes education, medication access, and adherence support to reduce recurrence and improve outcomes.

Simultaneous pancreas-kidney (SPK) transplantation is a surgical treatment for patients with long-standing type 1 diabetes mellitus who consequently develop diabetic nephropathy and end-stage renal disease. Well-documented complications of pancreas transplant surgery include acute rejection, chronic rejection, pancreatitis, graft thrombosis, hemorrhage, anastomotic leakage, and intra-abdominal infection. However, small bowel obstruction (SBO), either through internal hernias or adhesive bands, can also occur. Our report details the case of a patient with a history of SPK transplantation 1.5 years earlier, presenting with peritonitis on examination and CT imaging concerning for a closed-loop SBO between the pancreatic allograft and small bowel mesentery. The patient successfully underwent laparoscopic management with laparoscopic small bowel resection and primary anastomosis.

Necrotizing fasciitis (NF) is a rare but life-threatening soft tissue infection characterized by rapid necrosis of fascia and surrounding tissues. While NF is most commonly associated with group A Streptococcus or polymicrobial etiologies, monomicrobial cases due to Escherichia (E.) coli are uncommon. When they do occur, these infections are often highly virulent and frequently fatal, especially in immunocompromised patients. This report describes a fatal case of monomicrobial E. coli NF in a 64-year-old woman with end-stage renal disease (ESRD) on hemodialysis and type 2 diabetes mellitus. The infection originated from a urinary tract infection and vulvar abscess, culminating in septic shock and multiorgan failure. Blood and wound cultures grew E. coli. Despite aggressive resuscitation, broad-spectrum antibiotics, and emergent surgical debridement, the patient deteriorated rapidly and died within three days of admission. This case highlights the aggressive nature of gram-negative monomicrobial NF in immunocompromised patients and underscores the importance of early recognition, prompt surgical intervention, and multidisciplinary critical care management.

To investigate the association between serum complement component 3 (C3) levels and renal pathological injury across different estimated glomerular filtration rate (eGFR) strata in patients with diabetic kidney disease (DKD) and evaluate its potential as an early-warning biomarker.

This retrospective study enrolled 187 DKD patients. Serum C3 levels were measured, and renal biopsies were evaluated by two independent pathologists using a standardized scoring system. Patients were stratified by eGFR (low: <90; high: ≥90 ml/min/1.73m²). The association between serum C3 levels and renal injury was evaluated using multivariable linear regression and binary logistic regression analyses, after adjusting for age, sex, TC, duration of diabetes, HbA1c, albumin and 24-h (24-hour) proteinuria. Restricted cubic spline analysis explored nonlinear relationships in the low eGFR subgroup. Exploratory longitudinal analysis was performed to compare changes in 24-h proteinuria over 1 year of follow-up between patients stratified by serum C3 levels.

Serum C3 levels were negatively correlated with renal C3 deposition and eGFR (ρ = -0.167, P = 0.022; ρ = 0.238, P = 0.001). In patients with low eGFR, lower C3 levels were consistently associated with higher renal pathology (RP) scoring. After full adjustment, this association remained significant (β = -2.640, P = 0.047). Interstitial fibrosis and tubular atrophy and C3 (OR = 0.09, P = 0.037), showed significant inverse associations. Restricted cubic spline analysis demonstrated a linear relationship (P for overall = 0.031, P for nonlinear = 0.079). At 1-year follow-up, exploratory longitudinal analysis showed that patients with lower C3 (<1.10 g/L) showed significantly greater 24-h proteinuria progression (-2869.27 vs. 250.46 mg/24h, P = 0.040).

In DKD patients with eGFR <90 ml/min/1.73m², reduced serum C3 levels are associated with specific renal pathological injuries and may serve as a biomarker of disease progression.

To investigate the relationship between type 2 diabetes mellitus and postmenopausal women with fracture risk when using PPIs.

We conducted an observational study to investigate the association between PPI use and an increased fracture risk in postmenopausal women and type 2 diabetes mellitus. We searched for epidemiological studies published between 2006 and 2023 in PubMed, Google Scholar, and other bibliographies of the retrieved papers. The pooled OR was obtained using the random-effects model, and a subgroup analysis was conducted.

Eight studies, including six cohorts and two case-control studies, were conducted with 1.3 million participants. In these studies, 1,63,346 cases of fracture risk were identified. The pooled effect estimate of these studies was OR 1.61, with a 95% CI of 1.36-1.90. This indicates a significant correlation between Type 2 diabetes mellitus, post-menopausal women, and the risk of fractures. The OR for type 2 DM alone was 1.34 (95% CI 1.14-1.57), and for menopausal women alone, the OR was 2.15 (95% CI 1.36-1.90). Notably, there was no evidence of publication bias.

This meta-analysis provides strong evidence that PPI use in type 2 DM and menopausal women is significantly associated with the risk of developing fractures.