Diabetes is one of the four main non-communicable diseases in Sri Lanka with prevalence of 26%. SGLT2 inhibitors, primarily used for glycaemic control in type 2 diabetes, have recently garnered attention for their potential effects on neuromuscular function. The primary objective of this scoping review was to map the existing literature to determine the extent, range and nature of published evidence on the effects of SGLT2 inhibitors on peripheral nerve morphology, electrophysiology and skeletal muscle function and metabolic kinetics.

Guided by the PRISMA extension for Scoping Reviews (PRISMA-ScR), an electronic search was executed across PubMed, ScienceDirect and Google Scholar for literature published from 2010 onwards. Applying a strict Population-Concept-Context (PCC) framework, two independent reviewers screened and analyzed studies evaluating human populations or corresponding animal models with T2DM (Population) undergoing SGLT2 inhibitor therapy (Concept), in relation to somatic/autonomic nerve conduction, nerve histology, muscle mass and metabolic processing (Context). Data extraction charted study characteristics, species, specific drug types, duration of effect and symptom relief versus electrophysiological outcomes.

Thirty-two studies met the inclusion criteria with 16 evaluating peripheral nerves and 16 focusing on skeletal muscle kinetics. Evidence from animal models and human trials suggests potential improvements in peripheral nerve conduction velocity (NCV), epidermal nerve fiber density, skeletal muscle substrate flexibility, toward fatty acid and ketone oxidation, and mitochondrial structural dynamics. However, divergent and neutral functional outcomes, particularly in human muscle grip strength and short-term versus long-term clinical symptom recovery-were observed, highlighting critical knowledge gaps.

SGLT2 inhibitors demonstrate promising neuroprotective and myo-metabolic modulating properties via multiple pathways. However, the current literature is heavily geared towards animal models, with clear knowledge gaps on long-term effects on human function and symptom improvement. This review provides a mapped baseline to guide future targeted clinical trials.

The global public health burden of aortic valve disease (AVD) is growing due to its high mortality rate and lack of suitable pharmaceutical therapies in clinical practice, a challenge that is largely attributable to our poor understanding of its complicated underlying mechanisms. A better understanding of the pathological processes underlying AVD is urgently needed to identify novel therapeutic options. Appropriate animal models are emerging as vital tools for basic and translational research, and the development of new models and the important information they have provided has significantly aided our research. However, different animal models have unique limitations in their ability to mimic human AVD pathology. In this review, we summarize the available AVD animal models and provide a detailed description of the major principles underlying each animal model, including methodology, pathological features, and potential use and application in AVD research. Both the advantages and disadvantages of specific models are also carefully highlighted; thus this comprehensive review provides a valuable animal model reference for both basic and preclinical researchers.

Diabetes and suicide are intersecting public health concerns, yet evidence at this intersection remains sparse for Black males and especially Black sexual minority males (SMM). This focused narrative review synthesizes direct and adjacent evidence, with emphasis on diabetes-specific disparities, intersectional stress processes, and primary care implications.

The diabetes-suicide literature is heterogeneous, but consistently identifies depression, diabetes distress, treatment burden, complications, and access to insulin or other medications as clinically relevant pathways. For Black males, structural racism, economic inequity, health care discrimination, and constrained access to high-quality diabetes and mental health care may intensify these burdens. The most directly relevant study identified found more lifetime suicide attempts among African American adults with type 1 diabetes than controls, but did not report male-specific estimates. We identified no study estimating diabetes-related suicidal thoughts or behaviors specifically among Black SMM. Common tools such as the Patient Health Questionnaire-9, Diabetes Distress Scale, and Columbia-Suicide Severity Rating Scale have broad clinical support but have not been specifically validated in Black males with diabetes or Black SMM. Common tools such as the Patient Health Questionnaire-9, Diabetes Distress Scale, and Columbia-Suicide Severity Rating Scale have broad clinical support, but the literature identified in this review did not establish their population-specific validity among Black males with diabetes, including Black SMM. The central finding is an evidence gap, not proof of a multiplicative risk effect. Primary care clinicians should use culturally responsive psychosocial inquiry, direct suicide assessment when indicated, collaborative safety planning, and integrated behavioral health care while avoiding assumptions that screening tools perform equivalently across populations. Prospective, disaggregated research and population-specific measurement studies are urgently needed.

Interventional studies directly targeting natriuresis in refractory cirrhotic ascites are scarce, and no prospective study has examined whether sodium-glucose transporter 2 (SGLT2) inhibitor-induced glucosuria is associated with changes in renal sodium handling. We conducted a randomized, open-label, proof-of-concept study to characterize the short-term natriuretic response to empagliflozin in patients with diabetes and refractory ascites Methods: Adults with type 2 diabetes, decompensated cirrhosis, and refractory ascites were randomized 1:1 to empagliflozin 10 mg once daily plus standard care or standard care alone for 10 days. The primary outcome was the between-group difference in mean change in fractional excretion of sodium (FENa, %) from baseline (Day 0) to the mean of post-baseline Days 1, 3, 7, and 10, estimated using a linear mixed-effects model. Key secondary outcomes included 24-hour urinary sodium excretion, 24-hour urine volume, and mean daily paracentesis volume.

Twenty-one participants were randomized (empagliflozin n=10; control n=11). In the empagliflozin group, the between-group difference in mean change in FENa from baseline to the post-baseline mean (days 1, 3, 7, and 10) was +0.44 percentage points (95%CI: 0.05-0.83; p=0.029). Empagliflozin increased 24-hour urinary sodium excretion by +92.1 mmol/24 h (95%CI: 47.1-137.2) and 24-hour urine volume by + 822 mL/24 h (95%CI: 403-1240) versus control. Mean daily paracentesis volume was 0.6 ± 0.4 L/day with empagliflozin and 1.3 ± 0.6 L/day with control (mean difference -0.70 L/day, 95%CI: -1.17 to -0.23). No serious adverse events occurred.

In this open-label, proof-of-concept study, empagliflozin was associated with improved short-term natriuretic indices over 10 days in diabetic patients with decompensated cirrhosis and refractory ascites, without serious adverse events. Larger, blinded, longer-term trials are warranted to confirm these preliminary findings.

Pancreatogenic diabetes mellitus (type 3c diabetes, T3cDM) is a distinct form of diabetes resulting from primary pancreatic disorders, most commonly chronic pancreatitis. It involves both - endocrine and exocrine dysfunction, leading to unstable glycemia with frequent hypo-and hyperglycemia. The condition is often underdiagnosed despite its notable prevalence in patients with pancreatic disease, including malignancy and post-surgical states. Clinically, it overlaps with type 1 and type 2 diabetes but is distinguished by malabsorption and weight loss. Diagnosis requires standard glycemic criteria alongside evidence of pancreatic pathology and exclusion of other diabetes types. Management combines lifestyle measures, pancreatic enzyme replacement, and primarily insulin therapy, with metformin in selected cases. Early recognition is crucial due to its association with pancreatic cancer and increased risk of microvascular complications.

Gestational diabetes mellitus (GDM) is an increasing public health concern among Vietnamese women. However, evidence across Vietnam and Vietnamese diaspora populations remains fragmented. Reported in accordance with the PRISMA-ScR guideline, this scoping review mapped available evidence on GDM among Vietnamese-origin women from database inception to November 2025 to inform future research and culturally responsive care. English and Vietnamese literature was searched across international databases, national repositories, and grey literature. Seventy-six eligible studies were included and synthesised descriptively. In Vietnam, the sample-size-weighted average prevalence of GDM was 23.24%, with substantial variation between 2010 and 2024. Consistent candidate risk factors included advanced maternal age, higher pre-pregnancy body mass index, family and obstetric history, diet-related factors, and physical inactivity. Studies also reported limited knowledge among pregnant women. GDM was associated with adverse maternal outcomes, larger birthweight, whilst maternal knowledge remained limited. Meanwhile, studies concerning the Vietnamese diaspora consistently reported a higher GDM prevalence and related obstetric complications compared with host-country populations. However, diaspora research lacked interventional trials. Existing literature is heavily hospital-based and methodologically heterogeneous. Future research must prioritise standardised screening protocols, community-based longitudinal cohorts, and controlled interventions to improve holistic GDM prevention and management across both Vietnam and migrant healthcare settings.

This study assessed the real-world effectiveness and safety of a fixed-dose combination (FDC) of metformin and empagliflozin in Chinese patients with type 2 diabetes mellitus (T2DM).

This prospective, multicenter, real-world study enrolled consecutive patients with T2DM treated with the FDC of metformin and empagliflozin between August 2023 and August 2025 across 50 clinical centers in China. The primary endpoint was the 6-month glycemic clinical control rate (HbA1c < 7.0%). The safety outcome included adverse events (AEs), major adverse cardiovascular events (MACEs), and major adverse kidney events (MAKEs).

A total of 2602 adults with T2DM were enrolled. The full-analysis sets included 1719 patients, respectively. Median age was 54 years, median body mass index (BMI) was 25.7 kg/m², median HbA1c was 8.3%, and median diabetes duration was 3 years; 34% of patients were female. At 6 months, the proportion of patients achieving HbA1c < 7.0% increased from 20.2% to 58.9%, with median HbA1c falling by about 1.1%-1.2%. Treatment also lowered fasting plasma glucose, body weight, and waist and hip circumference, and modestly reduced blood pressure, improving blood pressure control and shifting the BMI distribution toward normal weight. Subgroup analyses showed higher HbA1c target attainment in younger patients, those with lower baseline HbA1c, and those with higher BMI. Most patients remained on metformin/empagliflozin. AEs, MACEs, MAKEs, ketoacidosis, and genitourinary infections were infrequent.

In this large-scale, real-world study in a Chinese population, the empagliflozin and metformin FDC improved long-term HbA1c control and was well tolerated.

Coexistence of type 2 diabetes mellitus (T2DM) and heart failure increases the risk of morbidity and mortality. Ventricular dysfunction and lower limb ischemic changes are assessed with left ventricular ejection fraction (LVEF), NT-proBNP, and ankle-brachial index (ABI). We conducted this study to determine the correlation of ABI with NT-proBNP and LVEF.

We conducted this cross-sectional study from March 2024 to February 2026 at the Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India. We enrolled adult diabetic patients with newly diagnosed heart failure. We categorized the participants according to their LVEF: heart failure with preserved ejection fraction (HFpEF) (LVEF ≥ 50%), heart failure with mid-range ejection fraction HFmrEF (LVEF 41%-49%), and heart failure with reduced ejection fraction (HFrEF) (LVEF ≤ 40%). These groups were assessed for ABI and NT-proBNP. We assessed the correlations of ABI with NT-proBNP and of LVEF with Spearman's correlation. The R software version 4.6.1 (R Foundation for Statistical Computing, Vienna, AUT) was used for data analysis.

Our study population comprised 801 patients (median age 64.0 (59.0-70.0) years; males 447 (55.81%)) with T2DM and heart failure. There were 166 (20.72%), 418 (52.19%), and 217 (27.09%) participants with HFpEF, HFmrEF, and HFrEF, respectively. The median LVEF was 44.0 (39.4-48.8)%. The median ABI of the study population was 1.06 (0.97-1.20). The median ABI values of those with HFpEF, HFmrEF, and HFrEF were 1.04 (0.98-1.17), 1.08 (0.99-1.22), and 1.05 (0.95-1.15), respectively (p < 0.001). The study population's median NT-proBNP was 1291.0 (978.0-1822.0) pg/mL. The median NT-proBNP values of those with HFpEF, HFmrEF, and HFrEF were 1007.5 (817.0-1370.5) pg/mL, 1295.5 (995.0-1752.3) pg/mL, and 1510.0 (1167.0-2098.0) pg/mL, respectively (p < 0.001). The correlation between ABI and NT-proBNP values was weakly negative (r = -0.059, 95% CI = -0.129 to 0.009, p = 0.139). The correlation between ABI and LVEF was weakly positive (r = 0.057, 95% CI = -0.012 to 0.126, p = 0.293). Only the participants with HFpEF showed a statistically significant positive correlation between ABI and LVEF (r = 0.164, 95% CI = 0.012 to 0.309, p = 0.015). None of the remaining correlations were statistically significant.

Most of the correlations of ABI with NT-proBNP and LVEF were not statistically significant. However, reduced LVEF and higher NT-proBNP levels were correlated with lower ABI values. These findings suggest the associations among elevated cardiac strain, impaired ventricular performance, and peripheral vascular disease. Our study highlighted the usefulness of ABI as a simple, non-invasive screening technique for cardiovascular disease risk.

Growing evidence indicates that cardiovascular abnormalities may develop during the prediabetic period. One of the earliest signs of these is biochemical evidence suggestive of subclinical myocardial injury characterised by elevated high-sensitivity cardiac troponin levels (>the 99th percentile upper reference limit). There is a paucity of studies on high-sensitivity troponin T (hs-cTnT) levels, the prevalence of subclinical myocardial injury, and related cardiometabolic predictors in individuals with prediabetes in Southeast Asia. Therefore, this study aimed to determine the distribution of hs-cTnT values suggestive of subclinical myocardial injury; assess the relationship between hs-cTnT values and HbA1c levels; and identify the predictors of suggestive of subclinical myocardial injury in people with prediabetes in Kota Bharu, Kelantan, Malaysia.

This cross-sectional study included 101 adults with prediabetes at two primary care centres in Kota Bharu, Kelantan, Malaysia. Blood samples were collected for the evaluation of hs-cTnT, HbA1c, lipid profile (total cholesterol, triglycerides, high- and low-density lipoprotein cholesterol), urea, and creatinine levels. Biochemical evidence suggestive of subclinical myocardial injury was defined as hs-cTnT concentrations >14.00 ng/L. Associations between hs-cTnT values and HbA1c levels were analysed using Spearman's rank correlation; predictors suggestive of subclinical myocardial injury were evaluated using Firth bias-corrected logistic regression.

The median hs-cTnT value was 7.29 ng/L (interquartile range: 3.85-12.33). Biochemical evidence suggestive of subclinical myocardial injury was detected in 14.9% (n = 15) of participants. Hs-cTnT values in participants suggestive of myocardial injury ranged from 14.71 to 149.20 ng/L. No significant association was found between hs-cTnT values and HbA1c levels (Spearman's r = -0.053; p = 0.602). In exploratory Firth bias-corrected multivariable logistic regression analysis, higher systolic blood pressure was independently associated with biochemical evidence suggestive of subclinical myocardial injury after adjusting for demographic, metabolic, and cardiovascular risk factors (adjusted odds ratio: 1.13per mmHg increase, 95% confidence interval: 1.05-1.24; p = 0.001).

Biochemical evidence suggestive of subclinical myocardial injury was present in 14.9% of adults with prediabetes, possibly associated with elevated systolic blood pressure. No significant association was found between hs-cTnT values and HbA1c levels. These findings suggest that myocardial injury may occur early during prediabetes. A larger population-based study would help verify these findings and determine the clinical significance of subclinical myocardial injury in this patient population.

Type 2 diabetes mellitus (T2DM) is a growing global health concern linked to increased cardiovascular and renal complications. Two emerging therapeutic classes, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon like peptide-1 receptor agonists (GLP-1 RAs), have shown independent cardiometabolic benefits. However, limited realworld data exist on the comparative impact of combining these therapies versus using SGLT2i alone.

To compare the cardiovascular and renal outcomes of dapagliflozin monotherapy versus combination therapy with once-weekly injectable semaglutide among patients with type 2 diabetes mellitus (T2DM).

In this retrospective cohort study, 539 adult patients with confirmed type 2 diabetes mellitus (T2DM; baseline HbA1c ≥6.5%) treated at King Abdulaziz Hospital, Al-Ahsa, were followed over six months. Patients received either dapagliflozin alone or in combination with semaglutide. Generalized Estimating Equations (GEE) were used to assess changes in glycemic control, cardiovascular events, lipid profile, and renal function, adjusting for time and sex.

Both groups showed significant metabolic improvements over six months. Dapagliflozin monotherapy was associated with greater HbA1c reduction. Combination therapy was associated with higher HDL levels, improved eGFR, and a lower relative risk of heart failure (RR = 0.43, p = 0.04); the reduction in myocardial infarction risk (RR = 0.61, p = 0.13) did not reach statistical significance. No significant difference was observed in stroke risk. Most cardiovascular and renal markers improved modestly.

Combination therapy was associated with favorable renal outcomes and a reduction in heart failure risk, despite inferior glycemic control and a non-significant trend toward reduced myocardial infarction risk. These findings suggest potential complementary effects of SGLT2i and GLP-1 RA treatment in high-risk patients. However, due to the retrospective, non-randomized design, causal relationships cannot be inferred, and residual confounding may exist. Prospective trials are warranted to confirm these associations and guide treatment optimization.