While diabetes technologies such as insulin pumps, continuous glucose monitoring (CGM), and automated insulin delivery (AID) systems have demonstrated potential to improve glycemic control and reduce hypoglycemia, their utilization and effectiveness in Thailand remain underdocumented. This study aimed to assess the use and impact of diabetes technologies on glycemic outcomes at King Chulalongkorn Memorial Hospital (KCMH), a tertiary care center in Bangkok, Thailand.

A cross-sectional study was conducted among T1D patients receiving care at the endocrinology clinic of KCMH between August 2023 and July 2024. Data were collected at each patient's most recent follow-up visit, and participants were classified into technology users and non-technology users. Data collection focused on demographics, diabetes technology use, and clinical parameters, including HbA1c, hypoglycemia events, and CGM metrics (Time in Range (TIR), Time Above Range (TAR), Time Below Range (TBR)).

A total of 61 patients with T1D were included, of whom 49% were technology users (6% insulin pumps, 57% CGM, 37% AID). Technology users had a significantly higher mean HbA1c (8.1% ± 1.6) than non-technology users (7.2% ± 1.2, p = 0.011). AID users achieved a higher mean TIR (67.6% ± 16%) compared to CGM users (54.0% ± 23.8%), but the difference was not statistically significant. Both AID and CGM users maintained a low incidence of hypoglycemia (<54 mg/dL).

This study found a relatively high rate of diabetes technology adoption at our center compared to other Asian countries, highlighting its potential to reduce the risk of hypoglycemia and improve glycemic stability. However, technology users also had higher HbA1c levels, suggesting that diabetes technology is often prescribed to high-risk patients with poor glycemic control. Future research should focus on longitudinal studies to better understand and address barriers to optimal glycemic outcomes among diabetes technology users.

Erectile dysfunction (ED) is a common complication among men with Type 2 Diabetes Mellitus (T2DM), but updated data from the Philippines remain limited. This study determined the prevalence of ED and evaluated associated clinical and socioeconomic factors among Filipino men with T2DM.

We conducted a cross-sectional study among 384 adult Filipino men with T2DM recruited from private clinics, an outpatient service clinic, and an affiliated community clinic of Cardinal Santos Medical Center. ED was assessed using the International Index of Erectile Function-5 (IIEF-5). Comparative analyses between participants with and without ED were performed, followed by multivariable logistic regression analysis. Results are presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs).

The prevalence of erectile dysfunction (ED) among Filipino men with T2DM in this study was 88.02% (338/384; 95% CI: 84.4-91.1). Common comorbidities in the study population included hypertension (67.45%), dyslipidemia (44.53%), and coronary artery disease (26.56%). Regarding glycemic control, only 30.31% of participants had an HbA1c level <7%. Participants with ED were significantly older than those without ED (median age: 60 [IQR 17] vs 48 years [IQR 15], p <0.001) and were more likely to have a longer duration of diabetes. On multivariable analysis, dyslipidemia remained independently associated with higher odds of ED (AOR = 2.57, 95% CI: 1.20-5.53; p = 0.015), whereas higher socioeconomic status was associated with lower odds of ED (AOR = 0.31, 95% CI: 0.13-0.75; p = 0.010).

ED was highly prevalent among Filipino men with T2DM included in this study. Dyslipidemia and socioeconomic status were independently associated with ED and may help identify patients who could benefit from more thorough screening. Further studies involving larger cohorts and improved sampling methods are needed to validate these findings and better understand the factors underlying the high prevalence of ED observed in this population.

Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia. Initial therapy for type 2 diabetes typically starts with metformin monotherapy, but because of its progressive nature, combination therapy is often required to achieve glycemic targets. However, research on combination therapy with three oral antidiabetic drugs is currently limited.

This study assessed direct medical costs and the cost-effectiveness of a combination of triple oral antidiabetics with first-line metformin combined with glimepiride, pioglitazone, and DPP-4 inhibitors (sitagliptin/vildagliptin), among type 2 DM patients treated in the outpatient clinic of Dr. Ramelan Central Naval Hospital, Surabaya, Indonesia.

A retrospective cross-sectional analysis was conducted from the hospital perspective using medical records and cost data from January to December 2024. Eligible patients had type 2 DM, received a combination of triple oral antidiabetics with metformin as first-line treatment combined with glimepiride, pioglitazone, and DPP-4 inhibitors (sitagliptin/vildagliptin), attended monthly follow-ups, had at least two HbA1c measurements, and had complete clinical and cost data. Direct medical costs included doctor services, drug acquisition costs, and laboratory monitoring costs.

A total of 79 patients were included, 60.8% male, with an average (SD) age of 54.9 (9.26) years, and 69.6% with comorbidities. Compared with the combination of metformin + glimepiride + pioglitazone, the combination of metformin + sitagliptin/vildagliptin + glimepiride and metformin + sitagliptin/vildagliptin + pioglitazone was more cost-effective, with ICER values of IDR -162,119.77; IDR 845,655.5, respectively. Both ICER values were below the willingness-to-pay (WTP) threshold. One-way sensitivity analysis showed that the model results were relatively robust to parameter variations of ±20%. In the combination of metformin + sitagliptin/vildagliptin + glimepiride vs metformin + glimepiride + pioglitazone, laboratory monitoring costs had the greatest influence on the ICER value. Meanwhile, the combination comparison metformin + sitagliptin/vildagliptin + pioglitazone vs metformin + glimepiride + pioglitazone was most sensitive to changes in effectiveness (ΔHbA1c).

Metformin + sitagliptin/vildagliptin + glimepiride and metformin + sitagliptin/vildagliptin + pioglitazone are both more cost-effective compared to metformin + glimepiride + pioglitazone in this setting.

Type 2 diabetes mellitus (T2D) is the leading cause of end stage renal disease. Screening for chronic kidney disease is recommended for early diagnosis and intervention. This requires assessment of renal function by computing for estimated glomerular filtration rate (eGFR) and urine albumin-creatine ratio. Several formulas have been proposed for computation of eGFR. The European Renal Function Consortium (EKFC) equation, obtained by combining the full age spectrum (FAS) and Chronic Kidney Disease - Epidemiology Collaboration 2021 (CKD-EPI) equations, has been proposed as a more universal formula for eGFR. It has the advantage of eliminating correction for ethnicity and covers a wide age range. The aim of this study is to compare the EKFC and CKD-EPI 2021 equations to assess eGFR among Algerian population with T2D.

This is an observational, cross-sectional, analytical study. Serum creatinine levels were measured using the Cobas integra 400 Roche diagnostic device. The results were used to estimate GFR using the two formulas: CKD-EPI 2021 and EKFC.

There was a statistically significant difference between the performance of the CKD-EPI 2021 and EKFC equations (p <0.001). However, there was a very good correlation (r = 0.99) even though the EKFC underestimates eGFR compared to CKD-EPI 2021 (bias: -8 ml/min/1.73 m²).

The main value of the EKFC lies in its ability to provide a detailed stratification in the early stages of chronic kidney disease. Our study also represents the first attempt to establish the q-value in the Algerian population.

Increasing use and abuse of antibiotics has led to a rise in multidrug resistant organisms (MDRO) isolates among infected diabetic foot ulcers (DFUs) and is seen in more than half of all diabetic foot infection cases. This study aimed to identify risk factors for MDRO infection since there are no Filipino studies currently available to establish an association.

A cross-sectional, analytical study was conducted to evaluate risk factors for MDRO in DFUs. Adult patients admitted in a tertiary hospital from January 2019 - December 2023 for DFU were included in the study. Based on retrospective chart review, patients with DFU described to be infected with accompanying superficial or deep wound cultures were studied. Patients were classified under the MDRO-positive group if their cultures reported any of the following organisms: methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamases (ESBL), amp C and carbapenamases-producing Enterobacteriaceae, Metallo-beta-lactamases (MBL)-producing Pseudomonas, Acinetobacter species, or any isolate with at least one drug resistance in three different antibiotic classes. Those who did not fall into this definition, including cultures without growth, were classified under the MDRO-negative group. Clinical risk factors and pertinent laboratory findings were obtained from their data.

One hundred fifty-one (151) patients were included in the study and 52 (34.43%) patient had MDRO isolates. The most common isolates seen were Klebsiella pneumoniae for gram-negative organisms and Staphylococcus aureus for gram-positive organisms. For gram-negative isolates, erythromycin had the most resistance at 17.53% followed by oxacillin and clindamycin both at 13.4%. For gram-positive isolates, highest resistance were seen with ampicillin at 18.99% followed by cefuroxime at 13.57% and amoxicillin-clavulanate at 11.63%.Higher ulcer grade (Crude OR = 1.11 [95% CI 1.00 - 1.23], p-value 0.04; Crude OR = 1.29, [95% CI 1.04 - 1.60], p-value 0.02), as well as previous admission for diabetic foot ulcer (Crude OR = 2.28, [95% CI 1.10 to 4.73], p-value 0.04) were associated with multidrug resistance. Logistic regression showed that only a previous admission had significant association for MDRO positivity (Adjusted OR = 3.00 [95% CI: 1.04 - 8.62], p-value 0.04).

There is a high burden of multidrug resistant organism infection in diabetic foot ulcers with significant association in higher ulcer grades. A previous admission for diabetic foot ulcer significantly increases the odds for MDRO infection in succeeding diabetic foot infections.

Safe insulin administration requires delivery into the subcutaneous tissue to avoid intradermal or intramuscular injection. Although international guidelines recommend the universal use of 4 mm needles, local anatomical data supporting this recommendation among overweight and obese adults with type 2 diabetes mellitus (T2DM) in Malaysia are limited.

To assess skin thickness (ST) and subcutaneous adipose tissue (SAT) using ultrasound to evaluate the safety of 4 mm insulin needles in overweight and obese adults.

This cross-sectional study involved 98 adults with T2DM on insulin therapy (body mass index [BMI] ≥23 kg/m²) attending a primary care clinic in Johor Bahru, Malaysia. ST and SAT at 10 abdominal injection sites and 8 upper arm injection sites were measured using ultrasonography. Data were analyzed using descriptive statistics, correlation tests, and multiple linear regression to identify associations with BMI, age, gender, and other variables.

The median abdominal ST was 2.46 mm (interquartile range [IQR]: 2.20-2.80), and upper arm ST was 1.92 mm (IQR: 1.73-2.11). Only 6.1% of participants had any site with ST greater than 4 mm. Median abdominal SAT was 16.75 mm (IQR: 14.83-19.28), and upper arm SAT was 15.38 mm (IQR: 12.10-17.73). Multiple linear regression showed that abdominal ST was significantly predicted by BMI (β = 0.244, p = 0.015) and inversely by age (β = -0.202, p = 0.040). Gender was the strongest predictor of upper arm ST (β = -0.418, p <0.001), with females having thinner skin. Abdominal SAT was positively associated with BMI (β = 0.469, p <0.001) and male gender (β = -0.205, p = 0.026), suggesting that BMI may serve as a useful clinical indicator of abdominal injection depth. No significant predictors were found for upper arm SAT.

Most overweight and obese Malaysian adults with T2DM have adequate ST and SAT for safe insulin delivery using 4 mm pen needles. Ultrasonographic data support individualized injection technique education in primary care, considering BMI, gender, and age.

ReGenerating Tissue Agents (RGTA, trade name CACIPLIQ20) contain a structural analogue of heparan sulfates (HSs) that promotes tissue regeneration in hard-to-heal chronic wounds resistant to the best standard of care for 6 months or longer. The MATHCOW study aimed to evaluate the real-life performance and safety of RGTA administered in addition to optimal treatment in diabetic foot ulcers (DFUs), venous leg ulcers (VLUs), and leg ulcers with an ischemic component (arterial ulcers). The primary outcome measure was the rate of ulcer closure within the first 20 weeks of treatment. A total of 191 patients were recruited; 173 signed informed consent and constituted the intention-to-treat (ITT) analysis set. The per-protocol (PP) population included 114 patients. The primary endpoint was 50 wound closures at 20 weeks in the ITT analysis (28.9%) and 46 wound closures in the PP analysis (40.4%). Closure rates varied according to ulcer type: 43.7% for VLUs, 46.2% for DFUs, and 14.6% for arterial ulcers. Other endpoints also improved, including clinician global impression, pain, and ulcer area. Adverse events were recorded in 4% of cases. This open-label study confirms the performance and tolerability of RGTA in a population of patients with particularly hard-to-heal chronic ulcers.

Osteomyelitis presents with heterogeneous clinical, etiological, and microbiological characteristics depending on anatomical location. While foot osteomyelitis is commonly associated with diabetic foot infections and contiguous spread, non-foot osteomyelitis often arises from post-traumatic, hematogenous, or postoperative causes. However, direct comparative analyses between these two entities remain limited.

A retrospective analysis was conducted on 202 adult patients who underwent surgical treatment for osteomyelitis between 2011 and 2026. Patients were divided into foot (n = 89) and non-foot (n = 113) osteomyelitis groups. Clinical, etiological, microbiological, and treatment-related variables were compared. Only intraoperatively obtained deep tissue and/or bone cultures were included.

Patients with foot osteomyelitis were older and had a significantly higher prevalence of diabetes mellitus (49.4% vs. 5.3%, p < 0.001), which was identified as an independent predictor of foot osteomyelitis (OR 14.15, 95% CI 4.32-46.42; p < 0.001). Infections in foot osteomyelitis predominantly developed via contiguous spread (73.0%), whereas non-foot osteomyelitis showed more heterogeneous etiologies, including post-traumatic and hematogenous causes (p < 0.001). Microbiologically, Staphylococcus aureus was the most common pathogen in non-foot osteomyelitis, while foot osteomyelitis demonstrated a more diverse distribution with higher rates of polymicrobial infections. Amputation was significantly more frequent in the foot group (50.6% vs. 15.9%, p < 0.001), whereas antibiotic-loaded cement use was more common in non-foot osteomyelitis (p < 0.001).

Foot and non-foot osteomyelitis differ significantly in clinical, etiological, and microbiological characteristics. These findings suggest that foot and non-foot osteomyelitis differ in their clinical, etiological, and microbiological characteristics and may require different diagnostic and therapeutic approaches.

This study evaluated the clinical utility of circulating miR-342-3p for diagnosing gestational diabetes mellitus (GDM) and predicting adverse perinatal outcomes (APOs).

A retrospective cohort of 261 GDM women (the GDM group) and 261 propensity score-matched healthy controls (the Normal group) was analyzed. Circulating miR-342-3p levels were quantified by RT-qPCR, and diagnostic and predictive performances were assessed using receiver operating characteristic curves. Correlations with fasting plasma glucose (FPG), 2-h postprandial glucose (2hPG), and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) were evaluated by Spearman's analysis. Logistic regression was used to analyze the independent association between circulating miR-342-3p expression and APOs.

Circulating miR-342-3p was significantly elevated in GDM patients versus controls and demonstrated early diagnostic potential for GDM (AUC = 0.835). In GDM patients, miR-342-3p levels showed moderate positive correlations with FPG, 2hPG, and HOMA-IR (r = 0.780, 0.578, 0.613). miR-342-3p levels were elevated in both the GDM-APOs and the Normal-APOs groups compared with their respective non-APO subgroups. Circulating miR-342-3p yielded AUCs of 0.697 and 0.599 for predicting APOs in the GDM and Normal groups, respectively. After adjusting for pre-pregnancy BMI, parity, FPG, and 2hPG, the ORs for APOs per unit increase in miR-342-3p were 1.338 in the GDM group and 2.284 in the Normal group.

Circulating miR-342-3p may serve as a valuable adjunctive biomarker for early GDM screening. Across both GDM and non-GDM populations, circulating miR-342-3p is significantly associated with APOs, suggesting cross-population applicability, though GDM status may modulate the strength of this association.

To explore the potential incremental value of metabolic-inflammatory and insulin-resistance indices for diagnosing mild cognitive impairment (MCI) in type 2 diabetes (T2DM), and to furnish new candidate tools and insights for the risk stratification and early recognition of diabetes-related cognitive dysfunction.

This cross-sectional, observational study was jointly conducted by two tertiary endocrine centers in northwestern China. A uniform assessment of cognitive status was performed using the Chinese versions of the Montreal Cognitive Assessment (MoCA). MCI was defined as MoCA < 26. Baseline clinical characteristics, metabolic-inflammatory parameters and insulin-resistance indices were systematically compared between groups. Candidate predictors were first compressed via Lasso regression; key retained variables were then used to develop a binary logistic prediction model. The model's discrimination was assessed via ROC curves, and its calibration was evaluated by the Hosmer‑Lemeshow test combined with calibration plots. Decision-curve analysis (DCA) and clinical impact curves (CIC) were further employed to quantify net benefit and reclassification across a range of risk thresholds, providing a comprehensive appraisal of the model's clinical utility.

This study included 293 patients with type 2 diabetes mellitus, of whom 187 (63.8%) had mild cognitive impairment (MoCA<26). Compared with the 106 cognitively normal controls, the T2DM-MCI group were older, had fewer years of education and a lower proportion of higher education (all p<0.05). The prevalence of diabetic nephropathy (32.6% vs 18.9%, p = 0.006) and previous cerebral infarction (29.9% vs 10.4%, p < 0.001) was significantly higher, while diabetic peripheral neuropathy and carotid atherosclerosis showed borderline differences (p ≈ 0.06). Concurrently, inflammatory-metabolic burden increased across the board-NMLR, PHR, BRI, ABSI, WWI and LAP were all elevated (p ≤ 0.048)-and adiposity index RFM together with insulin-resistance markers TyG-WtHR and HOMA-IR also rose (p ≤ 0.017). Notably, Lasso regression identified WWI, RFM, and TyG-WtHR as candidate markers. However, none of these variables achieved statistical significance in the subsequent multivariable Logistic regression (all p>0.05). This finding suggests that novel anthropometric and metabolic indices may be linked to cognitive decline primarily through indirect pathways associated with traditional risk factors, offering new mechanistic insights into the obesity-metabolism-cognition axis.

Univariate analysis revealed that WWI, RFM, and TyG-WtHR were significantly correlated with cognitive decline (r=0.232, 0.194, and 0.154, respectively; all p<0.01). Incorporation of these three readily obtainable anthropometric and laboratory parameters into the baseline clinical model increased the area under the curve (AUC) from 0.768 to 0.771, offering potential clues into the mechanistic link between obesity-metabolism and cognitive impairment.