Cardiometabolic multimorbidity (CMM) prevalence has risen, but longitudinal evidence on trajectories and mortality links remains limited.

This study aimed to examine CMM trends and the impact of its statuses/trajectories on mortality in Guangdong, China.

This is a cohort study.

Data were collected from the Guangdong Provincial adult chronic diseases and risk factors cohort (GDACRC). The follow-up data were collected from the hospitalization record system and the vital register system in Guangdong Province.

Baseline surveys were separately conducted in 2007, 2010, 2013, 2015, and 2018, which recruited 34,244 participants aged 18 years or older.

Calculated age-sex standardized CMM prevalence. Cox proportional hazards models were used to assess the associations between CMM statuses/trajectories and mortality risk.

From 2007 to 2018, the prevalence of CMM increased significantly from 4.31 to 8.75% in Guangdong Province, China (p < 0.05). Compared with participants without any cardiometabolic diseases (CMD), the mortality risk of those with single CMD and CMM, respectively, increased by 30 and 85%, with a greater risk of patients aged < 65 years. The most common trajectory was from metabolic disease (M) to cardiovascular diseases (C), that 9.31% healthy participants at baseline developed CMM on this trajectory, which accounted for 53.5% of all CMM patients. Compared to patients with single M, patients with the trajectory from C to M had greater mortality risk (HR = 3.32, 95% CI: 2.13-5.16).

Single-province sample; self-report bias.

CMM represents a major public health challenge in Guangdong Province, China. Our findings provide new insights on the CMM progression, which may be helpful for prevention and clinical management of CMM.

JOURNAL/mgres/04.03/01612956-202612000-00007/figure1/v/2026-07-23T200825Z/r/image-tiff Since air pollution can cause acute exacerbation of asthma, we aimed to investigate the effects of short-term exposure to ambient air pollution on respiratory symptoms and lung function among patients with asthma. A prospective and observational panel study recruited 32 patients with asthma from November 2015 to December 2016. The Asthma Control Test scores and lung function measurements of the patients were repeatedly assessed. Daily ambient air pollution data, including particulate matter (PM2.5 and PM10), sulfur dioxide, nitrogen dioxide, and carbon monoxide, were obtained from nearby central air-monitoring stations. Mixed effects models were used to examine the associations between pollutant exposure and health measurements. Clinical data were repeatedly collected 2 to 13 times each month, totaling 266 visits. Increases in the interquartile ranges of PM2.5 (74.5 μg/m3, 6-day), PM10 (78 μg/m3, 5-day), sulfur dioxide (10 μg/m3, 7-day), nitrogen dioxide (37 μg/m3, 6-day), and carbon monoxide (0.7 mg/m3, 6-day) levels were significantly associated with reductions in Asthma Control Test scores by 3.6%, 2.8%, 3.2%, 3.8%, and 2.9%, respectively. An interquartile range increase of 78 μg/m3 in the 7-day moving average concentration of PM10 was significantly associated with reductions of 3.6% in percentage of predicted forced expiratory volume in 1 second and 6.0% in percentage of predicted forced expiratory flow at 25% of the forced vital capacity, respectively. Short-term ambient air pollution may aggravate respiratory symptoms and cause a decline in lung function among patients with asthma.

Heart failure with preserved ejection fraction (HFpEF) accounts for approximately 50% of heart failure cases and lacks effective treatment. Among its 5 phenotypes, obesity-related HFpEF is common and linked to higher cardiovascular mortality. However, the molecular mechanisms remain unclear. Research indicates that in patients with obesity-associated HFpEF, epicardial adipose tissue (EAT) is significantly increased, whereas non-EAT adipose tissue also exhibits pathologic distribution and accumulation. This review explores how the cardiac-adipose axis drives HFpEF pathophysiology. EAT is notably increased in these patients and contributes to diastolic dysfunction through pericardial restriction. Both EAT and non-EAT promote cardiac dysfunction via adipokines, inflammatory mediators, and oxidative stress. The review also highlights EAT thickness as a diagnostic marker and suggests a dual-screening approach combining waist-to-height ratio with NT-proBNP. Finally, potential adipose-targeted therapies based on clinical and preclinical evidence are summarized, providing a foundation for future treatment strategies.

Obesity, type 2 diabetes (T2D), and weight loss are associated with increased fragility fracture risk. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely prescribed, yet their effects on skeletal outcomes remain uncertain.

To evaluate the association between GLP-1 RA initiation and 3-year fragility fracture risk compared with dipeptidyl peptidase-4 inhibitor (DPP-4i) initiation among adults with T2D.

This comparative effectiveness study using retrospective target trial emulation examined data from the TriNetX Research Network (January 1, 2015, to December 31, 2022), a multicenter US electronic health record database. Adults aged 50 to 90 years with T2D who newly initiated a GLP-1 RA or DPP-4i were followed up for up to 3 years. A separate cohort stratified by T2D status was also analyzed. The database was queried on January 26, 2026, to generate a line-level analytic dataset.

Initiation of GLP-1 RAs vs DPP-4is.

The primary outcome was incident fragility fracture, defined as fractures after low-energy trauma (eg, fall from standing height). Cohorts were propensity score matched. Time-varying mediation analyses were used to evaluate the contribution of changes in body mass index and hemoglobin A1c.

After matching, 133 606 patients (66 803 per group; GLP-1 RA vs DPP-4i: mean [SD] age 63.2 [8.1] vs 63.8 [8.5] years; 35 195 [52.7%] vs 36 098 [54.0%] male) were included. Initiation of GLP-1 RA was associated with lower fragility fracture risk compared with DPP-4i initiation (hazard ratio [HR], 0.79 [95% CI, 0.76-0.83]; absolute risk reduction, 0.79% [95% CI, 0.60%-0.99%]; number needed to treat, 126 [95% CI, 101-168]). The largest risk reductions were observed with vertebral (HR, 0.68 [95% CI, 0.63-0.73]) and hip or femur (HR, 0.70 [95% CI, 0.63-0.79]) fractures. In a sensitivity analysis stratified by diabetes status, fracture risk reduction was observed among patients with T2D (HR, 0.91 [95% CI, 0.88-0.95]) but not among those without T2D (HR, 1.13 [95% CI, 1.04-1.23]; interaction P < .001). Mediation analyses showed that the direct association between GLP-1 RA use and lower fracture risk persisted (HR, 0.81 [95% CI, 0.76-0.86]).

This target trial emulation study of adults with T2D found that initiation of a GLP-1 RA was associated with lower 3-year fragility fracture risk compared with initiation of a DPP-4i, independent of changes in body mass index and hemoglobin A1c. Prospective studies are needed to establish causality and define long-term skeletal effects.

Diabetes mellitus is increasingly recognized as a systemic disorder associated with a broad spectrum of neurological complications, including diabetic peripheral neuropathy, autonomic neuropathy, cerebrovascular disease, cognitive impairment, and neurodegenerative disorders. Because neurological injury may develop before the onset of overt clinical manifestations, the identification of reliable biomarkers for early risk assessment remains an important challenge in diabetes care. This narrative review summarizes current evidence regarding molecular biomarkers implicated in diabetes-related neurological complications. A literature search was conducted using major biomedical databases, with emphasis on human studies, systematic reviews, prospective cohorts, and clinically relevant translational research. Biomarker categories reviewed include inflammatory mediators, oxidative stress markers, advanced glycation end-products, neuronal injury proteins, metabolomic signatures, circulating microRNAs, extracellular vesicles, and multi-omics approaches. Current evidence suggests that several biomarkers are associated with neurological injury and adverse neurological outcomes in patients with diabetes. However, the strength of evidence varies substantially across biomarker classes. While some biomarkers demonstrate biological plausibility and consistent associations with disease burden, most remain at an exploratory stage and lack sufficient prospective validation for routine clinical implementation. Major barriers include study heterogeneity, assay variability, limited reproducibility, uncertainty regarding incremental predictive value, and insufficient evaluation in diabetes-specific populations. Future research should focus on rigorous validation of candidate biomarkers, standardization of analytical methods, and assessment of their added value beyond established clinical risk factors. The integration of molecular biomarkers with clinical variables, neuroimaging findings, and advanced analytical approaches may contribute to future risk stratification strategies; however, substantial validation is required before clinical implementation can be considered.

Diabetic foot osteomyelitis (DFO) poses significant challenges due to its high morbidity and recurring nature. Current treatments involve prolonged antibiotics and often surgical intervention; however, the optimal route of antibiotic administration is unknown. This study evaluated the effect of route of antibiotic administration on treatment failure among patients with diabetic foot osteomyelitis.

The authors conducted a retrospective cohort study among patients with unresected diabetic foot osteomyelitis. A propensity score was used to match the treatment exposure groups. The primary outcome was treatment failure, defined as either (1) treatment with additional antibiotic course or (2) additional surgical debridement/amputation at the original site of infection within 1 year of initial treatment. Secondary outcomes included the impacts of hemoglobin A1c, peripheral arterial disease, obesity, and infection severity on treatment failure.

Among 152 patients meeting criteria, 49 matched pairs were analyzed. Treatment failure rates did not significantly differ between oral and intravenous groups (OR 0.98, 95% CI 0.30-3.19, p > 0.9). A time-to-event analysis similarly found no significant outcome disparities between groups (p = 0.3).

The study results support the previously published literature that demonstrates comparable treatment outcomes between routes of antibiotic administration when treating diabetic foot osteomyelitis.

Background: Diabetes mellitus (DM) is a metabolic disease with an increasing global prevalence. It is characterized by chronic and systemic complications. Due to these complications, DM significantly impacts patients' health-related quality of life (HRQoL). One of the most critical complications of DM is diabetic foot ulcers (DFUs), which have serious consequences for patients and healthcare systems. Objective: This study aimed to investigate variables potentially associated with HRQoL in patients with DFUs presenting to our wound care unit. Methods: This prospective cross-sectional study was conducted from February to May of 2023 at the Wound Care Unit of the General Surgery Department at Eskişehir City Hospital. A total of 209 patients who agreed to participate were included in the study. Data were collected via a structured questionnaire developed based on the literature, which included the Diabetic Foot Ulcer Scale-Short Form (DFS-SF). We used the Kolmogorov-Smirnov test, univariate analyses (Mann-Whitney U and Kruskal-Wallis tests), and multiple linear regression. Results: In the multivariate analysis, receipt of foot care education (p < 0.001), frequency of hospital applications due to DFU (p = 0.008), and Wagner classification (p = 0.012) were found to be predictors of HRQoL for DFUs (Adjusted R² = 0.206, F = 4.365, p < 0.001). Conclusions: To maintain a high HRQoL among DFU patients, they should immediately apply to specialized Wound Care Units, receive education, especially regarding early diagnosis and treatment, and receive multidisciplinary management for DFU.

Plantar load distribution and postural stability are key functional domains in diabetic foot assessment, yet their association in early-stage disease remains poorly characterized. This study aimed to investigate the association between static plantar load distribution and postural stability parameters in 31 patients with early-stage diabetic foot (Meggitt-Wagner grade 0-1). A cross-sectional study was conducted with 31 participants (mean age 58.48 ± 9.53 years; 51.6% with loss of protective sensation). Static plantar load distribution was assessed using the Tekscan Pressure Measurement System (Presto-Scan DB software) and postural stability was assessed using the Nintendo Wii Balance Board^® under bipedal eyes-open, bipedal eyes-closed, and single-leg stance conditions. Spearman correlation analyses with Benjamini-Hochberg false discovery rate (FDR) correction were performed. A rearfoot-dominant loading pattern was observed bilaterally (right: 61.5 ± 8.2%; left: 61.8 ± 7.9%). Mean CoP sway velocity was 4.78 ± 1.98 mm/s (eyes open) and 5.76 ± 1.88 mm/s (eyes closed) in bipedal stance. No statistically significant associations between plantar load distribution and CoP parameters were found after FDR correction (all q > 0.05). Adults with early-stage diabetic foot exhibit a rearfoot-dominant loading pattern and sensory-dependent postural control behavior. The absence of significant cross-domain associations suggests that static plantar load distribution and postural stability represent complementary assessment targets. Future controlled studies with matched healthy comparators are needed to determine clinical significance.

Women with diabetes mellitus experience higher rates of urinary tract infections (UTIs) and recurrent UTIs, yet evidence-based guidance on risk factors and management in this population remains limited. Given that urogynecologists frequently evaluate women with recurrent UTI symptoms-many of whom also have diabetes-clarifying diabetes-specific risks is essential for guiding clinical decision making. This Clinical Consensus Statement reviews and summarizes existing evidence in a topic that is highly relevant to urogynecologists, who routinely manage women with recurrent UTI symptoms and diabetes mellitus.

A team of 7 urogynecologists and pelvic reconstructive surgeons conducted a systematic review of literature from January 1995 to October 2024, analyzing 249 abstracts and 119 full-text articles, ultimately including 32 studies. Initially aiming to create clinical guidelines, insufficient evidence led to the development of a Clinical Consensus Statement, which was revised using the Delphi method.

Consensus was reached on 7 of 11 statements in the first round, with the remaining 4 condensed into 2 final statements. Nine statements were developed and categorized into 3 areas: (1) epidemiology, (2) risk factors (glycemic control, glucose-lowering medications, and bacteriuria), and (3) prevention and treatment.

UTI and recurrent UTI prevalence are higher in women with diabetes mellitus, but there is a significant lack of prospective studies, including randomized trials, on the risks and side effects of medications related to lower UTIs in this population. Future studies assessing the efficacy of UTI prevention and treatment strategies specifically in women with diabetes mellitus are urgently needed.

Diabetic foot ulcers (DFU) impose a healthcare burden due to prolonged hospitalization, high amputation rates, and increased mortality. This study evaluated healing outcomes and explored factors associated with adverse outcomes among patients managed within a structured multidisciplinary DFU care setting at a specialized diabetes care center in Kerala.

A retrospective analysis was conducted among 1057 patients with DFUs managed between January and November 2022. Care included wound culture-directed antibiotics, glycemic optimization, offloading, daily debridement and dressing, and vascular assessment when indicated. Healing outcomes were assessed, and factors associated with poor outcomes and delayed healing were evaluated using multivariable logistic regression.

In the full cohort, 74.7% of patients achieved complete healing, whereas the major amputation rate was 2.6%. After excluding referrals, deaths, and loss to follow-up, 887 patients comprised the complete follow-up cohort, of whom 790 (89.1%) achieved favorable outcomes, and 97 (10.9%) experienced poor outcomes (nonhealing ulcer or major amputation). Coronary artery disease (OR 2.08, 95% CI 1.23-3.51; p = 0.006) and prior ulcer history (OR 2.41, 95% CI 1.55-3.74; p < 0.001) were independently associated with poor outcomes. Among patients with healing-time data (n = 766), chronic kidney disease was independently associated with delayed healing (> 5 months) (OR 1.96, 95% CI 1.26-3.06; p = 0.003).

High rates of favorable outcomes and low rates of major amputation were observed in this cohort managed within a multidisciplinary DFU care model. These findings support the need for prospective multicenter evaluations of multidisciplinary DFU care models.