Diabetic foot ulcer (DFU) is a chronic and predominantly microvascular and neuropathic complication in more severe or chronic cases of diabetes mellitus. It is characterized by chronic nonhealing wounds, vascular impairment, and delayed healing process, leading to severe complications, limb amputations, and increased mortality. With an annual incidence rate of approximately 2%, DFU poses a significant global healthcare and economic burden. Despite its prevalence, current treatment options remain limited, necessitating the urgent need for a deeper understanding of the underlying molecular pathways or mechanisms to develop effective therapeutic strategies. Present work is emphasized on molecular mechanisms involved in pathogenesis of DFU and current and emerging therapeutic interventions for the treatment of DFU. Due to its high prevalence, multifaceted pathophysiology, and significant healthcare and economic burden, a thorough understanding of molecular pathways underlying DFU is essential to develop precise therapeutic interventions to improve clinical outcome and reduce the healthcare burden associated with DFU. Several therapeutic interventions have been utilized, like modulators of key signaling pathways (Wnt/β-catenin, PI3K/Akt/mTOR, JAK/STAT, and Notch), repurposed pharmacological agents (e.g. metformin, colchicine, deferoxamine, and lithium carbonate), and advanced local treatments such as bioactive hydrogels and next-generation dressings. Furthermore, regenerative approaches like gene therapy, stem cell transplantation, therapeutic peptides, and 3D-bioprinted adipose tissue constructs provide a promising strategy for restoring tissue integrity and promoting healing.

The global epidemic of type 2 diabetes (T2D) is a critical public health issue, particularly in New Zealand, where prevalence rates are high, especially among Māori and Pacific people. Recent research indicates that dietary interventions, particularly carbohydrate reduction, can lead to the remission or reversal of T2D. However, little is known about how such approaches perform when implemented in routine New Zealand primary care, particularly within high-risk and underserved populations. This study aimed to evaluate changes in HbA1c, diabetes status, and cardiometabolic outcomes among adults with prediabetes and T2D engaged in such a model of care.

This study reports findings from a retrospective, observational, real-world, multi-site clinical audit (service evaluation) of a holistic model of care implemented in three primary care practices in New Zealand. The model of care is characterised by a three-pronged approach: whole food, carbohydrate reduction; a health-coach, behaviour-change-based delivery approach; and community- or peer-based initiatives. Audit data from 106 patients with prediabetes (PD) and T2D were analysed (median follow-up 19 months; IQR 6-32) to assess changes in glycosylated haemoglobin (HbA1c) levels, diabetes status, and cardiometabolic outcomes.

We observed an overall reduction in HbA1c (median change -3 mmol/mol (IQR: -7 to 3), p = 0.004), with 32% of patients with T2D at baseline achieving reversal and 44% of those with PD attaining normoglycaemia at final follow-up. Weight loss was associated with greater HbA1c reduction (0.56 mmol/mol decrease per kg lost) and additional improvements seen in lowered alanine aminotransferase (ALT). HDL cholesterol showed a small decline (r = 0.31), and triglycerides and blood pressure showed no significant change, indicating that these measures remained broadly stable over the evaluation period.

Given the retrospective and uncontrolled audit design, findings should be interpreted with appropriate caution. However, the consistent improvements observed across multiple practices suggest that carbohydrate-reduction strategies within holistic models of care can meaningfully improve diabetes outcomes in real-world primary care settings. Future research should evaluate longer-term sustainability, implementation fidelity, and the applicability of this model at scale, particularly for Māori and Pacific communities.

Background: Type 2 diabetes mellitus (T2DM) is a growing global health challenge requiring effective dietary management strategies. While the Mediterranean diet shows promise for cardiovascular and metabolic health, the last comprehensive meta-analysis of randomized controlled trials (RCTs) examining its effects on glycemic control and body mass index (BMI) in T2DM was published in 2015. Multiple RCTs, including culturally adapted interventions with extended follow-up, have since been completed, but remain unsynthesized. Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines (PROSPERO: CRD420251147035), searching PubMed, Web of Science, and Embase from inception through 17 August 2025. Unlike previous syntheses that combined observational cohorts or mixed dietary approaches, our analysis focused strictly on RCTs in adults with established T2DM and incorporated trials published after 2015. We included RCTs comparing Mediterranean diet interventions against non-Mediterranean control diets in adults with T2DM. Primary outcomes included glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and body mass index (BMI). Secondary outcomes comprised low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and diastolic blood pressure (DBP). Pooled effects were estimated using random-effects models. Results: Eleven RCTs (10 publications) involving diverse populations met inclusion criteria. Compared with control diets, Mediterranean diet interventions showed reductions in HbA1c (mean difference [MD] -0.307%, 95% CI: -0.451 to -0.163), FPG (MD -0.845 mmol/L, 95% CI: -1.307 to -0.384), and BMI (MD -0.828 kg/m², 95% CI: -1.4 to -0.256). Secondary analyses revealed reductions in LDL-C (MD -8.060 mg/dL, 95% CI: -14.213 to -1.907), SBP (MD -5.130 mmHg, 95% CI: -10.877 to 0.617), and DBP (MD -2.008 mmHg, 95% CI: -3.027 to -0.989). Sensitivity analyses supported stability of findings, with no substantial publication bias detected. Subgroup analyses revealed geographic variation in blood pressure responses, with greater benefits observed in non-Mediterranean populations. Conclusions: Mediterranean dietary patterns were associated with modest improvements in glycemic control, body composition, and cardiometabolic risk factors among adults with T2DM. The cultural adaptability of this approach may support implementation in clinical practice, though larger multicenter trials with standardized protocols and extended follow-up remain necessary.

In recent years, the prevalence of diabetes in China has increased significantly, and approximately 11.9% of Chinese adults had diabetes in 2020. Moreover, there are several rigorous challenges in diabetes prevention and glycaemic control, especially at the primary medical care level. In order to guide primary healthcare providers in providing comprehensive and continuous care to affected patients, the Office for Primary Diabetes Care of the National Basic Public Health Service Program and the Chinese Diabetes Society issued national guidelines for the prevention and control of diabetes at the primary care level in 2025. The management objects were adults with type 2 diabetes aged ≥18 years. The main contents include basic requirements for management, health management process, diagnosis, screening, evaluation, treatment, recognition and management of acute complications, traditional Chinese medicine, referral and health management and education.

With the increasing number of diabetic patients, the rapid and accurate diagnosis of early diabetic retinopathy becomes crucial. However, diabetic retinal lesions are challenging to label since the identification of disease depends on accessing multiple lesion regions in images, which requires specialists to make detailed judgments and label them, resulting in an extremely costly and time-consuming.

To reduce costs, we propose diabetic retinopathy detection network (DRD-Net), an improved weakly supervised object detection model based on adversarial complementary erasure learning (ACoL) framework, designed for diabetic retinopathy detection. DRD-Net enhances small lesion localization while relying only on image-level labels.

DRD includes an improved EfficientNet-B0 network, which leverages compressed network structure with parallel downsampling and the efficient channel attention (ECA) module for feature extraction from fundus images. A multi-scale parallel attention module (MPA) is designed and combines with adversarial complementary erasure learning to enhance classification and localization of small lesion accross multi-scale features. For data processing, we cropped and re-annotated three datasets into 35,828 lesion patches (224 × 224 pixels) to solve the problem of information loss in high-resolution fundus images. The dataset is partitioned into training (25,079, 70%), validation (7166, 20%), and test (3583, 10%) sets. Benchmark models include CNN-based methods (CAM, ACoL, SLT-Net, etc.) and Transformer-based approaches (TRT, SAT, etc.). Performance is evaluated using Top-1/Top-5 classification accuracy (Top-1/Top-5 Cls), Top-1/Top-5 localization accuracy (Top-1/Top-5 Loc), and ground-truth known localization accuracy (GT-Known Loc). Statistical analyses employs paired t-tests with Holm-Bonferroni correction for multiple comparisons, Cohen's d for effect size, and a significance level of α = 0.05.

Experiments verify that the performance of DRD-Net is better than the state-of-the-art methods, achieving 82.41%, 76.94%, and 86.05% in Top-1 Cls, Top-1 Loc and GT-Known Loc, respectively. Compared to top-performancing baselines, gains are 1.64% (Cohen's d = 1.016, p = 0.0318), 3.16% (d = 1.377, p = 0.0090), and 0.96% (d = 0.85, p = 0.0481), all significant at α = 0.05.

Experiments confirm that DRD-Net has good feasibility to accurately and comprehensively identify DR lesions. This suggests that it could potentially enhance clinical screening efficiency and promote further development in diabetic retinopathy detection.

The coexistence of tuberculosis (TB) and diabetes mellitus (DM) presents a significant global health challenge, particularly in patients with poorly controlled glycemic levels. Subclinical or silent pulmonary TB in diabetic individuals-characterized by the absence of classic symptoms-often leads to delayed diagnosis, atypical clinical presentations, and suboptimal treatment outcomes. This review explores the underlying pathogenesis, unique clinical manifestations, and diagnostic and therapeutic challenges in this high-risk population. We highlight the interplay between hyperglycemia and immune dysfunction, the limitations of current diagnostic tools, and the need for tailored management strategies to improve TB control in diabetic patients.

Nutritional status is related to the postoperative complications in gastrointestinal tumors. Early-onset and late-onset tumors have differences in molecular characteristics and clinical manifestations. The purpose of this study is to explore the relationship between preoperative nutritional assessment indices (prognostic nutritional index (PNI), nutritional risk index (NRI), and controlled nutritional status (CONUT) score) and the occurrence of complications after laparoscopic treatment in patients with gastrointestinal tumors aged ≤60 years.

1405 patients with gastrointestinal tumors aged ≤60 years who underwent laparoscopic surgery were retrospectively analyzed. Medical records (age, gender, body mass index (BMI), hypertension, diabetes mellitus, tumor location, preoperative laboratory test results, imaging results, complications) were collected. The relationship between PNI, NRI, CONUT and postoperative complications were analyzed.

There were 584 (41.6%) patients with postoperative complications and 821 (58.4%) without. The distribution of CONUT grade and the means PNI and NRI were significant differences between the two groups (all p<0.001). When postoperative complication was set as the endpoint of PNI and NRI, the cutoff value of PNI and NRI was 43.425 and 100.045, respectively. Logistic regression analysis showed that low NRI level (<100.045 vs. ≥100.045) (odds ratio (OR): 1.863, 95% confidence interval (CI): 1.377-2.522, p < 0.001), abnormal CONUT score (OR: 1.333, 95% CI: 1.002-1.772, p = 0.048) were significantly associated with postoperative complications.

Low NRI level, abnormal CONUT score, underweight, and intestinal tumor were significantly associated with postoperative complications in gastrointestinal tumors patients with aged ≤ 60 who performed laparoscopic surgery.

To explore the independent risk factors for technical survival in patients undergoing peritoneal dialysis (PD), construct a nomogram model for predicting 1-, 3-, and 5-year technical survival rates, and validate the clinical value of nursing interventions in improving PD patients' prognosis.

A retrospective cohort study was conducted on 475 patients with end-stage renal disease (ESRD) who received PD at Huangshi Central Hospital from February 2010 to April 2025. Patients were randomly divided into a training group (n = 332) and a validation group (n = 143) at a 7:3 ratio. Spearman correlation analysis was used to identify factors associated with PD duration. Univariate and multivariate Cox regression analyses were performed to screen independent risk factors for PD technical survival, based on which a nomogram prediction model was established. The model's performance was validated using receiver operating characteristic (ROC) curves, concordance index (C-index), calibration plots, and decision curve analysis (DCA). Kaplan-Meier method was applied to analyze cumulative risk differences related to nursing intervention factors.

Spearman correlation analysis showed that PD duration was negatively correlated with age, body mass index (BMI), fasting blood glucose, serum creatinine (Scr), peritonitis, catheter-related complications, Self-Rating Depression Scale (SDS) score, and Self-Rating Anxiety Scale (SAS) score, while positively correlated with years of education, DUV, albumin level, number of primary caregivers, and frequency of health education (all p < 0.05). Multivariate Cox regression analysis identified six independent predictors of PD technical survival: age ≥60 years (hazard ratio [HR] = 9.084, 95% confidence interval [CI]:5.912-13.959), history of diabetes mellitus (HR = 15.047, 95%CI:9.802-23.101), albumin level (HR = 0.894, 95%CI:0.849-0.940), peritonitis (HR = 6.172, 95%CI:3.970-9.595), catheter-related complications (HR = 1.740, 95%CI:1.304-2.320), and abnormal mental state (HR = 2.261, 95%CI:1.589-3.217) (all p < 0.01). The nomogram constructed based on these factors showed good predictive performance in both the training and validation groups.

The constructed nomogram can accurately predict the 1-, 3-, and 5-year technical survival rates of PD patients. Enhanced health education (≥1 session/month), optimized caregiving support systems, improved psychological conditions, and narrowed urban-rural disparities in healthcare resources are effective nursing interventions to improve the technical survival outcomes of PD patients.

Contrast-induced acute kidney injury (CI-AKI) remains a significant complication in patients with type 2 diabetes mellitus (T2DM) and renal insufficiency undergoing percutaneous coronary intervention (PCI). Many studies have shown that sodium-glucose cotransporter-2 inhibitors (SGLT2i) can improve cardiovascular and renal outcomes in T2DM patients. And chronic administration of SGLT2i has been shown to reduce the risk of CIAKI after PCI in patients with T2DM. However, the impact of short-term SGLT2i administration on the incidence of CIAKI after PCI in T2DM patients with renal insufficiency remains unclear.

To investigate the impact of short-term (<2 weeks) administration of dapagliflozin on CIAKI in patients with T2DM and renal insufficiency undergoing PCI.

This retrospective study included patients with T2DM and renal insufficiency who underwent PCI in our hospital, from January to December 2024. The patients were divided into a short-term dapagliflozin group and a control group. Renal function was recorded before PCI, as well as at 48 h and 1 week post-PCI. The primary endpoint was the incidence of CIAKI after PCI in both groups. The secondary endpoints included changes in renal function at 48 h and 1 week post-PCI, as well as the occurrence of major adverse cardiovascular events (MACE) during the 3-month follow-up.

(1) A total of 354 patients with T2DM and renal insufficiency underwent PCI were included in this study, with 183 patients in the short-term dapagliflozin group and 171 patients in the control group. The median duration of short-term dapagliflozin administration before PCI was 3 (2, 6) days, with an average duration of 3.56 ± 1.62 days. (2) The incidence of CIAKI was higher in the short-term dapagliflozin group (14.2%) compared to the control group (7.0%) (χ²  = 4.769, p = 0.029). Logistic regression analysis indicated that short-term dapagliflozin administration before PCI was associated with an increased risk of CIAKI (OR = 2.308, 95%CI: 1.002-5.314, p = 0.049). (3) During the 3-month follow-up after PCI, Log-rank test showed no significant difference in the incidence of MACE between the two groups (Log-rank χ²  = 0.851, p = 0.356). (4) Cox regression analysis revealed that CIAKI significantly affected the short-term prognosis of T2DM patients with renal insufficiency after PCI (HR = 3.025, 95%CI: 1.246-7.343, p = 0.014), whereas dapagliflozin did not significantly improve the short-term prognosis of these patients after PCI (HR = 1.024, 95% CI: 0.967-1.084, p = 0.415).

Short-term (<2 weeks) dapagliflozin administration may increase the risk of CIAKI in T2DM patients with renal insufficiency undergoing PCI. It is recommended to avoid initiating dapagliflozin in high-risk CIAKI patients prior to PCI.

Peripheral Arterial Disease (PAD) is a significant complication among patients with Type 2 Diabetes Mellitus (T2DM), characterized by atherosclerosis that leads to reduced blood flow to the extremities. This article assesses the traditional risk factors for PAD and the predictive value of the new inflammatory biomarkers like fibrinogen and C-reactive protein (CRP), and the implications of PAD in T2DM patients, drawing from recent studies and findings. The presence of PAD in T2DM patients poses serious health risks, including increased risk of foot ulcers, limb amputation, and cardiovascular events, necessitating comprehensive cardiovascular risk management. The study aims to assess the effectiveness of various diagnostic tests for PAD, particularly the Ankle-Brachial Index (ABI), in detecting PAD and stratifying cardiovascular risk in T2DM patients.

The study population comprises the recruitment of 112 Type 2 DM patients and an equal number and sex matched healthy participants as controls from three centres in Calabar, making a total of 224 participants. Socio-demographic information was collected. After physical examination and anthropometric measurements, the ABI was performed using a Doppler ultrasound device. Descriptive statistics were used to summarize clinical and demographic characteristics, and comparative analysis was done using chi-square for categorical variables and t-test for continuous variables. Logistic regression was used for independent risk factors associated with PAD.

The median ages for the Type 2 DM patients and the controls were 58 years (IQR 10) and 58 years (IQR 11), respectively. The prevalence of PAD using ABI<0.9 in this study was 37.5% in people living with type 2 diabetes and 14.3% in controls. The prevalence of PAD for Type 2 DM patients and controls using symptoms of palpation of pedal pulsations and intermittent claudication was 17.0% vs 3.6% and 11.6% vs 2.7% respectively. There was a statistically significant relationship between advanced age, hypertension, duration of diabetes, glycaemic control, fibrinogen, as well as CRP, and PAD among people living with Type 2 diabetes. After multiple regression analysis, the predictors of PAD in this study were age, duration of Diabetes, and elevated serum CRP. There was no correlation between smoking, obesity, and lipid profiles with PAD.

There is a high prevalence of peripheral artery disease among people with T2DM in Calabar. The use of ABI is of great value in the detection of PAD, as evidenced by a more objective assessment of PAD compared to intermittent claudication and reduced/absent pedal pulses. Routine screening of PLWDM for PAD using ABI would enhance early diagnosis and intervention.