Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. While considerable attention has been paid to the management of GDM during pregnancy, women's perceptions of GDM, knowledge of associated risk factors and health behaviours before and between pregnancies are less well understood, despite their importance for informing diabetes prevention programmes.

To explore women's knowledge of GDM risk factors, perceptions of GDM and preconception health behaviours.

Individual semi-structured interviews were undertaken with 23 women with GDM in the third trimester of pregnancy. Data were analysed using a template analysis based on preconception knowledge, risk communication, and perceptions and behaviours.

Women often had limited knowledge of GDM before pregnancy, with many first learning about the condition during antenatal screening. Perceptions of risk were largely weight or BMI centred, with less recognition of other factors. Although participants commonly described intentions to improve diet quality and increase physical activity prior to conception, these intentions were rarely translated into sustained behaviours. Reported barriers included time constraints, caregiving responsibilities, financial costs and limited access to clear, culturally appropriate guidance. Pregnancy preparedness varied by parity: women approaching a first pregnancy focused on general preparation and navigating the healthcare system, whereas women with a prior GDM experience planned around potential recurrence, including early self-management and glucose monitoring.

Findings support two priorities: (1) strengthening communication and education at the time of GDM screening and diagnosis so that results and next steps are clear, supportive and person-centred; and (2) providing universal, general preconception support delivered proportionately to need, alongside targeted interconception pathways for women at higher absolute risk, following GDM. The findings do not imply universal GDM-specific preconception education for all women; rather, they indicate a need for needs-based communication during pregnancy and targeted interconception support delivered with clear signposting to resources.

An advisory group of seven women has been involved in this project. Four online sessions were conducted (between October 2023 and July 2024) to develop the research question, study materials, recruitment plans, interview schedules and participant retention plan.

Objective: Diabetes mellitus encompasses chronic metabolic disorders marked by impaired insulin secretion, action, or both, with type 1 and type 2 diabetes presenting distinct mechanisms and therapeutic needs. Achieving durable glycemic control remains essential to preventing microvascular and macrovascular complications. Data Sources: The growing prevalence of obesity among people with diabetes-driven by insulin resistance, lifestyle factors, and, in type 1 diabetes, insulin-associated weight gain-has increased the demand for therapies targeting both glycemia and body weight. Study Selection and Data Extraction: Traditional agents such as insulin, metformin, sulfonylureas, and thiazolidinediones have long served as treatment foundations but are limited by risks like hypoglycemia and weight gain. Incretin-based therapies, particularly glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter 2 (SGLT-2) inhibitors, have reshaped diabetes care by improving glycemic control, promoting weight loss, and offering cardiovascular and renal protection. Data Synthesis: Newer dual and multiagonists, including tirzepatide and emerging triple agonists, show unprecedented reductions in HbA_1c and body weight, approaching outcomes seen with bariatric surgery. However, rising off-label use of antidiabetic drugs for weight loss raises safety concerns, including gastrointestinal effects and rare motility disorders, underscoring the need for careful patient selection and pharmacovigilance. Conclusion: Ongoing challenges include high costs, inequities in access, medication shortages, and the need for sustained pharmacovigilance. Future directions involve oral non-peptide incretin mimetics, broader indications for multiagonists, and deeper understanding of long-term safety, particularly in off-label contexts.

Gestational diabetes mellitus (GDM) is a common pregnancy complication with significant maternal and neonatal risks, and its prevalence is particularly high in Qatar. Myo-inositol has been proposed as an insulin-sensitizing supplement that may reduce the incidence of GDM, but evidence is limited in this population. This study aims to evaluate the effect of antenatal dietary myo-inositol supplementation on the incidence of GDM among pregnant women in Qatar and to assess the impact on fetal and neonatal outcomes. Sidra Medicine, Qatar, conducted this prospective, randomized, double-blind, placebo-controlled pilot trial (2022-2023). The trial was registered with International Standard Randomised Controlled Trial Number (ISRCTN; protocol number ISRCTN16448440) and approved by the Institutional Review Board of Sidra Medicine (IRB Number: 1538656). Only 67 pregnant women were recruited, and 43 of them finished the trial till birth, despite the study's initial power to enrol 640 pregnant women (320 each group). This was due to funding-related early discontinuation. Eligible women were ≤16 weeks of gestation, planned to deliver at the study center, and had no pre-gestational diabetes. Participants were randomized to receive either myo-inositol supplementation (2 g twice daily) or a placebo until delivery. Data collection included maternal demographics, anthropometric measurements, and pregnancy and neonatal outcomes. The primary outcome was the incidence of GDM diagnosed by oral glucose tolerance test in both groups. Secondary outcomes included pregnancy and neonatal outcomes, along with predictors of insulin resistance (Homeostasis Model Assessment of β-cell function (HOMA B; %) and Homeostatic Model Assessment of Insulin Resistance (HOMA IR; index)). Although the study concluded before reaching target recruitment due to funding challenges, an analysis of the cumulative data was performed. Sixty-seven pregnant women were recruited, and 43 patients completed the study until delivery. There were 18 patients in the myo-inositol group and 25 in the placebo group. No significant difference was observed between the two groups in the incidence of GDM. Additionally, there were no significant differences between the two groups in the measures of insulin resistance (HOMA B or HOMA IR) and maternal and neonatal outcomes. Dividing the study population into those who developed GDM (16 patients) versus those who did not develop GDM (27 patients) revealed significantly higher fasting insulin levels (12.65 ± 7.29 µIU/mL vs 7.37 ± 3.24 µIU/mL, p=0.027) and increased insulin resistance measured by HOMA IR (3.05 ± 1.82 vs 1.54 ± 0.69, p=0.010) in the GDM group compared to the non-GDM group. However, there was no significant difference in HOMA B between the two groups. The GDM group had a lower gestational age at delivery (37.8 ± 3.89 weeks vs 39.21 ± 0.57 weeks, p=0.03) than the non-GDM group. There was no statistically significant difference in the incidence of GDM or the outcomes for mothers and newborns between the myo-inositol and placebo groups in this severely underpowered sample. This study was unable to definitively evaluate the original hypothesis due to the significant recruitment deficit and consequent lack of statistical power. Therefore, the results should be regarded as inconclusive, and we are unable to draw clear conclusions about the effectiveness of myo-inositol supplementation.

Background Mitral stenosis (MS) is a common valvular heart disease that is frequently complicated by arrhythmias, heart failure, pulmonary hypertension, and thromboembolic events. This study aimed to determine the clinical and echocardiographic factors of complications in patients with MS. Methodology This retrospective cross-sectional study was conducted at the Cardiology Department of Northwest General Hospital and Research Centre, Peshawar, including 121 patients diagnosed with MS using echocardiography. Patients of either gender, aged ≥18 years, and diagnosed with MS confirmed by transthoracic echocardiography (either rheumatic or non-rheumatic) with complete clinical and echocardiographic data were included in the study. Complications were assessed at the time of initial hospital evaluation and defined as the presence of one or more disease-related adverse conditions attributable to MS, including atrial fibrillation or other clinically significant arrhythmias, heart failure, pulmonary hypertension, thromboembolic events (ischemic stroke or systemic embolism), left atrial thrombus, and respiratory complications secondary to pulmonary congestion or hypertension. Information regarding demographics, pre-existing comorbid conditions, New York Heart Association (NYHA) functional class, and multiple echocardiographic parameters was recorded. Data were analyzed using SPSS Statistics version 27 (IBM Corp., Armonk, NY, USA). Associations were assessed using chi-square and independent t-tests. Multivariate logistic regression identified independent factors. A p <0.05 was considered significant. Results The mean age was 57.4±16.8 years, with female predominance (63.6%). Diabetes mellitus and hypertension were present in 34.3% and 27.8% patients, respectively. Overall, 38 patients (31.4%) developed complications; arrhythmias (10.7%) and heart failure (9.3%) were most frequent, while stroke occurred in 1.7%. On univariate analysis, female sex (odds ratio (OR) 1.91, p=0.048), diabetes mellitus (OR 2.31, p=0.032), hypertension (OR 2.11, p=0.041), NYHA class III-IV (OR 3.18, p=0.003), severe MS (OR 5.38, p<0.001), pulmonary artery systolic pressure (PASP) >50 mmHg (OR 3.57, p=0.002), and left atrial diameter ≥50 mm (OR 3.44, p = 0.001) were significantly associated with complications. Multivariate analysis identified severe MS (adjusted OR (AOR) 3.58, CI 1.62-7.89, p=0.002), PASP >50 mmHg (AOR 3.12, CI 1.41-6.91, p=0.005), left atrial diameter ≥50 mm (AOR 2.74, CI 1.21-6.20, p=0.016), diabetes mellitus (AOR 2.29, CI 1.03-5.10, p=0.041), and NYHA class III-IV (AOR 2.88, CI 1.29-6.45, p=0.010) as independent factors. Conclusion Complications in MS are driven by both clinical and echocardiographic factors. Integrated assessment may improve risk stratification and guide timely management.

The purpose of this review was to systematically identify, explore, and synthesize findings from primary qualitative studies on adolescents' self-management experiences with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) following participation in a structured diabetes education program.

Systematic searches were conducted in CINAHL, MEDLINE, and PsycINFO without restrictions on publication dates or language. Any qualitative or mixed-methods studies reporting the self-management experience and/or perspectives of adolescents ages 10 to 24 with either T1DM or T2DM following participation in a structured diabetes education program were included. Tools from the Clinical Appraisal Skills Program were used to evaluate study quality, and thematic synthesis was employed to analyze the qualitative data.

Four studies focused on adolescents with T1DM were included, with no studies found addressing the experiences of adolescents with T2DM. Thematic synthesis revealed 6 analytical themes. Three themes related to experiences of T1DM self-management: (1) self-confidence in diabetes self-management, (2) improving diabetes self-management practice, and (3) coping with diabetes; three further themes related to the barriers and facilitators to T1DM self-management: (1) parents' attitude and understanding of the condition, (2) peer support, and (3) communication with health care providers.

Several factors were identified as valuable in helping adolescents with T1DM improve self-management adherence. However, evidence on self-management experiences after participating in a structured diabetes education program for adolescents with T2DM remains limited. There is urgent need for future research to find the best ways to support and empower young people in self-managing their diabetes through tailored education.

Early identification of high-risk fracture populations is clinically vital for comprehensive diabetes management. This study aimed to investigate whether the vertebral bone composition is associated with vertebral fracture risk in patients with type 2 diabetes mellitus (T2DM). This retrospective longitudinal study included 405 T2DM patients (135 with new-onset vertebral fractures and 270 matched controls) from a cohort of 937 individuals with at least two spinal computed tomography (CT) scans between July 2019 and July 2022. Vertebral bodies (T12 level) were segmented on baseline CT images into three regions based on Hounsfield Unit (HU) thresholds: Area A (< 110 HU, low density), Area B (110-160 HU, median density), and Area C (> 160 HU, high density). The areas of these regions and the mean vertebral CT value were measured. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors for vertebral fractures. Predictive models were developed and evaluated using time-dependent receiver operating characteristic (ROC) curves, C-index, calibration, and decision curve analysis. After adjusting for potential confounders, both a smaller Area of C (adjusted Hazard Ratio [aHR] = 0.99 per mm² increase; 95% confidence interval (CI): 0.99-0.99) and a lower vertebral CT value (aHR = 0.99 per HU increase; 95% CI: 0.99-0.99) were independent predictors of vertebral fractures. Patients with a C-area < 308.7 mm² had a 4.32-fold higher fracture risk (95% CI: 2.61-7.32), and those with a vertebral CT value ≤ 100.7 HU had a 1.58-fold higher risk (95% CI: 1.06-2.63). The combined model (C-area + CT value) demonstrated superior predictive performance, with area under the curve (AUC) values of 0.775, 0.796, and 0.822 at 2, 3, and 4 years, respectively, outperforming models based on either variable alone (C-index: 0.751 for combined vs. 0.713 for C-area and 0.659 for CT value). Smaller high-density bone area (Area C) is a significant and independent risk factor for vertebral fractures in T2DM patients. A model combining high-density area and vertebral CT value provides a more robust prediction of fracture risk than traditional bone mass metrics alone, suggesting the potential for improved risk stratification in clinical practice.

Background: Visceral fat plays a central role in cardiometabolic risk among people with type 2 diabetes mellitus (T2DM), yet its assessment in routine clinical practice remains largely dependent on imaging techniques or indirect anthropometric measures. Identifying accessible blood-based markers that reflect visceral adiposity may facilitate improved phenotyping in this population. This study aimed to investigate whether circulating coiled-coil domain-containing protein 3 (CCDC3) reflects visceral fat accumulation in adults with T2DM. Methods: Public RNA-sequencing datasets and human adipose tissue samples were analyzed to identify CCDC3 as a visceral fat-enriched secretory gene. In this cross-sectional study of 160 adults with T2DM undergoing dual-energy X-ray absorptiometry, plasma CCDC3 was measured by ELISA. Associations between plasma CCDC3 and visceral fat area (VFA) were examined using multivariable regression. Logistic regression models for abdominal obesity (VFA ≥ 100 cm²), with and without CCDC3, were evaluated using receiver operating characteristic (ROC) analysis, calibration curves, decision curve analysis (DCA), and Shapley additive explanations (SHAP). Results: Circulating CCDC3 levels were positively associated with VFA (β = 3.11, p < 0.001), independent of demographic and metabolic factors. Incorporating CCDC3 into the baseline model significantly improved discrimination of abdominal obesity (AUC 0.820 vs. 0.663; p = 0.009). Calibration curves and DCA supported better model fit and higher net clinical benefit with CCDC3. SHAP analysis showed that CCDC3 contributed the greatest incremental importance beyond waist circumference, sex, and age. Conclusions: Circulating CCDC3 may serve as a blood-based biomarker reflecting visceral adiposity in adults with T2DM and provides complementary information beyond traditional anthropometric measures.

Background: Ischemic stroke remains the most feared complication of atrial fibrillation (AF), and thromboembolic risk is commonly estimated using clinical scores that may not fully capture the cardiometabolic dimension of cerebrovascular vulnerability. The aim of this research was to assess whether additional parameters can be used, to predict ischemic stroke risk in patients with AF, in order to explore whether TG/HDL-C may complement conventional clinical risk scores for ischemic stroke risk stratification in PAF, and to better characterize a metabolically high-risk phenotype beyond the recommendations provided by the CHA₂DS₂-VA score, which is useful but still far from perfect in predicting AF-associated ischemic stroke risk. Methods: In this retrospective, single-center observational study, we evaluated whether the triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDLc), a simple surrogate of atherogenic dyslipidemia and insulin resistance, is associated with ischemic stroke risk in patients with paroxysmal atrial fibrillation (PAF). We screened 1111 consecutive AF admissions between 1 January 2015 and 31 December 2016 and, from these 1111 AF cases, we extracted only the patients with PAF for analysis. Patients were stratified based on TG/HDLc values into two groups, Group 1 (TG/HDLc > 2.5; n = 155) and Group 2 (TG/HDLc < 2.5; n = 194). Statistical analysis was performed with MedCalc v23.4.0 using Chi-square and unpaired/Welch's t-tests as appropriate, Pearson correlations, Kaplan-Meier analysis with log-rank testing, Cox regression for first ischemic stroke, and multivariable logistic regression to identify independent correlates of TG/HDLc > 2.5. Results: Patients with TG/HDLc > 2.5 had a significantly higher prevalence of ischemic stroke after AF onset compared with those with TG/HDLc < 2.5 (37.4% vs. 21.1%, p = 0.0008), despite similar CHA₂DS₂-VA and HAS-BLED scores, and also exhibited a higher burden of cerebrovascular and neurodegenerative findings, including cortical atrophy and cerebral lacunarism. Ischemic stroke-free survival curves diverged significantly over time (log-rank p = 0.0186), and an elevated TG/HDLc ratio was associated with a 68% higher hazard of first ischemic stroke (HR 1.68; 95% CI 1.09-2.60). In multivariable analysis, type 2 diabetes mellitus (OR 4.53), hyperuricemia (OR 3.83), dyslipidemia (OR 1.94), stroke (OR 1.77), and cortical atrophy (OR 4.48) were independently associated with TG/HDLc > 2.5. Conclusions: These findings suggest that TG/HDLc identifies a metabolically high-risk PAF phenotype associated with greater cerebrovascular burden and reduced ischemic stroke-free survival, providing an inexpensive and broadly available marker that may complement conventional clinical risk scores.

Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder requiring safe, multitarget therapeutic strategies. Marine macroalgae represent an underexplored source of bioactives with pleiotropic metabolic effects. This study investigated the antidiabetic potential of an ultrasound-assisted ethanolic extract of Caulerpa racemosa (UAECr) and its key phytosterol, campesterol, through an integrative framework combining metabolomics, network pharmacology, molecular docking, molecular dynamics simulation, and in vitro validation. Untargeted ultra-high-performance liquid chromatography-high-resolution mass spectrometry (UHPLC-HRMS) metabolomics characterized UAECr constituents, followed by in silico bioactivity prediction, target-network analysis, molecular docking, and 100 ns molecular dynamics simulation of the peroxisome proliferator-activated receptor gamma (PPARγ)-campesterol complex. Functional validation was performed in differentiated 3T3-L1 adipocytes assessing glucose uptake, PPARγ expression, dipeptidyl peptidase 4 (DPP-4) inhibition, and cytotoxicity. Metabolomics identified campesterol as a prominent bioactive. Network pharmacology highlighted PPARγ as a central hub, supported by strong docking affinity of campesterol toward PPARγ (-11.4 kcal/mol) and DPP-4 (-8.3 kcal/mol). Molecular dynamics simulations demonstrated stable PPARγ-campesterol interactions, with preserved protein compactness and low residue fluctuation. In vitro, UAECr and campesterol significantly enhanced glucose uptake (up to 134% vs. control, p < 0.001), upregulated PPARγ expression (4-fold, p < 0.0001), and moderately inhibited DPP-4 activity (p < 0.01) without cytotoxicity. C. racemosa-derived extracts and campesterol exert antidiabetic effects primarily via stable PPARγ-mediated insulin sensitization with complementary DPP-4 modulation, supporting its potential as a marine-derived functional food candidate.