Type 3c diabetes is a heterogeneous secondary diabetes caused by pancreatic disease, injury or resection. Glycaemic outcomes alone do not capture the combined effects of insulin deficiency, impaired counter-regulation, exocrine insufficiency, pain, altered nutrition and treatment burden. We mapped standardized patient-reported outcome measures (PROMs) across aetiologies and pancreatic resection extent.

MEDLINE via PubMed, Scopus and Web of Science Core Collection were searched from inception to 23-24 July 2026, supplemented by public trial registries and targeted citation checking. A scoping review framed by Population-Concept-Context followed JBI guidance and PRISMA-ScR. An automation-assisted title/abstract pathway was followed by independent report-level adjudication by two reviewers.

The searches yielded 5,132 records and 3,372 unique database records after deduplication. Fifty-six reports underwent independent report-level adjudication; one was not retrieved, 15 were excluded and 40 were included. In a reproducible post hoc random validation sample of 200 of 3,321 early exclusions, exact and binary reviewer agreement were 100% (Cohen's kappa = 1.00); three records marked unclear by both reviewers were excluded after targeted adjudication, leaving no eligible record in the sample (0/200; Wilson 95% confidence interval 0-1.88%). Twenty-six included reports concerned pancreatic resection or an insulin-treated TPIAT subgroup, 11 cystic-fibrosis-related diabetes, two diabetes secondary to chronic pancreatitis and one fibrocalculous pancreatic diabetes. Generic health and physical function were often impaired after total pancreatectomy, whereas some comparator studies reported similar PAID, ADDQoL or treatment-satisfaction results to type 1 or other insulin-treated diabetes. No report used SARC-F. Only six reports were available to the authors in full text; the favorable technology signals depended on abstract-based reports and were therefore hypothesis-generating.

Patient-reported burden in type 3c diabetes is multidimensional and measurement remains fragmented. Future studies should combine complementary measures and report aetiology, diabetes timing and total versus partial resection explicitly.

Difficult-to-treat resistant Pseudomonas aeruginosa (DTR-PA) represents the most severe antimicrobial resistance phenotype of P. aeruginosa, with limited therapeutic options and poor clinical outcomes. However, previous studies have largely focused on carbapenem-resistant P. aeruginosa (CRPA), and the factors associated with resistance acquisition and progression remain insufficiently characterized. This study aimed to investigate the clinical characteristics and risk factors associated with different resistance phenotypes of P. aeruginosa from the perspectives of both resistance acquisition and resistance escalation.

A retrospective case-control study was conducted from January 2020 to December 2025 at a tertiary teaching hospital. P. aeruginosa isolates were classified according to antimicrobial susceptibility profiles. All DTR-PA cases (n = 67) were included, and CRPA and carbapenem-susceptible P. aeruginosa (CSPA) controls were selected using a time-stratified 1:2:2 sampling strategy. Clinical data were collected, and three comparative models were developed to explore determinants of resistance acquisition and resistance escalation across different P. aeruginosa phenotypes: resistant P. aeruginosa (R-PA, defined as CRPA and DTR-PA) versus CSPA, DTR-PA versus CRPA, and DTR-PA versus non-DTR-PA.

During the study period, 2,692 P. aeruginosa clinical isolates were included for analysis, including 67 (2.5%) DTR-PA, 407 (15.1%) CRPA, and 2,218 (82.4%) CSPA. A total of 335 patients were included in the risk factor analysis. With increasing antimicrobial resistance severity, inflammatory markers showed a stepwise increase, whereas nutritional status, as reflected by serum albumin levels, demonstrated a progressive decline. In the R-PA versus CSPA model, invasive respiratory procedures, prolonged hospitalization, and polymicrobial co-infection were associated with increased risk, whereas higher BMI and serum albumin levels showed modest inverse associations with resistant P. aeruginosa infection. In the DTR-PA versus CRPA model, diabetes mellitus, chronic respiratory diseases, and recent ICU admission were associated with DTR-PA infection. In the DTR-PA versus non-DTR-PA model, prior antibiotic exposure, central venous catheterization, and invasive procedures were associated with DTR-PA infection.

Antimicrobial resistance in P. aeruginosa follows a dynamic, stage-dependent process with distinct risk profiles. Healthcare exposure primarily contributes to resistance emergence, whereas host comorbidities and intensive care exposure are more closely associated with progression to DTR-PA. This resistance gradient framework may support early identification, risk stratification, and infection control strategies.

Penile prosthesis implantation is the gold-standard treatment for men with erectile dysfunction refractory to conservative therapies. Surgical implantation may become technically challenging in patients with significant musculoskeletal deformities because altered pelvic anatomy can affect patient positioning and corporal access. We report the case of a 50-year-old man with type 2 diabetes mellitus and post-polio residual paralysis associated with fixed pelvic deformity who presented with severe erectile dysfunction refractory to phosphodiesterase type 5 inhibitors, low-intensity extracorporeal shockwave therapy, and intracavernosal injections. A Shah malleable penile prosthesis was successfully implanted through a penoscrotal approach despite difficulties related to pelvic tilt and altered corporal orientation. Careful patient positioning, meticulous corporal dilatation, and intraoperative modification of the surgical technique enabled successful implantation without complications. The postoperative course was uneventful, and at four weeks, the patient demonstrated satisfactory wound healing without evidence of infection, erosion, or device-related complications and reported satisfaction with the early surgical outcome. This case highlights the technical considerations required during penile prosthesis implantation in patients with post-polio musculoskeletal deformities and emphasizes that successful outcomes can be achieved with appropriate preoperative planning, careful surgical technique, and individualized perioperative management.

To determine whether retinal optical coherence tomography angiography (OCTA) parameters are associated with subsequent worsening kidney function (WKF) in patients with type 2 diabetes (T2D) and to assess their relationship with early renal function trajectory.

In this prospective cohort study, 180 patients with T2D underwent macular OCTA imaging and were followed for renal outcomes (median follow-up, 37 months). Cross-sectional associations between OCTA parameters and systemic biomarkers were examined. Multivariable Cox models adjusted for age, sex, diabetes duration, HbA1c, HDL-c, and baseline estimated glomerular filtration rate (eGFR) evaluated associations with WKF. eGFR slope over the first 12 months was estimated using linear mixed-effects models in 141 participants. Sensitivity analyses further evaluated image quality distributions, ocular comorbidities, single-eye selection, and additional adjustments for baseline renal/hemodynamic parameters. Exploratory mediation analysis assessed whether early eGFR slope accounted for OCTA-outcome associations.

Forty-two participants (23%) developed WKF. Several OCTA parameters correlated with systemic and renal biomarkers in unadjusted analyses but were not significant after multivariable adjustment. In primary adjusted Cox models, nasal inner-ring superficial vessel density (NI-SVD) was independently associated with WKF (HR, 1.10 per 1% increase; 95% CI, 1.02-1.19; p=0.013). Early eGFR slope (-1.53 ± 1.38 mL/min/1.73 m²/year) was strongly associated with WKF (HR, 0.70; 95% CI, 0.54-0.89; p=0.004). NI-SVD remained significant after adjustment for early eGFR slope (HR, 1.11; 95% CI, 1.02-1.21; p=0.021). Sensitivity analyses indicated that the association between NI-SVD and WKF remained consistent with the primary analysis. Mediation analysis did not demonstrate a statistically significant indirect effect (indirect HR = 1.02, 95% CI: 0.996-1.050).

NI-SVD, a parafoveal OCTA metric was independently associated with WKF in T2D. This association was not explained by early renal functional decline, suggesting that retinal microvascular alterations are independently linked to long-term renal prognosis in T2D.

Attention-deficit/hyperactivity disorder (ADHD) has been linked to elevated risk of type 2 diabetes (T2D). However, the impact of ADHD and ADHD medication use on prognosis and health outcomes in T2D remains unclear. This study investigates the associations of (1) ADHD and (2) ADHD medication use with rates of major adverse cardiac events (MACE) and all-cause mortality after a T2D diagnosis.

This multinational cohort study used population-based data from Australia, Denmark, the Netherlands, Norway, Sweden, the United Kingdom, and the United States. Using a standardized analytical protocol, we identified adults with a first recorded T2D diagnosis during 2010-2020. Exposures were (1) ADHD, defined by a recorded ADHD diagnosis or ADHD medication dispensation, and (2) among adults with ADHD, the use of ADHD medication, both analysed as time-varying exposures. Main outcomes were MACE (acute myocardial infarction, stroke, or cardiovascular disease-related death) and all-cause mortality after T2D diagnosis. Cause-specific Cox models estimated hazard ratios (HRs) with 95% confidence intervals (CIs); results were pooled using random-effects meta-analyses and stratified by age and sex.

The cohort included 1,929,027 adults with T2D (909,176 [47.1%] males). In pooled analyses, adults with T2D and ADHD had a higher rate of all-cause mortality (HR, 2.42; 95% CI, 1.72-3.41), but not MACE (HR, 1.04; 95% CI, 0.81-1.35), after a T2D diagnosis compared with those without ADHD. Among adults with T2D and ADHD, ADHD medication use was associated with higher rate of MACE in those diagnosed with T2D before age 45 years (HR, 1.58; 95% CI, 1.18-2.10). These associations remained consistent, after adjusting for sex, age, calendar year at T2D diagnosis, psychiatric history, other psychotropic medication use, and cardiometabolic medication use.

Adults with T2D and co-occurring ADHD were found to have increased risk of all-cause mortality after T2D diagnosis, while ADHD was not consistently associated with MACE across countries. ADHD medication use was linked to higher rate of MACE in adults with early-onset T2D. These findings suggest the potential need for integrated somatic-psychiatric care and careful consideration of ADHD medication use that may help reduce MACE and mortality, particularly in younger-onset T2D.

Hypercortisolism and type 2 diabetes mellitus (T2D) independently contribute to an increased burden of cardiometabolic morbidity and mortality. However, data on the interaction of hypercortisolism and T2D are scarce-thus, we aimed to assess the cortisol-associated morbidity and mortality in the context of T2D and adrenal mild autonomous cortisol secretion (MACS).

This is a retrospective cohort study including 668 patients with adrenal adenomas, who were visiting the endocrine outpatient clinic at the Vienna General Hospital between 01.01.2000 to 31.12.2022. Of those, 151 were diagnosed with T2D at the time of their 1 mg dexamethasone suppression test (DST), other diabetes types were excluded. MACS was defined as a post 1 mg DST cortisol of > 1.8 µg/dL in the absence of Cushing's stigmata and after biochemical exclusion of ACTH-dependency. The database was linked to the governmental death registry and patients alive after 01.12.2024 were censored. Kaplan Meier curves and cox proportional hazard models were analyzed via RStudio.

Patients with T2D had a higher post 1 mg DST cortisol level and were more often diagnosed with hypertension, dyslipidemia and cardiovascular disease (CVD) compared to those without T2D. Compared to patients with non-functioning adrenal adenomas (NFAA) without T2D, MACS was strongly linked to increased mortality only in T2D (HR 2.51 [CI95% 1.41-4.48], p < 0.01) but not in those without T2D, even after adjustment for age, sex, BMI, smoking, hypertension, dyslipidemia and CVD at baseline. The T2D cohort with MACS had higher HbA1c and a 3-fold elevation in CVD prevalence compared to those without hypercortisolism. They did not differ according to age, sex or other cardiometabolic risk parameters (dyslipidemia, hypertension, BMI).

Among patients with adrenal adenomas, MACS is related to increased CVD prevalence and is associated with mortality in patients with T2D. These findings highlight the need for confirmatory prospective studies incorporating larger sample sizes to further assess the importance of earlier identification and treatment of MACS in patients with T2D.

Chronic kidney disease-associated pruritus (CKD-aP) is a common and burdensome complication in patients undergoing maintenance hemodialysis (MHD). However, reported prevalence and associated factors remain inconsistent across studies.

In accordance with PRISMA 2020 guidelines, we systematically searched eight electronic databases from inception to March 11, 2026 for observational studies reporting prevalence and/or associated factors of pruritus in adult MHD patients. Only multivariable-adjusted odds ratios were included in analyses of associated factors. Continuous and dichotomised estimates were analysed separately, and sensitivity analyses restricted to high-quality studies were performed where feasible.

A total of 25 studies involving 8,955 participants were included. The pooled prevalence of any pruritus among MHD patients was 60.0% (95% CI: 57.0-63.0%). Serum phosphorus was positively associated with pruritus in both continuous (OR = 2.03, 95% CI: 1.44-2.87) and dichotomised analyses (OR = 2.93, 95% CI: 1.83-4.69), although substantial heterogeneity remained in the continuous analysis. Associations for PTH/iPTH, CRP, β₂-microglobulin, dialysis vintage, and age varied according to variable definition and/or study quality. Diabetes mellitus was associated with higher odds of pruritus (OR = 2.64, 95% CI: 1.69-4.14), whereas high-flux hemodialysis showed an inverse association (OR = 0.31, 95% CI: 0.17-0.56). Exploratory meta-regression among continuous phosphorus studies suggested regional variation (P = 0.002), with a stronger association in Asian than non-Asian studies; however, only two non-Asian studies were available.

Approximately 60% of patients undergoing MHD experience pruritus. Serum phosphorus showed the most consistent association with CKD-aP, whereas estimates for several other factors varied according to variable definition, methodological quality, and between-study heterogeneity. The observed regional variation in the phosphorus-pruritus association should be regarded as hypothesis-generating. Standardised exposure definitions and prospective studies are needed to clarify these associations.

This study was registered in the PROSPERO platform (CRD420261337554).

Not applicable.

This systematic review and meta-analysis explored lipid alterations associated with tuberculosis-diabetes comorbidity. We quantitatively synthesised the lipid parameters, comparing high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and total cholesterol among patients with TB-DM comorbidity, TB-only, and DM-only.

Following PRISMA guidelines and a registered protocol (PROSPERO: CRD420261355915), we searched PubMed (n = 150), Scopus (n = 679), and Google Scholar (n = 70) through April 7, 2026. Observational studies reporting lipid parameters were included. Methodological quality was appraised using the Newcastle-Ottawa Scale, and certainty of evidence was evaluated using GRADE. Pooled mean differences and pooled means were estimated using random-effects models, with between-study variance estimated by REML and Hartung-Knapp-adjusted confidence intervals. Heterogeneity was quantified using the I² statistic and τ², and 95% prediction intervals were also calculated.

Nine studies comprising 1,494 participants were included. Compared to the TB-only group, patients with TB-DM exhibited higher concentrations of LDL-C (MD = 14.99 mg/dL; 95% CI: 1.28-28.71), TG (MD = 30.13 mg/dL; 95% CI: 17.58-42.67), and TC (MD = 17.29 mg/dL; 95% CI: 5.42-29.16), while HDL-C showed no significant difference (MD = -1.15 mg/dL; 95% CI: -5.07-2.77). A principal sensitivity analysis showed that TG elevation remained robust, whereas LDL-C and TC findings lost statistical significance. In the secondary comparison, TB-DM patients exhibited significantly lower concentrations across all four lipid parameters relative to the DM-only group. Heterogeneity was substantial for the primary comparison (I² >70%) but ranged from 1% to 67% in the secondary comparison. Exploratory subgroup analyses showed statistical differences for LDL-C, TC, and TG, whereas no subgroup difference was found for confounder adjustment, geographic region, or study design. The overall certainty of evidence was rated as very low across all outcomes.

The findings suggest that TB-DM may be associated with a higher TG concentration compared to patients with TB alone. Significant associations with LDL-C and TC were also observed but were not robust to sensitivity analyses, while no significant difference was found for HDL-C. Conversely, TB-DM may be associated with a relative reduction in HDL-C, LDL-C, TG, and TC compared to DM-only.

This retrospective study aimed to evaluate the MRI-based volumetric and histogram characteristics of the parotid and submandibular salivary glands in patients with type 2 diabetes mellitus (T2DM) compared with control participants, and to investigate potential correlations between gland volumes, HbA1c levels, and disease duration.

Following approval from the Harran University Clinical Research Ethics Committee, magnetic resonance (MR) images of 30 patients with T2DM and 30 control participants were retrospectively analyzed. Salivary gland volumes were measured, and demographic data, HbA1c values, and diabetes duration were recorded for the T2DM group. In addition, histogram analysis was performed on T1-weighted MR images using standardized regions of interest to calculate mean grayscale values, skewness, and kurtosis parameters. Statistical analyses were conducted to compare gland volumes between groups and to assess correlations with clinical parameters.

There were no statistically significant differences in the volumes of the parotid and submandibular glands between the T2DM and control groups (p > 0.05). Additionally, no significant correlations were found between gland volumes and HbA1c levels or disease duration within the diabetic group. Patients with T2DM demonstrated significantly lower mean grayscale values across all major salivary glands compared with controls (all p < 0.01), whereas skewness and kurtosis values remained comparable between groups (all p > 0.05).

The findings suggest that T2DM was not associated with significant volumetric differences in the major salivary glands in this study population. However, significantly lower mean T1-weighted grayscale values were observed in patients with T2DM, whereas skewness and kurtosis remained comparable between groups. These signal-intensity differences should be regarded as exploratory imaging findings rather than direct evidence of specific microstructural alterations, and their functional and clinical significance remains uncertain. Further studies incorporating quantitative MRI techniques and functional correlation are needed to clarify their biological and clinical relevance.

Noninvasive differentiation of diabetic kidney disease (DKD) from non-diabetic kidney disease (NDKD) in patients with type 2 diabetes mellitus (T2DM) remains challenging, as conventional clinical markers and ultrasound imaging lack sufficient accuracy and reliability. This limitation often leads to unnecessary renal biopsies or delayed diagnosis. To address this gap, this study aimed to develop and validate a machine learning model integrating renal ultrasound radiomic features and clinical predictors to distinguish DKD from NDKD in T2DM patients.

Patients with T2DM who underwent renal biopsy were retrospectively enrolled from three centers. Based on biopsy findings, patients were classified as DKD or NDKD, with overlapping lesions assigned to DKD. Renal ultrasound images were collected for ROI delineation and radiomic feature extraction. Clinical predictors were selected using logistic regression, correlation analysis, and LASSO. SVM, KNN, RF, and XGBoost models were developed using radiomic features alone or combined with clinical variables. Performance was evaluated by AUC, accuracy, precision, recall, and F1-score, and SHAP was used for model interpretation.

Univariate analysis identified serum creatinine, eGFR, albumin and LDL‑C as significant variables, and eGFR was selected as the final clinical predictor after LASSO and multivariable logistic regression. The radiomics‑only model performed well in the training cohort but showed lower performance in the validation cohorts. The integrated model combining radiomic features with eGFR achieved AUCs of 0.991, 0.895 and 0.721 in the training, internal validation and external validation cohorts, respectively, with corresponding F1‑scores of 0.939, 0.815 and 0.714. DeLong's test further showed that XGBoost performed better than several comparator algorithms in the training and internal validation cohorts, whereas no significant differences were observed among models in the external validation cohort.

The XGBoost model integrating renal ultrasound radiomic features with eGFR showed favourable performance for differentiating DKD from NDKD in patients with T2DM. By using routinely available ultrasound images and a readily accessible clinical indicator, this model may serve as a non-invasive auxiliary tool for preliminary screening in primary-level hospitals or nephrology departments, providing supportive evidence for individualized assessment and renal biopsy decision-making.