Diabetes mellitus is a rapidly escalating global health concern, often leading to severe complications such as neuropathy, vision impairment, vascular dysfunction, and renal failure. In this work, we present a newly designed hexagonal photonic crystal fiber (HPhCF) sensor for the noninvasive detection of urine glucose, offering a compact, fabrication-friendly design. The proposed HPhCF demonstrates strong RS performance across a range of analyte concentrations. Specifically, RS values of 96.90%, 96.86%, 96.40%, 96.35%, 95.88%, and 95.78% are obtained for concentrations of 0-15 mg·dL^-1, 0.625 g·dL^-1, 1.25 g·dL^-1, 2.5 g·dL^-1, 5 g·dL^-1, and 10 g·dL^-1, respectively. These results indicate a gradual decline in sensitivity with increasing analyte concentration, while overall maintaining consistently high performance. Because of its simple structural configuration and compatibility with established photonic fabrication methods, the proposed sensor demonstrates strong potential as a low-cost and highly sensitive diagnostic tool for early-stage diabetes screening and ongoing glucose monitoring in biomedical settings.

Cost analysis of autonomous artificial intelligence (AI)-based screening of diabetic retinopathy (DR) for adults with diabetes at a primary care clinic.

This study provides a comparative cost analysis of actual results using AI-based DR screening with counterfactual results based on all patients going through the physician-based referral system. A cost analysis is conducted using cost data from published sources, provincial billing codes, statistical sources, and patient characteristics from a clinical study to compare autonomous AI-based screening for DR versus physician-based screening. Costs considered include direct costs of operating the AI system, physician fees, and indirect costs to patient time. Along with total cost comparisons, a cost per DR case detected is estimated and a sensitivity analysis based on variations in AI costs is provided.

Over the study period, 202 participants were screened for DR using autonomous AI. The majority (93.6%, n=189) of AI-based DR screening exams were completed successfully. The AI-based scenario results in total direct costs of $C7919.04 and indirect costs of $C5728.80, resulting in total costs of $C13 647.84 per 100 patients. The traditional physician-based approach results in total direct costs of $C8240 and indirect costs of $C19 998.09, resulting in total costs of $C28 238.09 for 100 patients. When costs are converted to costs per unit outcome, the total cost per diagnosed DR case is $C620.36 for the AI-based approach and $C1283.55 for the physician-based approach; the AI-based cost per diagnosed case was 52% lower.

Given the lower cost per diagnosed case of the AI-based approach, there are advantages to the implementation of AI-based screening for DR.

Self-management behaviours are crucial for glycaemic control in type 2 diabetes mellitus (T2DM) but adherence is often poor. Most studies treat diabetes self-management (DSM) behaviours as a single construct, ignoring variations in behavioural patterns and their metabolic impacts.

This study aims to identify distinct DSM behaviour profiles in T2DM patients, explore associated factors, and compare their metabolic outcomes.

A multicentre cross-sectional study.

The study was conducted from March to September 2024 at four tertiary care hospitals.

A total of 304 patients diagnosed with T2DM were included.

The primary outcomes were DSM behaviours, self-efficacy, habit strength and metabolic indicators (glycated haemoglobin (HbA1c), fasting blood glucose, lipid profile, blood pressure and body mass index). Latent profile analysis was used to identify distinct DSM behaviour profiles. Univariate analyses (χ² test or Fisher's exact test, as appropriate) were performed to identify factors associated with profile membership, followed by multinomial logistic regression analysis. Analysis of variance with post hoc tests was used to compare metabolic indicators across profiles.

Three distinct profiles were identified: low-engagement (14.0%), moderate-engagement (12.0%) and high-engagement behaviours (74.0%). These profiles were significantly associated with self-efficacy, personal monthly income, medication duration and diabetes-related complications (all p<0.05). Compared with the high-engagement profile, the moderate-engagement profile had significantly higher HbA1c, fasting blood glucose and total cholesterol, with the lowest high-density lipoprotein cholesterol levels, whereas the low-engagement profile showed higher fasting blood glucose, low-density lipoprotein cholesterol, total cholesterol and systolic blood pressure (all p<0.05).

Distinct DSM behaviour profiles exist among patients with T2DM and are influenced by psychosocial and clinical factors. The high-engagement behaviour profile was associated with more favourable glycaemic and lipid control, whereas the low- and moderate-engagement behaviour profiles were linked to poorer metabolic outcomes. These findings highlight the need for tailored interventions targeting behaviour-specific profiles to optimise metabolic management in T2DM.

To evaluate the feasibility of a 12-week, randomized, double-blind, placebo-controlled intervention with capsules containing green coffee extract enriched with magnesium di-malate in women with type 2 diabetes mellitus, including overall adherence to capsule use and tolerability, as well as to explore preliminary between-group differences in glycemic and cardiovascular biomarkers.

This randomized, double-blind, placebo-controlled pilot trial included 48 eligible women with type 2 diabetes mellitus, equally assigned to the placebo group (n=24) or the experimental group (n=24). Participants received capsules daily for 12 weeks and were followed up through nursing consultations. Overall retention was 83.3% (40/48), and overall adherence to capsule use was estimated at over 82%. Glycemic biomarkers included fasting glucose, estimated mean glucose, HbA1c, insulin, HOMA-IR, and HOMA-β. Cardiovascular biomarkers included urea, creatinine, uric acid, apolipoprotein B, triglycerides, and the triglycerides-glucose index. Data were analyzed based on avail-able data from participants who completed follow-up and the final evaluation.

The protocol was feasible under the study conditions, although retention differed between groups. Glycemic biomarkers varied during follow-up in both groups, without conclusive evidence of a consistent between-group effect. In the experimental group, triglycerides and the triglycerides-glucose index showed numerical reductions, while uric acid fluctuated in both groups. These findings should be interpreted as exploratory.

This pilot trial provided preliminary information on the feasibility of implementing this intervention in women with type 2 diabetes mellitus. The biomarker findings were exploratory and imprecise and do not allow for definitive conclusions on efficacy.

IntroductionABO groups impact macroangiopathy risk in T2D. It is unknown whether such modulation extends to microvascular complications.MethodSingle-centre cross-sectional study including 1,006 T2D patients.ResultsPrevalence of overall microangiopathy was 51%. No significant differences (ANOVA) were observed between ABO groups in terms of age, sex, diabetes duration, BMI, hypertension, chronic kidney disease or diabetic foot. Insulin sensitivity and the hyperbolic HOMA product [BxS] were lower among non-O groups (-20% and -14%, respectively; p 0.001 and 0.013), while HbA1c and lifetime hyperglycaemia exposure were higher (+5% and +25%, respectively; p 0.006 and 0.002). Overall microangiopathy was more prevalent among non-O patients (+23%; p 0.001), as was neuropathy (+44%; p 0.005). Differences across ABO groups were significant for overall microangiopathy (p 0.009) and neuropathy (p 0.027) (ANOVA). In multivariate analysis, group A (vs O) was associated with overall microangiopathy (OR=1.62; 95%CI: 1.18-2.22; p 0.003) after adjustment for diabetes duration, HbA1c, smoking, remnant-C and hypertension.ConclusionT2D patients of blood group A have increased frequency of overall microangiopathy, regardless of other risk factors. Group O subjects exhibit better glucose homeostasis, with better insulin sensitivity and β-cell function. The ABO system therefore impacts both glucose homeostasis and microvascular susceptibility in T2D.

PurposeTo investigate the longitudinal association between domestic water hardness and incident diabetic retinopathy (DR) in individuals with type 2 diabetes (T2D) and identify circulating proteomic mediators.MethodsThis study analysed data from 13,194 participants with prevalent T2D. Domestic water hardness was determined according to residential postcodes. Weighted Cox proportional hazards models and mediation analyses were employed to evaluate associations between water hardness, proteins, and DR risk.ResultsDuring a median follow-up of 13.28 years, 1,505 cases of incident DR were documented. Compared with soft water (<60 mg/L), very hard water (>180 mg/L) was associated with a 49% higher risk of DR (HR, 1.49; 95% CI, 1.12-2.00). The plasma protein GID8 (Glucose-induced degradation protein 8) was identified as a mediator, explaining 6.2% (95% CI, 1.2%-25.5%) of the association.ConclusionThese findings provide some preliminary proteomic insights that domestic hard water may be a novel, modifiable environmental risk factor for DR, potentially mediated through GID8-related pathways. Future research should include mechanistic studies to confirm the biological pathways linking domestic water hardness to diabetic retinopathy.

Medication non-adherence among chronic disease patients remains a major contributor to poor health outcomes and medication wastage, particularly in multi-ethnic populations such as Malaysia where cultural and religious beliefs strongly influence health behaviours. This study aimed to develop and evaluate machine learning models that integrate demographic, clinical, and complementary and alternative medicine (CAM) belief factors to predict medication non-adherence among patients with type 2 diabetes mellitus, hypertension, and dyslipidaemia. A cross-sectional survey was conducted using a structured questionnaire comprising demographic and clinical data, history of CAM use, the 17-item Complementary and Alternative Medicine Beliefs Inventory (CAMBI), and the Malaysian Medication Adherence Scale (MALMAS). Twelve conventional machine learning algorithms and three stacked ensemble models were utilised using both balanced and unbalanced datasets with all variables as well as feature-selected variables. The best-performing model was a stacked ensemble using logistic regression-selected variables with the unbalanced dataset, achieving the highest AUC of 0.816. Feature selection identified significant variables including CAM beliefs (natural and holistic), race, number of daily doses, number of medications prescribed, religion, educational level, treatment duration, and hypertension status which were later interpreted using SHapley Additive exPlanations (SHAP) analysis. Model performance was further evaluated using the Youden Index and Decision Curve Analysis (DCA) to stratify patients into lower- and higher-risk groups, with a suitable cutoff identified at 0.4. These findings show that incorporating cultural and belief-related factors into machine learning models provides a novel, population-specific approach to predict better non-adherence and guide targeted interventions to reduce medication wastage in chronic disease management.

Patients with diabetes mellitus undergoing coronary artery bypass grafting (CABG) with saphenous vein harvesting are at increased risk of impaired lower extremity perfusion and wound-related complications. Buerger-Allen exercises have been proposed to improve peripheral circulation; however, evidence supporting their effectiveness following CABG remains limited. This study evaluated the effect of Buerger-Allen exercises as an adjunct to phase I cardiac rehabilitation on lower extremity perfusion and wound healing in diabetic patients undergoing CABG.

A randomized controlled trial was conducted involving 60 diabetic patients undergoing CABG with saphenous vein harvesting. Participants were randomly allocated to an intervention group receiving standard phase I cardiac rehabilitation plus Buerger-Allen exercises (n = 30) or a control group receiving standard rehabilitation alone (n = 30). The primary outcome was ankle-brachial index (ABI). Secondary outcomes included wound healing disturbances and peripheral ankle swelling. Postoperative ABI was analyzed using two-way repeated-measures ANOVA, whereas categorical outcomes were analyzed using Fisher's exact test or the Chi-squared test.

A significant effect of time on ABI was observed (p = 0.004), whereas neither the group effect (p = 0.754) nor the group × time interaction (p = 0.711) was statistically significant. An earlier resolution of mild wound-related pain was observed on postoperative day 3 in the intervention group (p = 0.038); however, no between-group differences were present on postoperative day 5. No intervention-related adverse events were reported.

Buerger-Allen exercises were safe and feasible during early postoperative rehabilitation but did not provide additional improvement in lower extremity perfusion beyond standard rehabilitation during the 5-day postoperative period. The isolated improvement in wound-related pain should be interpreted cautiously.

Buerger-Allen exercises did not significantly improve the primary outcome of lower extremity perfusion following CABG. Although they appeared safe and were associated with transient improvement in wound-related pain, further adequately powered studies with longer follow-up are required to determine whether clinically meaningful benefits exist.

This study was prospectively registered in the Clinical Trial Registry India (CTRI/2023/10/058535).

Thirst and xerostomia are common symptoms in patients with chronic heart failure (CHF) and can be very distressing. Studies on the prevalence and associating factors of these symptoms are lacking in patients with CHF in Germany. The aim of the study was to assess the prevalence of thirst and xerostomia, to determine factors associated with thirst and xerostomia intensity, and to identify interventions that patients use to reduce these symptoms.

A cross-sectional study was conducted in seven hospitals. Participants completed a questionnaire on thirst and xerostomia and on interventions they performed themselves. Additionally, they were asked about possible associated factors (e.g., fluid restriction, other symptoms, alcohol intake). Prevalence of thirst and xerostomia was estimated with percentages and a 95% confidence interval. A multiple linear regression analysis was conducted to assess factors associated with the intensity of thirst and xerostomia. Interventions used by patients to alleviate thirst or xerostomia were content-analyzed.

Of 371 patients with CHF (71.7% male, mean age 62.4 ± 14.9 years), 78.7% reported thirst and 64.8% xerostomia in the last three days. Statistically significant factors associated with thirst intensity were thirst distress and body height. Fluid restriction, thirst in the last three days, leg oedema, and drug-treated diabetes mellitus were associated with xerostomia intensity. The most frequently reported intervention to reduce thirst or xerostomia was fluid intake (thirst: 95.1%; xerostomia: 86.2%).

A high proportion of patients with CHF reported thirst and/or xerostomia. Factors were identified that could have an influence on the occurrence of these symptoms.

Sex differences in the outcomes of bifurcation percutaneous coronary intervention (PCI) have received limited study. We compared procedural characteristics and outcomes between women and men in bifurcation PCI. 2,431 patients who underwent bifurcation PCI at 7 centers between 2013 and 2025 from the Prospective Global Registry for the Study of Bifurcation Lesion Interventions (PROGRESS-BIFURCATION) were studied. Of the study population, 25.3% (n=615) were women. Women were older (68.2 ± 11.9 vs 65.6 ± 16.3 years; p<0.001), had higher prevalence of diabetes mellitus (48.8% vs 33.5%; p<0.001), hypertension (84.2% vs 76.9%; p<0.001), and higher rates of moderate or severe proximal main vessel calcification (40.2% vs 32.4%; p<0.001) compared with men. Use of provisional stenting (63.2% vs 64.0%, p=0.694) and two-stent techniques (31.3% vs 30.3%, p=0.653) was similar between groups. Technical success was comparable (93.7% vs 95.4%; p=0.075), but women had lower procedural success (88.5% vs 93.2%; p<0.001) due to higher in-hospital major adverse cardiovascular events (MACE) (6.0% vs 2.7%; p<0.001), including in-hospital mortality (2.8% vs 1.0%; p=0.001), stroke (1.3% vs 0.2%; p=0.003), and procedural bleeding (1.0% vs 0.2%; p=0.010). On multivariable analysis, female sex was independently associated with higher in-hospital MACE (odds ratio 2.99; 95% confidence intervals [CI] 1.69-5.29; p<0.001). During a median follow-up of 2.6 years, female sex was independently associated with long-term MACE (adjusted hazard ratio 1.32; 95% CI 1.04-1.67; p=0.011). In conclusion, compared with men, bifurcation PCI in women is associated with similar technical success but higher in-hospital and follow-up MACE.