Objective: We aimed to quantify the prognostic value of glucose monitoring-derived time in range (TIR), including continuous glucose monitoring (CGM), flash glucose monitoring (FGM), and fingertip capillary glucose monitoring (FCGM), for predicting adverse clinical outcomes in patients with type 2 diabetes mellitus (T2DM). Research Design and Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL, via OVID) were systematically searched from 2017 to November 2025 for studies evaluating the risk of all clinically relevant outcomes associated with different TIRs in T2DM. Extracted data were standardized to evaluate the effect of a 10% increment in TIR. Pooled estimates were calculated using inverse-variance random-effects models incorporating dose-response analysis. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Results: Twenty-four observational studies involving 20 distinct associations and 35,916 participants were included. Dose-response meta-analyses were conducted for nine associations. The results showed that each 10% increment in TIR was significantly associated with a reduced risk of multiple adverse complications, including all-cause mortality (odd ratio [OR] = 0.88, 95% confidence interval [CI]: 0.82-0.93), vision-threatening diabetic retinopathy (OR = 0.93, 95% CI: 0.87-0.98), diabetic retinopathy (OR = 0.92, 95% CI: 0.89-0.95), lower extremity atherosclerotic disease (OR = 0.86, 95% CI: 0.82-0.91), diabetic peripheral neuropathy (OR = 0.77, 95% CI: 0.71-0.84), and cardiovascular autonomic neuropathy (OR = 0.81, 95% CI: 0.68-0.97). In contrast, the associations for albuminuria (KDIGO [Kidney Disease: Improving Global Outcomes] A2 and A3) and amputation did not reach statistical significance in the primary meta-analysis. Conclusions: In conclusion, each 10% increment in TIR is consistently associated with a reduced risk of mortality and various micro- and macrovascular complications in T2DM. These findings suggest TIR as a robust prognostic indicator and actionable therapeutic target in diabetes management.

Background: Cardiovascular disease (CVD) remains the leading cause of mortality across the European Union (EU), with a fourfold to fivefold east-west gradient in standardized circulatory-disease mortality. Romania ranks second highest in the EU (787 per 100,000 inhabitants in 2023). Primary-prevention practice is organized around two quantitative frameworks-the 2021 European Society of Cardiology (ESC) SCORE2/SCORE2-OP system and the 2018/2019 American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Equations (PCE)-which converge on therapy but diverge on patient selection. Methods: We conducted a structured narrative review (SANRA-compliant) of contemporary primary-prevention guidelines, validation studies, key trials of risk-modifier interventions, and Romanian epidemiological data through April 2026. On this basis, we developed ROMA-CV (Risk Of Multifactorial Atherosclerosis-CardioVascular) as a conceptual, country-specific risk-stratification framework anchored to existing Class I/IIa recommendations or Level A/B evidence, rather than as a fully developed, ready-to-use clinical tool Results: Four structural limitations of SCORE2 are clinically consequential in Romania: (i) an age floor of 40 years that excludes the population in which premature myocardial infarction is most preventable; (ii) a country-level calibration coefficient applied to individuals; (iii) permissive treatment of lipoprotein(a) [Lp(a)]; and (iv) an under-emphasis of subclinical-atherosclerosis imaging. We propose ROMA-CV (Risk Of Multifactorial Atherosclerosis-Cardiovascular), a four-step algorithm retaining SCORE2 as the quantitative spine while embedding once-in-a-lifetime Lp(a) measurement, a mandatory amplifier checklist, and selective coronary artery calcium (CAC) or carotid/femoral ultrasound imaging. Conclusions: ROMA-CV is a hypothesis-generating proposal that operationalizes existing evidence-based recommendations into a deterministic Romanian pathway aligned with the 2025-2030 Romanian National Plan for Non-Communicable Diseases and the EU Cardiovascular Health Plan. The algorithm is not a validated clinical decision tool and requires prospective external validation in Romanian cohorts-alongside feasibility, cost-effectiveness, and implementation studies-before any consideration of routine clinical adoption.

Since organ donation after citizen death became the sole legal source in 2015, lung transplantation (LTx) in China has undergone a systematic transformation, shifting from numerical scarcity to scale expansion and from technical exploration to sustained improvement in quality. From a management perspective, this article provides a comprehensive review of the development of LTx in China between 2015 and 2024, demonstrating that its central achievement has been the establishment of an integrated management system that combines national top-level policy design, standardized and homogeneous training, multidisciplinary collaboration, standardized clinical pathways, and rigorous quality assessment. Supported by a mechanism based on data-driven decision making, standard-guided implementation, and closed-loop management, this system has effectively ensured quality homogeneity and controllable risk during the dissemination of advanced transplantation techniques. Over the past decade, the number of hospitals performing LTx increased from 9 to 45, annual procedure volume rose from 118 to 925 cases, and the cumulative total of completed LTx was 5483. During the same period, 30-day survival improved from 78.5% to 85.3%. This system-oriented management model provides an important reference for the global community, particularly for developing countries facing challenges related to resource imbalance, by demonstrating how institutional innovation can facilitate the safe and efficient dissemination of highly complex medical technologies.

The ever-increasing disparity between lifespan and healthspan represents a challenging global issue, with metabolic dysregulation playing a central role in the initiation and progression of chronic non-communicable diseases (NCDs). This review highlights the importance of maintaining optimal redox homeostasis, with particular emphasis on reduced glutathione (GSH), for preserving metabolic health during aging. GSH participates in several physiological processes, including antioxidant defense, xenobiotic detoxification, redox signaling, and metabolic regulation. Diminished GSH levels are consistently reported in obesity, insulin resistance, type 2 diabetes mellitus, non-alcoholic fatty liver, and cardiovascular diseases. Current evidence from human clinical studies indicates that foods rich in bioactive constituents can enhance GSH levels and stimulate GSH-dependent enzyme activity, with the Nrf2/Are signaling pathway being a central mechanistic link. Fasting may promote adaptive redox responses by inducing mild oxidative stress and activating the same molecular mechanism, although the effects on GSH-related antioxidant mechanisms remain heterogeneous across fasting protocols and study populations. Altogether, the available clinical evidence suggests that these nutritional and lifestyle interventions exhibit more consistent beneficial effects in individuals characterized by increased oxidative burden and underlying metabolic dysfunction. Interindividual differences in GSH responses further underscore the need for targeted, tailor-made approaches that account for genetic, epigenetic, and lifestyle factors. Collectively, targeting GSH homeostasis through nutritional and lifestyle interventions represents a promising strategy for improving metabolic health and may further contribute to healthy aging, positioning redox biology at the forefront of aging research and NCD prevention.

Background/Objectives: Metabolic syndrome (MetS), defined by abdominal obesity, dysglycemia, dyslipidemia, hypertension, and insulin resistance, markedly increases the risk of type 2 diabetes mellitus and cardiovascular disease. Affecting an estimated 25-30% of the global adult population, MetS represents a major and growing public health challenge. A growing body of evidence supports a significant bidirectional relationship between MetS and oral health, particularly periodontitis. The present study aimed to synthesize current evidence on the pathophysiological mechanisms, epidemiological associations, interventional outcomes, and clinical implications of the bidirectional relationship between metabolic syndrome (MetS) and periodontitis. Methods: A narrative review following the SANRA framework was performed. PubMed, Scopus, and Web of Science were searched for articles published in January 2021-March 2026 using MeSH and free-text terms including "metabolic syndrome", "periodontal disease", "insulin resistance", and "oral microbiota". Eligible studies included original research and systematic reviews in English with full-text availability; animal and in vitro studies were included if directly informative of mechanistic pathways. Results: A total of 64 references were selected for inclusion. Shared mechanisms include chronic systemic inflammation, insulin resistance, oxidative stress, adipokine imbalance, endothelial dysfunction, and oral-gut microbiome dysbiosis. Cross-sectional and longitudinal studies show that MetS components are independently associated with higher prevalence and severity of periodontitis; meta-analyses report pooled odds ratios of 1.7-1.9 compared with metabolically healthy controls. Non-surgical periodontal therapy produces modest but significant reductions in glycated hemoglobin (HbA1c) and systemic inflammatory markers. Sodium-glucose cotransporter-2 (SGLT2) inhibitors may alter oral microbiota composition and cause mucosal changes, while glucagon-like peptide-1 (GLP-1) receptor agonists may increase caries risk through gastrointestinal side effects and xerostomia; both drug classes warrant proactive dental monitoring. Conclusions: The bidirectional relationship between MetS and oral health supports integrated screening and interdisciplinary management. Routine periodontal assessment should be integrated into the metabolic risk management pathway, and dental professionals should screen patients with severe periodontitis for metabolic risk factors. The oral microbiome emerges as a promising target for future mechanistic research and therapeutic intervention. Recognition of oral health as an integral component of metabolic health may improve risk stratification, prevention, and long-term patient outcomes. Large-scale randomized controlled trials with standardized endpoints are needed to establish causal directionality and optimize combined therapeutic strategies.

Background and Objectives: Patients with severe aortic stenosis (AS) frequently present with concomitant peripheral artery disease (PAD), which complicates transcatheter aortic valve implantation (TAVI) and increases the risk of vascular complications. Early identification of significant PAD may facilitate optimized procedural planning and risk stratification. This study aimed to develop and internally validate a clinical score for estimating the likelihood of significant PAD in patients with severe AS undergoing TAVI evaluation and to exploratorily assess its association with femoral access-site closure-device failure after TAVI. Materials and Methods: In this retrospective study, 138 patients with severe AS (124 undergoing TAVI) were evaluated. Logistic regression analyses identified independent predictors of significant PAD (≥50% stenosis), which were incorporated into the AS-PAD Score. The Score integrates age >75 years, diabetes mellitus, BMI ≥25 kg/m², Lp(a) >50 mg/dL (105 nmol/L), and Fontaine clinical stage. Model performance was assessed using receiver operating characteristic (ROC) analysis and internally validated using bootstrap resampling and stratified five-fold cross-validation. Vascular complications were adjudicated according to VARC-3 criteria. Results: The AS-PAD Score demonstrated good discriminatory performance, with an AUROC of 0.804. Advanced age (OR 2.43, 95% CI:1.05-5.70; p = 0.039) and diabetes (OR 3.18, 95% CI:1.29-7.83; p = 0.012) were independently associated with significant PAD, while BMI ≥25 kg/m² showed an inverse association. Elevated Lp(a) (>50 mg/dL) remained independently associated with significant PAD. Internal validation using bootstrap resampling and stratified five-fold cross-validation demonstrated consistent model performance. Femoral access-site closure-device failure occurred more frequently among patients classified as intermediate or high risk by the AS-PAD Score compared with low-risk patients. Conclusions: The AS-PAD Score may serve as an adjunctive clinical tool for estimating the likelihood of significant PAD in patients with severe AS undergoing TAVI evaluation. Its association with femoral access-site closure-device failure should be interpreted as exploratory and hypothesis-generating. Further external validation is required to confirm its role alongside standard CT-based vascular assessment.

Background and Objectives: ABO and Rh blood group systems represent clinically relevant genetic polymorphisms with established associations beyond transfusion medicine, including thrombotic risk. We investigated the prevalence of ABO and Rh blood group phenotypes in hemodialysis patients and their associations with documented vascular access thrombosis and all-cause mortality. Materials and Methods: This retrospective cohort study analyzed 3027 patients receiving maintenance hemodialysis in Hatay province, Türkiye, between January 2010 and April 2025. Data included ABO and Rh blood group determination, demographics, comorbidities, dialysis vintage, vascular access type, vascular access thrombosis events, and mortality. Multivariable binary logistic regression was used to identify independent factors associated with documented vascular access thrombosis. Multivariable Cox proportional hazards regression with vascular access thrombosis modeled as a time-dependent covariate was used to identify independent predictors of all-cause mortality. Results: Mean patient age was 63.95 ± 13.74 years; 58.3% were men. Blood group A was most prevalent (41.4%), followed by O (35.8%), B (15.9%), and AB (6.9%); 92.7% were Rh-positive. Documented vascular access thrombosis differed significantly by ABO group (p = 0.027), with the highest rate in group A (14.1%). In multivariable logistic regression, non-O blood group (OR 1.34, 95% CI 1.06-1.70; p = 0.014) and longer dialysis vintage (OR 1.01 per month, 95% CI 1.00-1.01; p < 0.001) were independently associated with documented vascular access thrombosis. In multivariable Cox regression, time-dependent vascular access thrombosis was independently associated with higher all-cause mortality (HR 1.33, 95% CI 1.12-1.59; p = 0.002), as were age (HR 1.02; p < 0.001), diabetes mellitus (HR 1.49; p < 0.001), coronary artery disease (HR 1.34; p < 0.001), and hypertension (HR 1.19; p < 0.001). Arteriovenous fistula was associated with lower mortality compared with temporary catheter (HR 0.46, 95% CI 0.37-0.58; p < 0.001). Blood group phenotype was not independently associated with all-cause mortality (all p > 0.5 vs. group O). Conclusions: In hemodialysis patients, non-O blood groups were modestly but independently associated with documented vascular access thrombosis, and vascular access thrombosis was independently associated with increased mortality when modeled as a time-dependent exposure. Blood group phenotype was not independently associated with mortality after adjustment for established risk factors. Blood group may contribute incrementally to vascular access risk awareness alongside established clinical risk factors, but its modest absolute risk difference limits standalone clinical utility.

Diabetes mellitus is highly prevalent in Saudi Arabia and shapes individuals' lived experiences within culturally and religiously embedded contexts. Although existing research has extensively examined biomedical, behavioral, and psychosocial dimensions of diabetes using quantitative and conventional qualitative approaches, there remains limited understanding of how individuals interpret, construct meaning, and reconstruct identity in relation to the illness over time. In particular, phenomenological inquiry is needed to access the lived, embodied, and existential dimensions of type 2 diabetes that are often not captured in existing outcome- or theme-focused qualitative studies. This study aimed to explore how Saudi adults with type 2 diabetes experience identity transitions, construct meaning, and undergo personal transformation.

A hermeneutic phenomenological design informed by van Manen was employed. Twenty-seven Saudi adults with type 2 diabetes of at least one year's duration were purposively recruited from a tertiary diabetes center in Riyadh. The sample size was guided by the principles of hermeneutic phenomenology, which prioritize depth, richness, and interpretive adequacy rather than numerical saturation. Recruitment and data collection continued until interpretive sufficiency was achieved, defined as the point at which no new experiential meanings or conceptual insights emerged across iterative analysis. Data were generated through in-depth, face-to-face interviews conducted in Arabic. Analysis followed an iterative interpretive process guided by the hermeneutic circle. Reflexivity, member checking, and peer review were used to enhance rigor.

Diabetes was experienced as a profound multidimensional disruption affecting embodiment, social roles, emotional well-being, and existential orientation. Participants described persistent fatigue and bodily limitation, shifting family roles and reduced social participation, emotional turbulence moving from shock to acceptance, and ongoing processes of meaning-making grounded in faith, gratitude, and strengthened family relationships.

Living with diabetes involves an ongoing process of meaning-making and identity reconstruction that extends beyond clinical disease management to include emotional, social, and existential dimensions. These findings highlight the importance of culturally sensitive, person-centered care that addresses the lived experience of chronic illness within its sociocultural and spiritual context.

Background: Gestational diabetes mellitus (GDM) and polycystic ovary syndrome (PCOS) are clinically distinct disorders that share important metabolic features. This Perspective proposes a non-causal intergenerational framework linking maternal PCOS-related metabolic vulnerability, susceptibility to GDM, intrauterine metabolic exposure, and later reproductive-metabolic risk in female offspring. Methods: A narrative synthesis of evidence from reproductive endocrinology, obstetrics, diabetology, developmental biology, and public health was undertaken. The strength of evidence supporting individual components of the proposed continuum was qualitatively appraised. Separately, aggregated surveillance data from Belgrade for 2015-2024 were used as a registry-based illustration of ICD-10 O24.4-coded GDM diagnoses. No formal time-series analysis, causal modeling, or forecasting was performed. Results: Evidence was strongest for the increased risk of GDM among women with PCOS and for the association between intrauterine exposure to maternal diabetes and later offspring metabolic susceptibility. Evidence linking maternal PCOS with offspring metabolic vulnerability was less definitive, while direct evidence that GDM exposure leads to clinically diagnosed PCOS in female offspring remained weak and indirect. Registry-recorded GDM rates varied across years, but this variability may reflect differences in screening, diagnostic criteria, coding, reporting completeness, and healthcare access rather than true changes in prevalence. Conclusions: The proposed GDM-PCOS continuum is a hypothesis-generating and probabilistic framework, not an established causal pathway. Its clinical value lies in connecting prevention opportunities before conception, during pregnancy, after delivery, and across the life course. Longitudinal maternal-offspring studies are required to test the proposed relationships.

Providing care for effective management of tuberculosis (TB) and diabetes mellitus (DM) is a challenge, particularly in resource-limited settings. This study assessed factors affecting the provision of care for patients with TB-DM in Addis Ababa, Ethiopia, using the six elements of the SELFIE-Sustainable intEgrated chronic care modeLs for FinancIng and performancE framework. A health facility-based cross-sectional study was conducted with randomly selected patients with TB-DM multi-morbidity. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 27. Logistic regression was employed to identify factors influencing TB-DM care provision. A total of 357 respondents participated, with a response rate of 96.5%. The mean age of the respondents was 49.8 years. Only 13.4% of patients received good TB-DM services. Key factors influencing TB-DM care were (a) insufficient counseling on the proper use of medication (AOR = 2.6, CI: 1.1-6.6, p = 0.035) and the risk of TB for DM patients (AOR = 10, CI: 3.7-27, p < 0.001), (b) leadership and governance including supportive leadership for TB-DM care (77.1%), organized TB-DM care (62.5%), the presence of a care policy (77.1%), and continuity of care (58.3%), (c) workforce factors such as the presence of a multidisciplinary team (60.4%), TB-DM service coordinator (58.3%), HCWs with adequate knowledge (87.5%), (d) costs of health services are fair (75%) and (e) lack of technologies such as EMR (88%) and lack of medical products to treat TB-DM (64.7%) delays care for TB-DM. Most TB-DM patients in Addis Ababa had limited access to care. The continuous monitoring of services can facilitate the identification of care gaps, thereby guiding the implementation of improved interventions.