The aim of this narrative review is to critically assess the renoprotective effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in managing albuminuria among patients with type 2 diabetes mellitus within the framework of personalized medicine. By integrating current evidence from clinical trials and meta-analyses, the review highlights how GLP-1RAs not only enhance glycemic control but also reduce blood pressure, induce weight loss, and mitigate inflammatory responses. While these given factors may vary according to individual patient profiles, they also collectively contribute to slowing the progression of diabetic kidney disease (DKD). Additionally, the discussion emphasizes the dual cardiovascular and renal benefits from these agents, underscoring their role in reducing albuminuria and preserving renal function. The review also identifies gaps in knowledge, suggesting future research directions for optimizing patient selection and treatment regimens to maximize therapeutic benefits.

Diabetes prevalence in older people residing in care homes is rising. This cohort of patients is characterised by multiple morbidities, polypharmacy, and frailty. As a result, they are exposed to an increasing burden of hypoglycaemia, which leads to unnecessary hospital visits and negative consequences. In addition, due to their high baseline morbidities, the risk of cardiovascular events increases. The newly introduced therapy of SGLT-2 inhibitors and GLP-1RA has a very low risk of hypoglycaemia and a significant cardiovascular protective effect. This makes it an appealing choice to be used in older people with complex morbidities, such as care home residents. So far, the current use of these agents is suboptimal in these settings because clinicians are cautious of side effects and tolerability, and also, clinical studies have not included this population. Furthermore, the guidelines in this area lack a personalised approach and are too general, with no clear specific description of which patients are suitable for such therapy. The currently available little evidence is indirect, which confirms the superior benefits of such therapy in frail compared with robust subjects, especially in those who are overweight or obese. The demographic mix of care homes is largely heterogeneous in terms of variations in body composition. In addition to malnourished, frail phenotype subjects, the prevalence of individuals with obesity living in these settings is increasing. Therefore, there is scope for increased use of these new agents in residents who have at least a normal or higher body weight. Because of the high baseline cardiovascular risk, these patients will benefit most from such therapy. Otherwise, these agents are better when less used for frail patients who are anorexic and malnourished because of the risk of inducing further weight loss, volume loss, low blood pressure, falls, and fractures.

"Unusual sporotrichosis", a concept proposed in this review, refers to severe, extracutaneous, or anatomically atypical manifestations of sporotrichosis occurring in immunocompetent hosts and represents an underrecognized clinical subset associated with important diagnostic and therapeutic challenges. This systematic review aimed to characterize unusual sporotrichosis worldwide and to clarify its epidemiological, clinical, diagnostic, and therapeutic patterns. Following a registered protocol and PRISMA guidelines, PubMed, Scopus, and BVS/LILACS were searched up to November 2025 using a PICO-based strategy. Eligible studies included peer-reviewed case reports and case series with laboratory-confirmed sporotrichosis in patients without immunosuppression, diabetes mellitus, alcoholism, or other confounding comorbidities; classical lymphocutaneous and fixed cutaneous forms were excluded. From 922 records, 39 studies were included (13 case series and 26 case reports), yielding 55 cases reported between 1957 and 2024 across five world regions, mainly from the United States of America and Brazil. Adults aged 40-59 years (41.8%) and males (74.5%) predominated. Sapronotic transmission was most frequent (69.0%), although zoonotic transmission increased over time. Sporothrix schenckii/Sporothrix schenckii sensu stricto was the predominant species (87.3%). Osteoarticular (30.9%) and systemic (27.2%) forms were the most common presentations. Although cure was achieved in most cases (58.1%), sequelae were frequent (21.8%), and the worst prognosis-including most deaths-was observed in osteoarticular sporotrichosis. Unusual sporotrichosis is globally distributed and clinically distinct; therefore, early recognition and multimodal diagnostic and therapeutic strategies are essential to improve outcome.

The COVID-19 pandemic has contributed to the increase in maternal mortality due to the direct effects of the viral infection and the indirect effects caused by the overload of health services, and the resulting economic and social crises. This study aims to analyze sociodemographic, gestational, and clinical factors associated with maternal deaths from COVID-19 in Pernambuco between 2020 and 2021.

The study included 37 cases (deaths) and 112 controls (survivors). Crude and adjusted odds ratios were estimated using conditional and Firth's penalized logistic regression models, respectively, to evaluate sociodemographic, gestational, and clinical factors.

In the bivariate analysis, the main factors associated with maternal death from COVID-19 were ≤8 years of schooling, the postpartum period, multiparity, oxygen saturation below 95%, obesity, and diabetes mellitus. The presence of fever and cough was associated with a lower probability of death. The independent factors that remained associated with maternal death were the postpartum period (aOR: 80.78; 95% CI: 16.54-394.37), parity ≥ 1 (aOR: 5.74; 95% CI: 1.16-28.22), and oxygen saturation below 95% (aOR: 7.16; 95% CI: 1.37-37.44), with fever acting as a possible protective factor (aOR: 0.08; 95% CI: 0.01-0.42). Factors such as obesity and diabetes were not independent predictors in the final multivariable model.

The findings reinforce that maternal death is a multifactorial phenomenon. The relevance of this investigation lies in identifying clinical and obstetric vulnerability profiles in a region heavily impacted by the health crisis. Knowledge gained from past crises contributes to the improvement of public health strategies and clinical management protocols, aiming to mitigate preventable maternal deaths in future public health emergencies.

To determine whether left atrial (LA) strain by speckle-tracking echocardiography can identify supraventricular arrhythmia risk in patients with type 2 diabetes mellitus (T2DM) without overt structural heart disease.

Prospective, single-center observational cohort study including 107 adults: 57 with T2DM and 50 age-matched controls. Participants underwent clinical assessment and echocardiography at baseline and 12 months. LA reservoir, conduit, and contractile strain (LASr, LAScd, LASct) were measured; left atrial volume indexed (LAVI) and LA stiffness index (LASI) were calculated. The primary endpoint was clinically significant supraventricular arrhythmia at 12 months on 24 h Holter (atrial fibrillation (AF)/atrial flutter (AFL) ≥ 30 s and/or excessive supraventricular ectopy). Predictors were assessed using penalized logistic regression and discrimination by ROC analysis.

At baseline and 12 months, T2DM showed impaired LA mechanics versus controls (baseline: LASr 20.1 ± 5.7 vs. 25.8 ± 6.3%, LAScd -11.6 ± 4.2 vs. -15.6 ± 4.9%, LASct -9.9 ± 3.2 vs. -13.1 ± 3.7%; all p < 0.001) and higher LASI (0.4 ± 0.2 vs. 0.3 ± 0.1, p < 0.001). LAVI was higher in T2DM at 12 months (34.0 ± 7.0 vs. 29.9 ± 6.5 mL/m², p = 0.003). Supraventricular arrhythmias occurred in 20/57 patients (35.1%) of the T2DM vs. 1/50 patients (2.0%) of the control group (p < 0.001). Arrhythmias were assessed by 24 h Holter monitoring at the 12-month follow-up. In T2DM, LAScd provided the best single-parameter discrimination (AUC 0.692), with an optimal cut-off around -8% (sensitivity 55.6%, specificity 81.8%); a LAScd+left ventricular ejection fraction (LVEF) model improved AUC to 0.772.

In this prospective observational cohort, T2DM was associated with subclinical LA dysfunction and a higher burden of supraventricular arrhythmias. LAScd emerged as the most clinically informative LA deformation marker for arrhythmic risk stratification and may support targeted rhythm surveillance in diabetic patients. These findings require external validation in larger, independent multicenter cohorts.

Background/Objectives: Conventional wound care often fails to address the complex pathology of diabetic wounds adequately. Research shows that hyaluronic acid and its derivatives promote tissue regeneration in the later stages of wound healing. We evaluated the efficacy of a novel topical formulation in promoting socket healing following post-extraction in patients with type-2 diabetes mellitus, by combining sodium hyaluronate and six amino acids involved in collagen synthesis. Methods: A single-center, two-arm randomized controlled trial was conducted in adults aged 18 and over with type 2 diabetes requiring extraction of at least one non-impacted tooth. Forty-four participants were randomized to receive either the intervention or no treatment. Primary outcomes included a modified Landry's healing index and rate of socket closure. Results: Comparative analysis showed significantly improved healing index scores in the intervention group by day 7 and day 14 compared to control, with no improvements in the rate of socket closure. Conclusions: This research provides evidence on the therapeutic efficacy of the gel formulation under study in promoting wound healing of post-extraction sites in diabetic patients undergoing tooth extraction. Further research is needed to compare its efficacy with standard treatments and adjunct therapies.

Diabetic foot infection (DFI) represents a major complication of diabetes mellitus with significant morbidity, frequently leading to amputation if not optimally managed. The aim of this study was to analyze clinical, microbiological, and antibiotic susceptibility data from patients with type 2 diabetes who presented with foot infections in Indonesia. The retrospective study, conducted at St. Elisabeth Hospital in North Sumatra, Indonesia, predominantly comprised male farmers with a mean diabetes duration of 8.6 years, most of whom exhibited advanced ulcer severity (64.5% at Wagner grade III). Surgical debridement was performed in 79.0% cases, and amputation in 21.0% of cases. Laboratory investigations revealed poor glycemic control (mean HbA1c 10.12%) and biochemical markers indicative of systemic inflammation and renal impairment. Microbial cultures identified a predominance of Gram-negative bacteria (58.1%), primarily Klebsiella pneumoniae, Proteus mirabilis, and Escherichia coli, whereas Gram-positive isolates (41.9%) were dominated by Staphylococcus aureus, including methicillin-resistant strains. Empirical outpatient and inpatient antibiotic regimens commonly included amoxicillin, ciprofloxacin, metronidazole, and ceftriaxone; however, in vitro susceptibility testing demonstrated limited efficacy of β-lactams such as ampicillin and amoxicillin (<10% sensitivity). In contrast, linezolid, amikacin, vancomycin, carbapenems, and fosfomycin exhibited superior activity against the isolated pathogens. These findings emphasize the critical need for empirical antibiotic guidelines tailored to local microbial ecology and resistance profiles, integrated with early surgical management, stringent glycemic control, and multidisciplinary care. This comprehensive approach is essential to reduce the risk of amputation and improve clinical outcomes in tropical, resource-limited settings.

To evaluate the association between serum vitamin D3 levels in patients with type two diabetes mellitus (T2DM) and diabetic macular edema (DME) taking into consideration other factors such as demographic, metabolic, and clinical confounders.

This retrospective case-control study included patients with T2DM attending a tertiary ophthalmology clinic. Cases were patients with clinical and OCT-confirmed DME. Controls had no DME. Patients with severe NPDR or higher stage were excluded. The study involved collecting several variables including age, sex, diabetes duration, HbA1c, BMI, smoking status, vitamin D3 levels, comorbidities, and vitamin D supplementation. Vitamin D3 was categorized into three groups: <10, 10-30, and >30 ng/mL. Logistic regression was used to identify independent predictors of DME.

A total of 332 participants were analyzed. A total of 184 control patients were compared to 148 DME patients. DME patients had significantly longer diabetes duration (12.91 y vs 17.21 y, p < 0.001 for Non-DME and DME groups respectively) and lower vitamin D3 levels (25.16 ng/mL vs 16.71 ng/mL, p < 0.001 for non DME and DME groups respectively). Vitamin D3 deficiency (<10 ng/mL) was independently associated with increased odds of DME, whereas vitamin D3 sufficiency (>30 ng/mL) was protective. Cigarette smoking, paradoxically, was found to be associated with lower odds for DME.

Vitamin D3 deficiency is associated with increased odds of DME. Interpretation should be cautious due to methodological limitations, including potential selection bias, unmeasured confounding, and lack of adjustment for diabetic retinopathy severity. Further research is required to explore further cause-effect relationship and effect of supplementation on the disease itself and response to treatment.

This study aimed to examine the association between maternal uric acid (UA) concentrations measured prior to 24 weeks of pregnancy and the risk of gestational diabetes mellitus (GDM) between 24 and 28 weeks.

In this retrospective cohort conducted at a single institution, 847 expectant mothers receiving prenatal services at Zhengzhou People's Hospital from August to December 2024 were enrolled. All participants had their UA levels measured prior to 24 gestational weeks, followed by a 75 g oral glucose tolerance assessment conducted between weeks 24 and 28. Multivariable logistic regression analysis was performed to evaluate the association between UA levels and the risk of GDM, supplemented by subgroup analysis, sensitivity analysis, and analytical procedures including receiver operating characteristic (ROC) curve evaluation and modeling with restricted cubic spline (RCS).

Among 847 enrolled pregnancies, the proportion with GDM was 21.1% (n = 179). Multivariate logistic regression showed that each 1 µmol/L or each one-standard-deviation elevation in serum UA corresponded to a markedly greater risk of GDM (OR: 1.005, 95% CI: 1.001-1.009; OR: 1.274, 95% CI: 1.062-1.528, respectively). In comparison to the lowest UA tertile (T1), T2 and T3 exhibited elevated risk for GDM, with ORs of 1.976 (95% CI: 1.203-3.247) and 2.468 (95% CI: 1.520-4.007), respectively. Subgroup analyses revealed that in women aged > 30, with gravidity < 2, parity < 2, or body mass index before conception below 24 kg/m², both continuous and categorical UA demonstrated a clear and statistically meaningful association with GDM. Sensitivity analyses supported consistent results, with both median- and quartile-based groupings showing a significant association between higher UA levels and greater GDM risk (P < 0.05). ROC curve analysis suggested that serum UA provided limited yet statistically significant discriminative information for GDM (AUC = 0.623). RCS modeling revealed a notable positive linear association between UA concentrations and the risk of GDM (P for nonlinearity = 0.140).

Higher maternal serum UA measurements taken prior to 24 gestational weeks were strongly linked to GDM risk during weeks 24-28.