This study investigated whether routinely used second-trimester triple screening markers (alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol) could help identify pregnancies at increased risk of gestational diabetes mellitus. In addition, several hematological inflammation indices were evaluated as potential adjunctive predictors.

Medical records of 405 singleton pregnancies were retrospectively reviewed. All participants underwent triple screening during gestational weeks 15-20 and subsequently underwent oral glucose tolerance testing during gestational weeks 24-28. Patients were categorized, according to oral glucose tolerance test findings, as either having gestational diabetes or as normoglycemic controls. Receiver operating characteristic analyses were performed to assess both the isolated and combined predictive capacities of measurements of alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol. The impact of maternal body mass index on model performance was also analyzed.

Alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol levels showed poor discriminatory ability for identifying pregnancies complicated by gestational diabetes, both individually and in combined models. However, adding maternal body mass index to the combined biomarker model substantially improved predictive accuracy (area under the curve=0.809; p<0.001). None of the evaluated inflammatory indices demonstrated significant predictive performance for gestational diabetes mellitus.

Routine second-trimester triple screening markers appear to have limited standalone value for predicting gestational diabetes. Nevertheless, incorporating maternal body mass index considerably enhances model performance and may improve clinical risk stratification.

Human Serum Albumin (HSA) is abundant plasma protein in human blood. It plays a critical role in the transport and distribution of endogenous and exogenous compounds. Protein binding affects free fraction of a drug thus affecting pharmacokinetics and therapeutic efficacy. Glycation of HSA under diabetic conditions and the accumulation of uremic toxins in uraemia may alter drug-protein interactions. Therefore, the present study aimed to investigate the binding interactions of ribavirin and selected uremic toxins with binding interactions involving glycation-sensitive HSA residues using molecular docking analysis. Molecular docking results demonstrated that ribavirin bind to HSA with hydrogen bonding and hydrophobic interactions. Key glycation-prone residues, including ARG222, ARG218, and LYS195, were identified at the ribavirin binding site. Several of these residues were also involved in the binding of uremic toxins, indicating potential competition for ligand binding in diabetic and uremic conditions. The overlap of interaction sites suggests that glycation and toxin accumulation may influence the structural and biochemical properties of HSA, thereby affecting ribavirin binding affinity and distribution. In conclusion, this study highlights the important role of glycation-sensitive HSA residues in mediating ribavirin and uremic toxin interactions. These insights may support the future design and optimization of ribavirin-based therapeutics.

Continuous glucose monitoring (CGM) is central to diabetes care, but explaining CGM patterns consistently and empathetically remains time-intensive in clinical practice. Large language model (LLM)-based systems may support patient-facing interpretation of CGM data, but evidence remains limited for retrieval-grounded tools evaluated against clinician-authored responses in counseling scenarios. The system was intended for CGM interpretation and communication support rather than autonomous therapeutic decision-making.

This study aimed to evaluate whether a retrieval-grounded LLM-based conversational agent (CA) could support patient understanding of CGM data and preparation for diabetes consultations by generating responses to questions arising during CGM-informed diabetes counseling, with quality comparable to clinician-authored responses.

We developed a scaffolded LLM-based CA for CGM interpretation and diabetes counseling support. The system was designed to provide plain-language explanations of CGM patterns and responses to diabetes management questions while avoiding directive or individualized medical advice, such as recommending medication initiation, dose adjustment, or regimen changes. Around 12 CGM-informed cases, each comprising a deidentified CGM trace, a synthetic patient vignette, and accompanying CGM visual materials, were constructed from using available clinical datasets. Between October 2025 and February 2026, 6 senior UK diabetes clinicians each reviewed 2 assigned cases and answered 24 questions (12 per case). In a source-masked multirater evaluation, each CA-generated and clinician-authored response was independently rated by 3 clinicians on 6 quality dimensions, including clinical accuracy, guideline adherence, actionability, personalization, communication clarity, and empathy. Safety flags and perceived source labels were also recorded. The primary analysis used linear mixed effects models with random intercepts for case and rater.

A total of 288 unique responses (144 CA and 144 clinician responses) were evaluated, generating 864 ratings. CA-generated responses received higher quality scores than clinician-authored responses under controlled vignette-based conditions, with mean scores of 4.37 (SD 0.57) versus 3.58 (SD 0.90) and an estimated mean difference of 0.782 points on a 5-point scale (95% CI 0.692-0.872; P<.001). This pattern was observed across all 6 categories of patient questions. The largest estimated differences were for empathy (mean difference 1.062, 95% CI 0.948-1.177) and actionability (0.992, 95% CI 0.877-1.106). Safety flag distributions were similar between CA and clinician responses, with major concerns rare in both groups (n=3, 0.7% each). Although CA responses were longer, additional analyses adjusting for word count did not indicate that response length explained the overall quality difference.

Scaffolded LLM-based systems may have value as adjunct tools for CGM review, patient education, and preconsultation preparation by supporting standardized explanatory tasks. However, these findings should be interpreted in light of the vignette-based design, restricted datasets, and a small clinician panel, and they do not establish suitability for autonomous therapeutic decision-making, medication adjustment, or unsupervised real-world use. Prospective validation in clinical workflows is needed before implementation.

Diabetes mellitus caused 3.4 million deaths in 2024. Although α-glucosidase and DPP-IV inhibitors are utilised therapeutically, synthetic drugs cause side effects. Durio kutejensis was examined for antihyperglycemic potential. This study assessed the antihyperglycemic activity of the leaves and bark of D. kutejensis from four Kalimantan provinces and identified active compounds through untargeted metabolomic analysis. Ethanol extracts were tested for in vitro α-glucosidase and DPP-IV inhibitory activities, confirmed through in vivo, and followed by untargeted metabolomic via UHPLC-Q-Orbitrap-HRMS. Bark extracts suppressed α-glucosidase activity with IC₅₀ values ranging from 1.65 to 15.10 µg/mL. A total of 44 metabolites were putatively identified; 12 were linked to α-glucosidase inhibition. In vivo, East Kalimantan bark extract (KT2) significantly improved glycemic control (p < 0.05), with a reduction in blood glucose of 24 mg/dL. These findings reinforce the therapeutic value of D. kutejensis bark as an antihyperglycemic agent.

Off-label underdosing of direct oral anticoagulants (DOACs) is common among Asian patients with atrial fibrillation (AF), partly reflecting concerns about bleeding, yet Southeast Asian data remain limited. This study aimed to characterize DOAC dosing patterns, identify predictors of off-label underdosing, and evaluate associated effectiveness and safety outcomes.

We conducted a retrospective cohort using electronic health records (EHRs) from two tertiary hospitals in Thailand (2015-2023). Incident AF patients initiating dabigatran, rivaroxaban, apixaban, or edoxaban were included. Doses were classified as on-label, underdosed, or overdosed based on guideline criteria. Propensity score-based inverse probability of treatment weighting (PS-IPTW) Cox proportional hazards regression models was used to evaluate ischemic stroke or systemic embolism (ISSE) and bleeding outcomes.

Among 553 patients, 20.4% were underdosed, 6.3% overdosed, and 73.2% received on-label dosing. Rivaroxaban was most frequently underdosed. Older age and diabetes mellitus independently predicted underdosing. Compared to on-label dosing, underdosing was not associated with ISSE (adjusted hazard ratio [aHR] 0.48, 95% CI 0.11-2.16; p = 0.336) or bleeding (aHR 1.06, 95% CI 0.30-3.73; p = 0.924).

Off-label underdosing occurred in one-fifth of patients but was not associated with significant differences in ISSE or bleeding. Larger, prospective studies in broader Asian and non-Asian populations are warranted.

Incretin-based therapies, including glucagon-like peptide-1 receptor agonists (GLP-1RAs), are established therapies for obesity and type 2 diabetes mellitus, providing sustained weight reduction, improved glycaemic control, cardiovascular and renal benefits. Despite these established benefits, safety concerns remain an important clinical issue because adverse events may affect treatment persistence, patient acceptability, and clinical decision-making. This review evaluates a number of safety profiles of GLP-1RAs using clinical, mechanistic, and pharmacovigilance evidence, with attention to both common adverse events and emerging safety signals.

A narrative review was conducted to evaluate the safety profile of GLP-1RAs in obesity and type 2 diabetes mellitus. PubMed/MEDLINE, Embase, and Web of Science were searched for studies published between January 2005 and April 2026. Evidence from randomised controlled trials, observational studies, meta-analyses, pharmacovigilance investigations, and regulatory safety reports was synthesised qualitatively.

Findings from 60 studies and safety reports were included. Common adverse events were predominantly gastrointestinal, particularly nausea, vomiting, diarrhoea, and constipation, and represented the most consistently reported adverse effects and the principal cause of treatment discontinuation. Uncommon safety concerns included renal adverse events, which were reported infrequently and often occurred in clinical contexts involving gastrointestinal intolerance, volume depletion, or other predisposing factors. Gallbladder and biliary complications were also infrequent and appeared to be influenced by rapid weight loss and baseline patient risk factors. Acute pancreatitis remained rare in clinical trials, although severe cases have been reported in postmarketing settings. Human evidence did not demonstrate an increased risk of thyroid malignancy. Emerging safety signals, including early worsening of diabetic retinopathy, muscle mass reduction, psychiatric symptoms, and alopecia, were identified mainly through observational and pharmacovigilance evidence.

GLP-1RA adverse events predominantly reflect predictable pharmacological and physiological effects rather than off-target toxicity. Safety profiles appear agent-specific, dose-dependent, and influenced by underlying mechanisms and patient characteristics. Risk-stratified prescribing should therefore align agent selection, dose escalation, and monitoring intensity with patient-specific vulnerabilities, particularly gastrointestinal tolerability, risk of renal dehydration, gallbladder history, retinopathy risk during rapid glycaemic improvement, and frailty or sarcopenia risk. Continued long-term surveillance and further evidence generation are needed to better define rare, delayed, and emerging safety signals and to optimise safe use across diverse clinical populations.

A 5-year-old spayed female domestic shorthair cat was referred to the Clinical Nutrition Service at the Ontario Veterinary College (Guelph, Ontario) for management of chronic, nonresponsive enteropathy and recently diagnosed diabetes mellitus. The cat was presented with persistent diarrhea, perianal ulceration, weight loss, and poor glycemic control despite treatment with prednisolone, cobalamin injections, a hydrolyzed diet, and short antimicrobial trials. Once hospitalized, the cat was transitioned to a high-protein, low-carbohydrate commercial veterinary therapeutic diet containing mixed protein sources. Nutritional support was initiated via a nasogastric tube but discontinued after 48 h when voluntary oral intake resumed. Clinical signs improved gradually over 5 d, blood glucose stabilized below the renal threshold, and insulin therapy was discontinued at discharge after 6 d of hospitalization. The commercial veterinary therapeutic diet was maintained, and psyllium husk was later added to improve stool quality. Soft stools persisted for several months, with normalization occurring only after targeted fiber supplementation was introduced alongside ongoing medical management. This case highlights the importance of individualized nutritional management in chronic enteropathy, as clinical response to dietary intervention may evolve over time and long-term stabilization may require alternative strategies beyond hydrolyzed-protein diets. Key clinical message: Dietary responsiveness in feline chronic enteropathy is highly individualized. Hydrolyzed-protein diets are commonly recommended, but responses may vary between cases. Sequential and sustained dietary trials, guided by clinical response, may be necessary to achieve durable remission.

Type 2 diabetes mellitus (T2DM) is a significant public health problem, particularly in Nigeria, with increasing prevalence worldwide. Hyperglycemia in T2DM is associated with various metabolic disturbances, including alterations in uric acid metabolism. This study investigates the effect of hyperglycemia on the serum uric acid (SUA) levels in patients with T2DM.

This cross-sectional observational study included 100 participants comprising 70 patients with T2DM and 30 age- and sex-matched non-diabetic individuals in the control group. Blood samples were obtained to measure fasting and postprandial plasma glucose and SUA levels. Statistical analyses were conducted to compare the groups.

A total of 100 participants were recruited for this study. The results indicated that diabetic patients had significantly higher fasting SUA levels (0.45 ± 0.16 mmol/L) when compared to the control group (0.28 ± 0.05 mmol/L, p = 0.02). Similarly, postprandial SUA levels were elevated in diabetic patients (0.58 ± 0.16 mmol/L) compared to controls (0.30 ± 0.06 mmol/L, p = 0.022). No statistically significant difference was observed between fasting and postprandial SUA levels within the diabetic and control groups (p>0.05).

Hyperglycemia in individuals with T2DM is significantly associated with increased serum uric acid levels. These findings show the clinical relevance of monitoring SUA in patients with type 2 diabetes.

Diabetic dyslipidemia is a prevalent metabolic disorder linked to obesity, diminished functional capacity, elevated cardiovascular risk, and poorer health-related quality of life (HRQoL) in people diagnosed with diabetes mellitus. Non-pharmacological approaches, particularly exercise-based rehabilitation and nutritional management, have gained increasing importance in improving metabolic and physical health outcomes in this population. This systematic review examined the effects of integrated exercise training programs and nutritional therapies on obesity measures, functional capacity, lipid profile, and quality of life in patients with diabetic dyslipidemia. An all-inclusive literature analysis was undertaken incorporating PubMed, Google Scholar, Scopus, ScienceDirect, and Web of Science with the aim to identify articles published between 2002 and 2025. The review focused primarily on randomized controlled trials, clinical trials, observational studies, cross-sectional studies, and meta-analyses of exercise, rehabilitation, and nutritional interventions. The evaluation of bias risk was conducted using the Revised Cochrane Risk of Bias Tool for Randomized Trials (RoB 2) and Appraisal Tool for Cross-Sectional Studies (AXIS), as per the study design. In total, 12 studies fulfilled the requirements for inclusion. The results showed that integrated exercise interventions, such as aerobic training, resistance exercises, combined exercise programs, and home-based rehabilitation, produced significant improvements in lipid levels, body composition, aerobic fitness, functional performance, obesity-related parameters, and HRQoL. Dietary interventions, including calorie-restricted diets and lifestyle modification strategies, also contributed positively to glycemic regulation, lipid metabolism, and reduction of cardiovascular risk factors. Most research in this review showed moderate-to-high methodological quality and generally a low risk of bias. This review concludes that combined exercise training and nutritional intervention programs are safe and advantageous for ameliorating obesity indices, functional capacity, lipid profile, and general well-being within people who have diabetic dyslipidemia. Therefore, multidisciplinary rehabilitation techniques may be essential for the long-term control and avoidance of problems associated with diabetic dyslipidemia.

One of the global epicenters of the diabetes mellitus pandemic is India. Over the past 40 years, there has been a sharp rise in the prevalence of diabetes mellitus in India due to rapid socioeconomic development, demographic shifts, and increasing susceptibility in the Indian population. Diabetes affects 74.2 million individuals in India, which places a significant strain on the country's economy and healthcare system. A patient's diet, lifestyle, medication, and glucose monitoring must all be customized for optimal diabetes control. The rates of glucose monitoring in India are abysmal. Most of the monitoring methods currently in use are based on single-point-in-time readings, which may not be totally indicative of the state of diabetes control. This presents problems. With advancements in technology, the new monitoring tool-continuous glucose monitoring (CGM)-provides visibility into the glycemic profile 24 × 7 with user-friendly reports that provide information much beyond glycated hemoglobin (HbA1c) and self-monitoring of blood glucose. This device also detects the time spent in range by the individual with diabetes. This review article discusses CGM in terms of its purposes, technologies, accuracy, clinical indications, benefits, and problems associated with it.