Medication for the disease of obesity has improved, and clinical trials based on natural gut hormones such as tirzepatide, showed only mild side effects and ~22% weight loss maintenance. However, patients with type 2 diabetes only lose 15% bodyweight with tirzepatide while tolerating the medications very well, but little is known in patients with the disease of obesity who also have type 1 diabetes, especially regarding safety of the medications. Tirzepatide's licence in the Gulf countries and Europe for obesity does not exclude patients with obesity and type 1 diabetes, unlike the USA. In Kuwait, more than a quarter of patients with type 1 diabetes also have the disease of obesity. Tirzepatide is not approved for glycaemic control in patients with type 1 diabetes, because it is unlikely to make a difference. Because tirzepatide is approved for the treatment of obesity in patients who also have type 1 diabetes we can now test how effective treatments for obesity such as tirzepatide are for patients with obesity and type 1 diabetes. Concerns regarding the safety of the medication in type 1 diabetes can also be addressed thus addressing an important knowledge gap.

This will be a randomised double blind controlled trial of 60 patients with obesity and type 1 diabetes to test usual care with or without maximum tolerable dose of tirzepatide to achieve weight loss. We will investigate the safety of the medications in patients with obesity and type 1 diabetes to address important knowledge gap which can change clinical practice.

The study has received ethical approval from the Dasman Diabetes Institute Ethical Review Committee (HR-RA-2025-03) and is registered at ClinicalTrials.gov (NCT07096908). Written informed consent will be obtained from all participants, with no financial compensation provided. Data will be reported in accordance with Consolidated Standards of Reporting Trials guidelines, ensuring participant anonymity. Findings will be disseminated through peer-reviewed publications and presentations at national and international conferences.

NCT07096908.

Accurate small-area estimates of vaccination rates and disease burden can inform public health interventions.

This study aimed to compare population denominators derived from census data and electronic health record (EHR) data from a statewide collaboration in Minnesota and examine concordance between Centers for Disease Control and Prevention and EHR-based estimates of diabetes and hypertension prevalence at the census tract level.

A retrospective study was conducted using EHR data from 2018 to 2022 from the Minnesota EHR Consortium (MNEHRC), population estimates from the 2020 census, and disease prevalence estimates among adults from the Centers for Disease Control and Prevention Population Level Analysis and Community Estimates (PLACES) project. Patients were included if they had a Minnesota address and a clinic visit in the last 3 years. Patients with hypertension and diabetes were identified based on the presence of at least 1 diagnosis code in the Observational Medical Outcomes Partnership condition occurrence table in the last 5 years or an elevated outpatient blood pressure (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) on 2 or more days in the last 3 years for hypertension or at least 1 hemoglobin A_1c value of ≥6.5 in the last 3 years for diabetes.

The 2020 census estimate for the population of Minnesota was 5,707,254. A total of 5,271,191 (92.4% of the census estimate) unique individuals visited 1 of the 11 MNEHRC health care systems in 3 years (2018-2020). The ratio of MNEHRC patients to the Minnesota statewide 2020 census estimate was higher for female individuals (0.97) than for male individuals (0.88) and higher for older age groups (individuals aged 65 years and older: 1.05) than for younger age groups (individuals aged 0-17 years: 0.83). The MNEHRC patient-to-census ratio also differed by race-the ratio was the highest for Black Minnesotans (1.17) and the lowest for American Indian and Alaska Native Minnesotans (0.68). According to MNEHRC data, the percentage of adults in Minnesota with diabetes in 2022 was 9.5% (415,914/4,376,805), and the percentage of adults in Minnesota with hypertension in 2021 was 32.2% (1,365,413/4,234,000). Estimates from PLACES for diabetes were 9.9% (435,481/4,389,028) and for hypertension were 29.9% (1,311,459/4,389,028). The percentage of census tracts where the MNEHRC estimate was within 10% of the PLACES estimate was 40.3% (605/1500) for diabetes and 42.3% (635/1500) for hypertension; 77.9% (1168/1500) of census tracts for diabetes and 79.7% (1195/1500) for hypertension were within 25% agreement.

Our analysis suggests that there are both similarities and important differences between small-area estimates derived from EHR and survey data. Such differences suggest that further research is needed to determine the optimal collection method for local estimates of health conditions.

Periodontal diseases are closely related to various systemic conditions including diabetes mellitus (DM), cardiovascular diseases, adverse pregnancy outcomes, and rheumatoid arthritis (RA). Internal medicine physicians frequently encounter patients with these systemic conditions and are in a strategic position to facilitate early diagnosis and referral for periodontal problems. Despite international evidence suggesting significant knowledge gaps among medical practitioners regarding periodontal health, limited data are available from Turkey. The aim of this study was to evaluate the knowledge levels and attitudes of internal medicine specialists and residents regarding periodontal health and periodontal disease, and their relationship with systemic conditions, in comparison with dentists.

This cross-sectional descriptive survey study was conducted between April 2021 and December 2021 in Turkey. A content-validated, self-administered online questionnaire consisting of 7 sociodemographic questions and 29 questions related to periodontal health and periodontal disease knowledge and attitudes was distributed to internal medicine specialists/residents (IMS group, n = 107) and dentists (control group, n = 133) via social media platforms. Internal consistency was assessed using Cronbach's alpha (α = 0.829). Normality of continuous variables was assessed using the Shapiro-Wilk test. Data were analyzed using chi-square tests, Kruskal-Wallis tests, and Mann-Whitney U tests, with statistical significance set at p < 0.05. Bonferroni correction was applied for multiple comparisons. Multiple linear and logistic regression models were used to adjust for potential confounders.

A total of 240 participants met the inclusion criteria. Internal medicine specialists/residents demonstrated significantly lower knowledge levels compared to dentists across most periodontal knowledge domains (p < 0.05). Only 65.4% of the IMS group correctly defined periodontitis compared to 98.5% of dentists (p < 0.001). Knowledge gaps were particularly prominent regarding the relationship between periodontal disease and pregnancy complications (46.7% vs. 91%, p < 0.001), the effect of smoking on periodontal tissues (59.8% vs. 97.7%, p < 0.001), and the role of radiographic examination in periodontal diagnosis (37.4% vs. 88.8%, p < 0.001). After Bonferroni correction, 14 of 22 comparisons remained statistically significant. Notably, both groups showed high and comparable knowledge regarding the recognition of diabetes as a risk factor for periodontitis (IMS: 93.5% vs. dentists: 92.5%). Subgroup analysis revealed that specialists scored significantly higher than residents across all knowledge domains (total score: 16.94 ± 2.90 vs. 14.38 ± 3.73, p < 0.001). Multivariate analysis confirmed that group differences remained significant after adjusting for age, sex, marital status, and years since graduation (adjusted B = 4.65, p < 0.001). Self-assessment scores for periodontal knowledge significantly increased after completing the survey in the IMS group (4.02 to 5.34, p < 0.001).

The findings of this study suggest that internal medicine specialists and residents in Turkey may have lower knowledge levels regarding periodontal health and periodontal disease, and the periodontal-systemic health relationship compared to dentists. Specialists demonstrated significantly higher knowledge than residents across all domains. While these results should be interpreted within the context of the study's methodological limitations, they point to a potential need for integration of oral health education into medical curricula and enhanced interprofessional collaboration between medicine and dentistry. Further research using representative sampling strategies and longitudinal designs is warranted to confirm these findings.

Salivary cortisol is an important biomarker for the assessment of stress-related disorders and endocrine function. Due to the noninvasive and convenient nature of saliva sampling, it has considerable potential for clinical application. However, the low concentration of cortisol in saliva, typically at the nanograms-per-milliliter level, together with the complexity of the salivary matrix, poses substantial challenges to analytical sensitivity and selectivity. In this study, an analytical method for salivary cortisol determination was developed based on immunomagnetic bead enrichment and purification coupled with liquid chromatography-tandem mass spectrometry (LC-MS/MS). Cortisol monoclonal antibodies were conjugated to carboxyl-modified nanomagnetic beads, and the target analyte was extracted and purified through immunoaffinity adsorption followed by ethanol elution. The method exhibited good linearity over the ranges of 0.10-1.00 ng/mL and 1.00-20.00 ng/mL, with a limit of detection (LOD) of 0.04 ng/mL and a lower limit of quantification (LLOQ) of 0.10 ng/mL. The method also showed satisfactory accuracy, with spiked recoveries ranging from 80% to 110%. In addition, salivary cortisol concentrations showed a strong positive correlation with serum cortisol concentrations (Pearson correlation coefficient, r = 0.91636). These results indicate that the proposed method provides a sensitive, selective, and reliable approach for salivary cortisol analysis and shows promise for clinical application.

This prospective multicenter cohort study aimed to assess the effectiveness and safety of bariatric and metabolic surgery (BMS) in Korean patients with class II obesity or higher and those with a body mass index (BMI) ≥ 27.5 kg/m².

Between September 2020 and December 2022, 116 patients undergoing BMS were enrolled from nine centers in Korea. Of these, 37 patients underwent gastric bypass and 79 underwent sleeve gastrectomy. Follow-up evaluations were performed for up to 2 years. Clinical data were collected alongside four quality of life (QOL) surveys (EQ-5D, IWQOL-lite, OP-scale, and BAROS) administered at 12, 24, 48, 72, and 96 weeks postoperatively. Clinical parameters included obesity severity, complications by surgery type, associated medical problems, nutritional status, and their longitudinal changes.

The cohort had a mean age of 37.0 ± 11.1 years and a mean BMI of 41.9 ± 7.6 kg/m²; 71.6% of participants were female. Baseline associated medical problems included type 2 diabetes mellitus (T2DM) in 45 patients (38.8%), hypertension in 77 (66.4%), and hyperlipidemia in 77 (66.4%). Total weight loss reached 26.8% at 1 year, 27.5% at 1.5 years, and 24.7% at 2 years. Remission rates for T2DM, hypertension, and hyperlipidemia at 1 year were 80.7%, 50.0%, and 49.0%, respectively, increasing to 85.7%, 50.0%, and 71.4% at 2 years. No significant differences were observed between the procedures in postoperative weight trajectories, nutritional outcomes, or improvements of associated medical problem. All QOL scores showed significant and sustained improvement across all surveys. The overall complication rate was 12.1% (early: 0.9%, late: 11.2%), which was considered acceptable.

Gastric bypass and sleeve gastrectomy are effective and safe BMS procedures for Korean patients, providing substantial weight loss, remission of associated medical problems, and improved QOL.

Patients with diabetes mellitus experience disproportionately worse postoperative outcomes, reflecting an underlying metabolic dysfunction that conventional perioperative optimization strategies fail to address. Although prehabilitation improves outcomes in selected surgical populations, its effectiveness in diabetes remains inconsistent, suggesting a mismatch between intervention strategies and the mechanisms driving perioperative risk. This review aimed to evaluate the role of metabolic dysfunction in perioperative risk among patients with diabetes and to propose a mechanism-informed prehabilitation framework targeting key metabolic disturbances. Evidence from clinical studies, systematic reviews, and perioperative guidelines was synthesized to develop a structured framework linking metabolic targets with targeted interventions within perioperative care pathways. Key metabolic disturbances, including insulin resistance, impaired metabolic flexibility, mitochondrial dysfunction, inflammation, and glycemic variability, amplify the surgical stress response and impair recovery in these patients. Conventional multimodal prehabilitation fails to adequately address these mechanisms. A targeted metabolic optimization approach incorporating exercise-based conditioning, nutritional optimization, glycemic management (including continuous glucose monitoring), and pharmacological modulation enables targeted interventions across these domains. Individualization strategies based on dominant metabolic features improves clinical applicability. The integration of this approach within perioperative pathways, including enhanced recovery after surgery (ERAS), provides a structured strategy to improve metabolic stability and perioperative resilience. Prehabilitation in patients with diabetes should shift from generalized multimodal strategies to targeted strategies involving metabolic optimization aligned with the underlying pathophysiology. A personalized and mechanism-informed approach integrated within the ERAS pathways may improve perioperative outcomes in this high-risk population. Prospective studies are needed to validate this strategy.

Metabolic dysfunction-associated liver disease (MASLD) is on a rising trend globally. An approximate 10-20% of those with MASLD have a lean phenotype (lean MASLD) with prevalence higher in Asian population Thin-fat phenotype seen in Asians, increased visceral adipose tissue, insulin resistance and genetic polymorphisms are considered to contribute to this. Atherogenic dyslipidemia, diabetes mellitus, cardiovascular disease and sarcopenia may commonly co-exist in individuals with lean MASLD. Due to lack of clinical symptoms, it is often detected on routine screening. While the presence of comorbidities such as diabetes mellitus, hypertension and hypertriglyceridemia are more than lean healthy individuals, it remains lower than non-lean MASLD. However, advanced fibrosis and all cause mortality remain higher in the lean MASLD cohort highlighting they are a high-risk group. Diagnostic tests such as serum fibrosis indices as well as non-invasive imaging are commonly used, but data on its performance among lean MASLD is still emerging. Diet and lifestyle measures remain the cornerstone of treatment with agents like Vitamin E, Saroglitazar and Resmetirom showing beneficial results. Several promising agents are in the therapeutic pipeline. Additional studies investigating disease pathogenesis, performance of diagnostic tests and treatment targets in lean MASLD are needed to improve long-term management of affected individuals.

Overweight and obesity are increasingly common amongst people with type 1 diabetes mellitus (T1DM). Low carbohydrate diets (LCDs) including intermittent fasting diets (IFDs) are popular in the general population, but the efficacy and safety of these diets for weight loss remains unclear in people with T1DM and overweight/obesity. It is also unclear whether eucaloric versus hypocaloric LCDs have a differential effect on metabolic and quality of life (QoL) outcomes.

This systematic review synthesised data from randomised and non-randomised interventional studies assessing the efficacy and safety of LCDs including IFDs in adults with T1DM; we included studies involving at least some participants with overweight/obesity. Co-primary outcomes included change in body weight/body mass index (BMI), HbA1c, and QoL measures. Secondary/exploratory outcomes included change in body composition, continuous glucose monitoring metrics, total daily insulin requirements, lipid profile, blood pressure, as well as adherence to the prescribed dietary regimen. The search yielded 3694 results, with 13 eligible papers (8 main papers, 5 sub-analyses). Meta-analysis was not possible due to study heterogeneity. Amongst the studies involving hypocaloric LCDs (n = 3, 2 studies involved IFDs), the majority reported significant reductions in body weight, but no significant change in HbA1c. Amongst the studies involving eucaloric LCDs (n = 5, no IFDs), the majority reported significant reductions in body weight and HbA1c. QoL measures were only available for the studies involving eucaloric LCDs, with no major adverse effects noted. None of the studies reported major safety issues.

The limited evidence available showed that the majority of studies involving eucaloric or hypocaloric LCDs reported beneficial effects on body weight. The majority of studies involving eucaloric (but not hypocaloric) LCDs reported a modest benefit on HbA1c and no adverse effects on QoL measures. To confirm and expand on the findings of this review, further high-quality, larger scale randomised controlled trials are required specifically in people with T1DM and overweight/obesity.

Automatic correction boluses (ABs) are a key feature of advanced hybrid closed-loop systems, yet their clinical relevance remains incompletely characterized.

We retrospectively analyzed insulin delivery and continuous glucose monitoring (CGM) data from 287 individuals with type 1 diabetes using the MiniMed 780G for ≥6 months with ≥80% auto-mode usage, recruited from four diabetes centers in Sicily. We quantified the contribution of ABs to total daily insulin dose (TDD) and total bolus insulin and evaluated associations with demographic factors, pump settings, and dietary habits using multivariate regression and receiver operating characteristic (ROC) analyses.

ABs accounted for 18.3% of TDD and 33.1% of total bolus insulin. AB/TDD was higher in pediatric participants and inversely associated with diabetes duration and AID use. Active insulin time and carbohydrate intake independently predicted AB/TDD. Higher AB/TDD was associated with lower time in range, higher glucose variability, time above range, and GMI; in pediatric participants, it was also associated with reduced time below range. An AB/TDD ≤20.3% predicted TIR >70% (AUC 0.785) and ≤18.6% predicted GMI <7% (AUC 0.828).

ABs represent a substantial component of insulin delivery in MiniMed 780G users. Higher AB contribution is associated with poorer glycemic outcomes. Identified thresholds may support system optimization in clinical practice.

The combined prevalence of heart failure (HF) with coronary atherosclerosis is frequent and often causally linked. The aim of this review is to elucidate whether lipid lowering drugs (LLDs) are useful in this context. The role of LLDs is interesting in two ways: incidence of HF patients treated with LLD versus outcomes in patients with a history of HF. Rosuvastatin and alirocumab have been tested in outcome trials specifically on patients with HF, the results are neutral since no benefit arose. To the contrary, use of statins in individuals without HF at baseline has been demonstrated to weakly but significantly reduce the incidence of HF. Overall, there is no notion that statins or other LLD are harmful in patients with HF. We will discuss the contribution of systemic inflammation and consider ischaemic versus non-ischaemic HF. We conclude that in contrast to other comorbidities like e.g. type 2 diabetes mellitus (T2DM), in HF we face a below-than-average efficacy of LLDs in terms of reducing hard cardiovascular endpoints.