Incorporating geographically diverse populations into real-world evidence studies is essential for generating globally applicable insights. However, many African healthcare institutions operate highly customized electronic medical record systems that lack interoperability with international data networks. This paper describes a collaborative implementation to transform legacy electronic medical record data into the OMOP Common Data Model at the Joint Clinical Research Centre (JCRC) in Uganda, enabling participation in federated real-world evidence networks.

A tri-partite collaboration was established between JCRC, IQVIA, and Gilead Sciences. The project was executed in three phases: (1) data assessment and architecture design, (2) extract, transform, and load execution and custom terminology mapping, and (3) validation of the transformed data through a cohort characterization study. JCRC's Integrated Clinical Enterprise Application (ICEA) database, containing over 48,000 patient records, was assessed and transformed to OMOP CDM v5.4. Following conversion, a descriptive observational study characterized four cohorts: all patients, people with HIV (PWH), hepatitis B virus (HBV)-infected, and hepatitis C virus (HCV)-infected patients.

The source database comprised 168 tables and 1,894 fields with no standardized medical coding systems -100% custom terminology- requiring manual mapping. Over 100 h of collaborative mapping achieved 95% data capture for core domains. A total of 48,748unique patients were successfully mapped to the OMOP CDM. The cohort characterization demonstrated the utility of the transformed data, revealing: HIV prevalence of 38.1% (n = 18,588); HBV prevalence of 7.0% (n = 3,423); and no HCV-infected patients identified. People with HIV demonstrated high care engagement (95.9% on antiretroviral therapy, a median of 25 visits per patient over a median follow-up of 7.6 years). Key data gaps included limited documentation of non-communicable diseases and mortality. Critical lessons included the need for detailed column-level data dictionaries and structured capacity building for local OMOP sustainability.

This collaboration demonstrates that full OMOP CDM implementation is feasible in highly customized data environments when built on a collaborative design that combines local clinical expertise with global technical support. The project successfully positioned JCRC to engage with OHDSI's federated ecosystem and provides a replicable model for other African institutions seeking to generate representative real-world evidence at scale.

This study investigates the role of cytochrome P450 2C19 (CYP2C19) gene polymorphisms and dyslipidaemic metabolism in ischemic cerebrovascular disease among Mongolian patients, analyzing their interaction with conventional risk factors. This case-control study enrolled 300 patients with ischemic cerebrovascular disease: 150 Mongolian patients (observation group) receiving CYP2C19 genotype-guided treatment and 150 Han Chinese patients (control group) undergoing standard care. Baseline characteristics, lipid profiles, CYP2C19 genotypes, NIHSS, and activities of daily living scores were analyzed. Baseline characteristics and CYP2C19 genotype distributions showed no significant differences between groups (P > .05). Multivariate logistic regression revealed that the poor metaboliser phenotype significantly increased the risk of ischemic cerebrovascular disease odds ratio (OR) = 2.31, 95% confidence interval: 1.25-4.26, P = .008), alongside hypertension (OR = 1.87, P = .043) and diabetes mellitus (OR = 2.12, P = .024). Dyslipidaemia prevalence was marginally but not significantly higher across genotypes in the Mongolian group. After 3 months of treatment, the genotype-guided observation group exhibited significantly greater reductions in total cholesterol and low-density lipoprotein cholesterol, and a slight increase in high-density lipoprotein cholesterol (P < .05). Furthermore, the observation group demonstrated significantly superior neurological recovery National Institutes of Health Stroke Scale and improved daily functioning (ADL) compared to the control group (P < .001). CYP2C19 poor-metaboliser status is associated with an increased risk of ischemic cerebrovascular disease in the Mongolian population and may contribute to dyslipidaemia and treatment response heterogeneity. Individualised intervention guided by CYP2C19 genotyping offers potential benefits in improving lipid profiles, neurological function, and short-term outcomes, serving as a valuable tool for precision medicine in this population.

Chronic kidney disease (CKD) is a major global health burden characterized by progressive loss of renal function and high cardiovascular morbidity and mortality. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, initially developed as glucose-lowering agents, have demonstrated pleiotropic metabolic and cardiorenal benefits. However, previous evidence syntheses have not fully clarified the magnitude of metabolic, hemodynamic, renal surrogate, and safety effects specifically in patients with diabetic CKD.

A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted up to December 2025. Randomized controlled trials (RCTs) evaluating SGLT2 inhibitors in patients with diabetic CKD were included. Outcomes were prespecified and grouped as primary renal surrogate marker outcomes (eGFR and UACR), secondary metabolic and hemodynamic outcomes (glycated hemoglobin, body weight, and blood pressure indicators), and safety outcomes (urinary tract infection and volume depletion-related adverse events). Meta-analyses were performed using RevMan 5.3 and R version 4.4.2 software.

A total of 17 randomized controlled trials involving 29,192 participants were included. For secondary metabolic and hemodynamic outcomes, SGLT2 inhibitors significantly reduced glycated hemoglobin levels (MD = -0.40%, 95% CI: -0.44 to -0.36), body weight (MD = -1.36 kg, 95% CI: -1.55 to -1.18), and systolic blood pressure (MD = -2.98 mm Hg, 95% CI: -3.44 to -2.52). For primary renal surrogate marker outcomes, no statistically significant differences were observed in eGFR (MD = 0.25 mL/min/1.73 m2, 95% CI: -0.08 to 0.57) or UACR (MD = -31.55 mg/g, 95% CI: -137.21 to 74.12). Regarding safety outcomes, SGLT2 inhibitors did not significantly increase the risk of urinary tract infections (RR = 1.20, 95% CI: 0.94 to 1.54) but were associated with a significantly higher risk of volume depletion-related adverse events (RR = 1.36, 95% CI: 1.16-1.59).

In patients with diabetic CKD, SGLT2 inhibitors significantly improve glycemic control, reduce body weight, and lower systolic blood pressure, while showing neutral short- to medium-term effects on eGFR and albuminuria. These neutral surrogate-marker findings should be interpreted alongside large outcome trials showing long-term cardiorenal protection. Although SGLT2 inhibitors increase the risk of volume depletion-related adverse events, their overall safety profile remains acceptable with appropriate clinical monitoring.

To investigate the predictive value of non-high-density lipoprotein cholesterol (non-HDL-C) and remnant cholesterol (remnant-C) for the progression of non-culprit coronary lesions with quantitative flow ratio ≤ 0.80. A total of 214 patients with coronary artery disease undergoing percutaneous coronary intervention from January 2022 to March 2024 were consecutively enrolled, with 321 non-culprit lesions. All patients completed at least 24 months of clinical follow-up. Based on follow-up quantitative coronary angiography assessment, patients were divided into lesion progression and non-progression groups. Baseline clinical data, laboratory parameters, and coronary angiography characteristics were collected. Univariate and multivariate logistic regression analyses were performed to assess the independent predictive value of non-HDL-C and remnant-C for lesion progression. Predictive performance was compared using receiver operating characteristic curves, and subgroup analyses were conducted. During follow-up, 62 patients (29.0%) experienced non-culprit lesion progression. The median angiographic follow-up interval was 14.2 months (interquartile range, 10.8-18.1; range, 6.1-23.8) overall and did not differ significantly between the progression and non-progression groups (14.6 vs 14.0 months, P = .47). Multivariable logistic regression showed that, after adjustment for prespecified clinical covariates, both non-HDL-C (odds ratio = 1.68, 95% confidence interval: 1.22-2.31, P = .001) and remnant-C (odds ratio = 1.52, 95% confidence interval: 1.24-1.86, P < .001) were independently associated with lesion progression. The apparent areas under the curves were 0.72 for non-HDL-C and 0.70 for remnant-C; after adding clinical variables, the apparent areas under the curves were 0.84 and 0.83, respectively. Numerically larger effect estimates were observed in patients with diabetes mellitus, multivessel disease, and renal dysfunction, but all interaction P values were >.05. Non-HDL-C and remnant-C are independent predictors of progression of non-culprit coronary lesions with quantitative flow ratio ≤ 0.80. Combining them with traditional risk factors significantly improves predictive performance, offering clinical value for high-risk patient identification and secondary prevention optimization.

Adults with diabetes mellitus are at increased risk of vaccine-preventable infections and complications. Despite recommendations for adult immunization, uptake remains suboptimal in many low- and middle-income countries, including the Philippines, where data remain limited. This cross-sectional study assessed adult immunization coverage and associated clinical and sociodemographic factors among Filipino adults with diabetes recruited from inpatient, outpatient, and community outreach settings at a tertiary hospital. Uptake of influenza, pneumococcal, herpes zoster, hepatitis B, tetanus-diphtheria-pertussis (Td/Tdap), and COVID-19 vaccines was evaluated using prespecified operational definitions. Crude associations and parsimonious multivariable logistic regression models were examined; COVID-19 vaccination was not modeled because only six participants were unvaccinated. Among 284 participants (mean age 61.5 ± 12.7 y, 55.6% females), uptake was 44.4% for influenza, 49.6% for pneumococcal, 18.1% for herpes zoster, 15.5% for hepatitis B, 23.2% for Td/Tdap, and 97.9% for the primary COVID-19 series. Males had lower adjusted odds of influenza and pneumococcal vaccination, while increasing age was associated with pneumococcal uptake. Middle and high household income and diabetes duration of 5-10 y were associated with influenza vaccination. Among adults aged ≥50 y, male sex and high income were associated with herpes zoster vaccination. High income was also associated with hepatitis B and Td/Tdap uptake. Provider recommendation was associated with all outcomes, while lack of provider recommendation, failure to prioritize vaccination, and financial constraints were common reasons for non-vaccination. Uptake was uneven and low for most recommended adult vaccines. Integrating vaccine assessment and counseling into diabetes care while addressing financial and access barriers may improve uptake.

Diabetic foot osteomyelitis (DFO) is a serious complication of diabetic foot ulcers and is associated with increased risk of amputation, morbidity, and mortality. Bone biopsy remains the most definitive diagnostic modality, yet controversy persists over its diagnostic utility This study reviews the diagnostic concordance of histopathology and microbiology in bone biopsy specimens from patients with DFO and examines the clinical implications of the findings.

A systematic review was conducted using PubMed, Medline, CINHAL, Cochrane Library, and Google Scholar. Studies included adult patients with DFO in whom bone biopsy specimens underwent both histopathological and microbiological analysis. Five core studies met the eligibility criteria. Data on study design, setting, population, diagnostic methods, concordance rates, and outcomes were extracted and synthesized utilising a quantitative narrative synthesis.

Across the five studies (n = 308 patients), histopathology and microbiology showed modest concordance, with mean rates of concordant positive results of 43.4% and common discordant findings. Histopathology demonstrated higher specificity, while microbiology had higher sensitivity, ranging from 70% to 83.9% but greater susceptibility to contamination. Positive histopathology was more strongly associated with the need for revision surgery or extended antibiotic therapy.

Histopathology appears to offer superior diagnostic specificity, whereas microbiology provides valuable information for antimicrobial management. Frequent discordance underscores the importance of interpreting results in a clinical context. Further robust, prospective studies are needed to clarify the optimal diagnostic approach and standardise definitions.

The risk of diabetic microvascular complications is well established among smokers with type 2 diabetes. However, whether and to what extent this excess risk declines according to smoking cessation duration remains unclear.

To investigate the association between smoking cessation duration and the risk of incident diabetic microvascular complications in patients with diabetes.

This nationwide, population-based cohort study included participants first diagnosed with type 2 diabetes in Korea between 2003 and 2013 and whose smoking status was assessed at least 4 times across repeated health checkups, with a final checkup during 2009 to 2013. Data were analyzed from November 10, 2025, to April 16, 2026.

Smoking status and cessation duration. Quitters were defined as participants who reported current smoking at their initial health checkup and reported smoking cessation at all subsequent checkups without relapse. Continuous smokers were defined as participants who consistently reported current smoking at every health checkup. Among quitters, smoking cessation duration was categorized as less than 2, 2 to 3, 4 to 5, 6 to 7, and 8 or more years.

Outcomes of interest were incident diabetic microvascular complications, including diabetic nephropathy, retinopathy, and neuropathy, identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes. Cox proportional hazards models were used to estimate unadjusted and adjusted hazard ratios (aHRs) and 95% CIs.

A total of 209 698 adults (mean [SD] age, 57.2 [10.3] years; 127 823 [61.0%] female) were included in the analyses. Compared with continuous smokers, cessation for 8 or more years was associated with a lower risk of all microvascular complications (aHR, 0.81; 95% CI, 0.70-0.95), diabetic nephropathy (aHR, 0.79; 95% CI, 0.64-0.94), diabetic retinopathy (aHR, 0.59; 95% CI, 0.36-0.97), and diabetic neuropathy (aHR, 0.80; 95% CI, 0.66-0.98). Smoking cessation for 6 to 7 years was associated with lower risk of diabetic neuropathy (aHR, 0.76; 95% CI, 0.64-0.89). In subgroup analyses by sex, these associations were significant only among male participants (eg, all microvascular complications: aHR, 0.82; 95% CI, 0.70-0.95).

In this retrospective cohort study of patients with diabetes, smoking cessation for 8 or more years was associated with a lower risk of all diabetic microvascular complications, diabetic nephropathy, retinopathy, and neuropathy compared with continuous smoking. These associations were observed mainly among male participants, underscoring the potential importance of sustained long-term smoking cessation for microvascular risk reduction.

Cardiovascular (CV) risk factors improve with carbohydrate-reduced nutrition, but the impact on CV outcomes is unknown. We assessed the incidence of CV outcomes associated with a carbohydrate-reduced telemedicine intervention in a retrospective claims-based cohort study.

Adults with type 2 diabetes or obesity receiving individualized nutritional therapy (INT) between January 1, 2016 and June 1, 2025, were compared with propensity score-matched controls. Primary outcomes included (1) 3-point major adverse CV events (MACE), defined as nonfatal myocardial infarction, nonfatal stroke, or death from any cause (MACE-3); (2) 6-point MACE, adding percutaneous coronary intervention, hospitalization for heart failure or unstable angina (MACE-6); (3) all new-onset CV disease (CVD) events; and (4) new-onset hypertension.

In 4877 participants in each cohort (mean age, 51 [SD 9.5] years; 2939 [60.3%] female), INT was associated with lower risk of all primary outcomes. Incidence per 1000 person-years was 4.1 vs. 9.3 for MACE-3, 5.7 vs. 10.8 for MACE-6, 27.7 vs. 36.9 for all new-onset CVD, and 41.8 vs. 49.3 for new-onset hypertension. Hazard ratios were 0.44 (95% CI, 0.29-0.65; P < 0.001) for MACE-3, 0.52 (95% CI, 0.37-0.73; P < 0.001) for MACE-6, 0.70 (95% CI, 0.59-0.82; P < 0.001) for all CVD, and 0.81 (95% CI, 0.70-0.93; P < 0.001) for new-onset hypertension.

Individualized telemedicine nutrition therapy was associated with lower CV event incidence compared to controls, suggesting the intervention may confer cardioprotection.

Pediatric diabetic ketoacidosis (DKA) is life-threatening; traditional IV insulin risks hypoglycemia and electrolyte issues. We evaluated the efficacy and safety of continuous subcutaneous insulin infusion (CSII) combined with electrolyte supplementation in DKA.

Sixty-six patients were randomly assigned to the study group (CSII + electrolyte supplementation) or control group (intravenous insulin infusion + electrolyte supplementation). Overall efficacy, time to pH normalization, target blood glucose achievement, urine ketone clearance, levels of BUN, creatinine, potassium, FPG, 2hPG and sodium, inflammatory markers, acid-base balance indicators, and adverse reactions were compared.

Study group had higher overall efficacy (χ² = 5.121), shorter time to pH normalization, target blood glucose achievement, and urine ketone clearance (t = 8.023, 7.712, 7.438), lower BUN, creatinine, FPG, 2hPG, sodium, CRP, TNF-α, and IL-6 levels (t = 8.893, 15.816, 5.865, 12.267, 4.542, 3.626, 2.615, 5.746), higher serum potassium, CO₂CP, and blood pH levels (t = 9.737, 4.220, 17.78), and lower blood lactate levels (t = 6.922) and adverse reaction rates (χ² = 4.243) than the control group (all P < 0.05).

 CSII with electrolyte supplementation improves pediatric DKA treatment outcomes by regulating blood glucose and electrolytes, alleviating inflammation and acidosis, and reducing adverse reactions during treatment.

• Pediatric diabetic ketoacidosis (DKA) is a life-threatening acute complication of diabetes mellitus. • Traditional intravenous insulin infusion is the standard treatment but carries risks of hypoglycemia, hypokalemia, and other electrolyte disturbances. • Electrolyte supplementation is routinely used alongside insulin therapy to correct dehydration and metabolic imbalances in DKA.

• This study provides clinical evidence that continuous subcutaneous insulin infusion (CSII) combined with electrolyte supplementation is more effective than conventional intravenous insulin therapy in pediatric DKA. • CSII-based regimen achieved faster pH normalization, blood glucose control, and urine ketone clearance, with better improvements in renal function, inflammatory markers, and acid-base balance. • The CSII group also showed lower rates of adverse reactions, suggesting that this approach may offer a safer and more efficient alternative for managing pediatric DKA.

The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the consensus statement on the management of type 2 diabetes in non-pregnant adults, published since 2006 and last updated In 2022. The target audience is the multidisciplinary healthcare team providing diabetes care in the USA and Europe. A systematic examination of publications since 2022 informed new recommendations. This update has broadened the focus from the management of hyperglycaemia to the holistic management of type 2 diabetes and its risk of associated multiple long-term conditions. Fundamental aspects of diabetes care include promoting healthy lifestyle behaviours (healthy eating, 24 h physical behaviours including sleep, and avoiding tobacco and substance use), alongside the provision of psychological support and weight management interventions. For the management of people living with type 2 diabetes, earlier use, potentially from diagnosis, of sodium-glucose cotransporter 2 (SGLT2) inhibitors or/and glucagon-like peptide-1 (GLP-1)-based therapies to offer organ protection and improve long-term outcomes in type 2 diabetes is advocated. Furthermore, earlier combination use of SGLT2 inhibitors and GLP-1-based therapies should be considered in people with concomitant CVD, chronic kidney disease and heart failure. Finally, the ability to transform outcomes for people living with type 2 diabetes is within our grasp through the consistent, equitable and systematic implementation of strategies and therapies that are already available.