The management of treatment strategies in COVID-19 is critical, especially in patients with type 2 diabetes. Non-enzymatic glycation of transmembrane protease serine 2 and angiotensin-converting enzyme 2 during COVID-19 in patients with diabetes may exacerbate immune dysregulation and inflammation. Elevated inflammatory cytokines such as IL-1, IL-2, IL-6, IL-7, and IL-10, tumor necrosis factor-α, interferon-γ, granulocyte-macrophage colony-stimulating factor, and monocyte chemoattractant protein-1 have been observed in COVID-19 patients. This review aims to assess the relationship between inflammatory markers, including C-reactive protein, and micronutrients (vitamins D and C, zinc, and copper) with the severity of COVID-19 infection in patients with type 2 diabetes. A narrative review was conducted through a comprehensive literature search of English-language articles published between 2000 and 2025. The databases searched included PubMed, Scopus, the ISI Web of Science, Cochrane, and Embase. Search terms included COVID-19, infections, type 2 diabetes mellitus, interleukins, and micronutrients. English-language scientific articles, systematic reviews, and meta-analyses were included, while studies lacking sufficient information, letters, comments, and editorials were excluded. Evidence suggests that immune-boosting components such as proteins, vitamins, and minerals can enhance immunity to infections. Vitamins D and C, zinc, and copper play supportive roles in immune function, potentially modulating the inflammatory response in COVID-19 patients with type 2 diabetes. High levels of inflammatory cytokines correlate with increased disease severity in this population. Understanding the interplay between inflammatory markers and micronutrients may guide improved therapeutic strategies for managing COVID-19 in diabetic patients. Further research is warranted to clarify these relationships and optimize clinical outcomes.

Cardiometabolic multimorbidity (CMM) is a growing concern as global population ages. Although baseline depression is a recognised risk factor for chronic diseases, the dynamic and cumulative effect of depression on CMM remains unclear. We aimed to evaluate the longitudinal association between long-term depressive burden and the risk of incident CMM.

This study included 51,416 participants from three large prospective cohorts conducted in China, the USA, and Europe. Incident CMM was defined as co-occurrence of two or more of heart disease, stroke, and diabetes. Long-term depressive burden was assessed by changes in depression and cumulative depressive scores during baseline and first follow-up assessments. Cox proportional hazards model, adjusted for sociodemographic, health status, and lifestyle behaviour factors, was performed to assess incident CMM associated with long-term depressive burden. Subgroup analyses by age and sex were further conducted to evaluate potential effect modification.

During the follow-up period, a total of 2,689 incident CMM cases were documented: 238 in China (average follow-up = 7.61 ± 2.18 years), 829 in the USA (6.81 ± 1.89 years), and 1,622 in Europe (6.00 ± 2.20 years). Depression progression was associated with elevated risks of incident CMM in China (hazard ratio (HR) = 1.474; 95% confidence interval (CI) = 1.002-2.168), the USA (HR = 1.325; 95% CI = 1.006-1.744), and Europe (HR = 1.456; 95% CI = 1.258-1.686). Conversely, depression remission correlated with a reduced risk in China (HR = 0.558; 95% CI = 0.357-0.874) and Europe (HR = 0.764; 95% CI = 0.633-0.923). The CMM risk increased with each SD increase in cumulative depressive scores. Sex was found to modify these associations in the USA and Europe, with a more pronounced impact in females.

Severe long-term depressive burden is associated with a higher risk of incident CMM, whereas remission from depression correlates with a relatively lower risk. These findings suggest that tracking the longitudinal dynamics of depression may serve as a valuable indicator for identifying individuals at an elevated risk of incident CMM.

This article describes how a structured lifestyle modification intervention for hypertension and diabetes was scaled within Kerala's health system, focusing on how implementation knowledge was generated and embedded in routine practice. Grounded in an implementation research approach, the work documents how evidence-informed strategies were continuously adapted through stakeholder engagement, peer-led delivery, and supportive institutional processes. Drawing on qualitative data from stakeholder consultations, document review, and field observations in Janakeeya Arogya Kendrams (basic unit of primary health care centres in Kerala), the article shows how local context, social learning, and power dynamics shaped iterative learning cycles. The findings outline key facilitators and barriers to knowledge use in practice. It offers practical insights for strengthening sustainable non-communicable disease prevention and control programmes in similar settings.

Introduction Cardiopulmonary bypass (CPB) has improved the safety and precision of complex cardiac surgery, but its inflammatory, embolic, and hemodynamic effects may contribute to postoperative acute kidney injury (AKI). This study explored whether longer CPB duration was associated with early postoperative AKI and related renal and clinical recovery outcomes in adult cardiac surgical patients. Methodology This prospective observational comparative study was conducted at the Department of Cardiac Surgery of the National Institute of Cardiovascular Diseases (NICVD) in Dhaka, Bangladesh, from July 1, 2022, to June 30, 2024. It included 100 adult cardiac patients aged 18-65 years who underwent cardiac surgery under CPB, selected by convenience sampling after ethical approval. Patients were divided into two equal groups after surgery according to recorded CPB duration: Group A included 50 patients with CPB time ≤120 minutes, while Group B included 50 patients with CPB time >120 minutes. Patients with pre-existing chronic kidney disease, kidney transplant history, emergency surgery, ejection fraction below 30%, previous cardiac surgery, or surgery without CPB were excluded. Results The two study groups were broadly comparable at baseline, with similar mean age (37.8±13.73 vs. 38.46±13.30 years; p=0.8), age distribution (p=0.93), gender distribution (male 58% vs. 52%; p=0.69), comorbidities, body mass index (BMI) profile, and underlying cardiac disease pattern. Smoking, hypertension, diabetes mellitus, and dyslipidemia were distributed without significant difference, while most patients in both groups had normal BMI, and isolated valvular heart disease was the commonest diagnosis. The intended difference between the groups was clearly established by CPB duration, with a mean CPB time of 93.00±11.42 minutes in Group A and 137.10±12.08 minutes in Group B (p<0.001). After surgery, patients with longer CPB time showed lower urine output at 24, 48, and 72 hours, with all differences reaching statistical significance (p<0.001). Although baseline serum creatinine was statistically insignificant (0.83±0.11 vs. 0.86±0.13 mg/dL; p=0.108), postoperative serum creatinine became significantly higher in Group B at 24, 48, and 72 hours (p<0.001). Postoperative AKI occurred in seven patients (14%) in Group A but in 23 patients (46%) in Group B, showing more than a threefold higher occurrence among patients with CPB time >120 minutes (p<0.001). Renal replacement therapy was required only in Group B in four patients (8%), and in-hospital mortality also occurred only in Group B in three patients (6%), though these differences were not statistically significant. Patients in the longer CPB group required longer mechanical ventilation (8.90±3.84 vs. 6.98±2.69 hours; p<0.001), longer ICU stay (10.15±4.68 vs. 4.87±1.58 days; p<0.001), and longer postoperative hospital stay (14.36±5.55 vs. 10.11±3.05 days; p<0.001). Conclusion Prolonged CPB time was significantly associated with greater early postoperative renal stress, higher AKI occurrence, and slower recovery, though the findings require cautious interpretation due to the single-center design, convenience sampling, short follow-up, and unadjusted perioperative factors.

Type 2 diabetes mellitus and metabolic dysfunction associated steatotic liver disease contribute to the growing burden of hepatocellular carcinoma, yet their effects on hepatic antitumor immunity remain incompletely defined. Recent single-cell and spatial profiling studies indicate that hepatocellular carcinoma contains diverse CD8⁺ T cell states, including cytotoxic, exhausted, tissue-resident, progenitor-like, and transitional phenotypes. This review synthesizes evidence linking hyperglycemia, insulin resistance, lipotoxic injury, chronic inflammation, fibrosis, altered antigen presentation, stromal remodeling, chemokine signaling, and nutrient availability to CD8⁺ T-cell remodeling in HCC arising in the context of metabolic dysfunction. Particular attention is given to GZMK⁺ CD8⁺ T cells, which may reflect non-terminal differentiation, inflammatory adaptation, or transitional immune states rather than conventional cytotoxic effector function. Although GZMK-high CD8⁺ T cell populations have been reported in hepatocellular carcinoma and therapy-associated immune contexts, direct evidence that type 2 diabetes induces these cells in the liver remains limited. This review specifically examines GZMK⁺ CD8⁺ T-cell states within the immunometabolic context of HCC, distinguishes direct hepatic and tumor evidence from extrapolated findings in metabolic liver disease and other inflammatory conditions, and proposes a testable framework for phenotypic, spatial, and functional validation. Integrated single-cell, spatial, protein level, T cell receptor clonality, functional, and clinical studies are needed to define their biological significance and translational value.

Physical activity (PA) is an important modifiable lifestyle factor associated with metabolic health and diabetes. This study examined the association between different levels of self-reported PA and prevalent self-reported diabetes among adults in the National Health and Nutrition Examination Survey (NHANES) 2005-2006 sample.

This cross-sectional secondary analysis included 8,174 adults aged 18 years or older from NHANES 2005-2006. PA was categorized as low (<150 minutes/week), moderate (150-300 minutes/week), or high (>300 minutes/week). Diabetes status was based on self-reported physician diagnosis. Logistic regression models were used to examine associations between PA level and prevalent self-reported diabetes with sequential adjustment for demographic characteristics, socioeconomic factors, and body mass index (BMI).

Overall, 650 participants (8.0%) had self-reported diabetes. Diabetes prevalence was 11.8% in the low PA group, 5.9% in the moderate group, and 5.7% in the high group. In the unadjusted model, moderate PA was associated with lower odds of diabetes (OR 0.47, 95% CI 0.36-0.61), as was high PA (OR 0.45, 95% CI 0.38-0.54). After adjustment for demographic and socioeconomic characteristics and BMI, the associations were attenuated but remained statistically significant for moderate activity (OR 0.75, 95% CI 0.57-0.99) and high activity (OR 0.81, 95% CI 0.66-0.99).

Moderate and high levels of self-reported PA were associated with lower odds of prevalent self-reported diabetes compared with low PA in the analyzed NHANES sample. Because of the cross-sectional design, temporality and causality cannot be established. Prospective studies using appropriate complex-survey methods are needed to further evaluate this association.

Young-adult stroke in the Arabian Gulf remains poorly characterized, despite a resident population dominated by South Asian labor migrants in whom cardiometabolic disease is often under-diagnosed. We therefore aimed to characterize the etiology and vascular risk-factor burden of young stroke in a single-center United Arab Emirates cohort, testing whether the recorded risk profile reflects true prevalence or diagnostic gaps. In this retrospective cohort study, we reviewed all patients aged 18-49 years with radiologically confirmed stroke admitted to a secondary-care hospital in Ras Al Khaimah between January 2020 and March 2026, applying adjudicated subtype classification, and used a pre-specified multivariable model to identify factors associated with ischemic presentation. Of 421 patients screened, 314 met criteria (mean age 41.0 years; 81.2% male; 65.6% South Asian). Objectively measured risk far exceeded documented history: only 49.0% had recorded hypertension, yet 74.5% had elevated admission blood pressure; dyslipidemia was documented in 15.9%, yet an abnormal lipid profile was found in 73.9% of those tested; and 29% of all diabetes was first diagnosed at the stroke admission. Small-vessel occlusion was the leading determined ischemic subtype, and diabetes was the only factor independently associated with ischemic stroke (adjusted OR 2.34, 95% CI 1.35-4.07). South Asian patients differed chiefly by sex and ischemic predominance rather than independent metabolic excess, indicating that ethnicity defined the exposed population while diabetes and hypertension were the operative mechanisms. We conclude that, in this workforce, the low recorded prevalence of vascular risk reflects widespread under-diagnosis, not low true prevalence-stroke was frequently the first presentation of unmanaged cardiometabolic disease, identifying accessible primary care and workplace screening as concrete prevention priorities.

Obesity is a well-established risk factor for diabetic chronic kidney disease (CKD), but the relationship between body mass index (BMI) and CKD risk remains inconsistent, with paradoxical findings in underweight individuals. These discrepancies may reflect age- and sex-related heterogeneity. Following the Lancet Commission recommendation to integrate adiposity measures, including BMI and waist circumference (WC), we assessed the association between adiposity and incident CKD by age and sex in Korean adults with type 2 diabetes mellitus (T2DM).

Using data from 1,824,317 adults aged ≥40 years with T2DM in the Korean National Health Insurance Service database (2015-2016), excluding those with proteinuria or impaired kidney function, participants were classified by combined BMI and WC as underweight (1.0%), no obesity (59.3%), and excess adiposity (39.6%). Incident CKD was defined by age-adjusted estimated glomerular filtration rate thresholds: new-onset eGFR <60 mL/min/1.73 m² (age 40-64) and eGFR <45 mL/min/1.73 m² (age ≥65).

During a 4-year follow-up, CKD incidence was 2.8%, 2.3%, and 2.9% across underweight, no obesity, and excess adiposity groups, respectively. Underweight was associated with a substantially greater risk of incident CKD than excess adiposity (OR 1.41, 95% CI 1.29-1.54 vs. OR 1.03, 95% CI 1.01-1.05). Age- and sex-stratified analyses revealed that underweight was associated with increased CKD risk across age and sex groups, particularly in middle-aged men, whereas excess adiposity was associated with increased risk in women but not in men.

In Korean adults aged ≥40 years with T2DM, underweight consistently predicted higher CKD risk, particularly in middle-aged men, whereas the association of excess adiposity with CKD differed by age and sex. These findings may help explain previously inconsistent associations between obesity and CKD risk.

Diabetic foot complications are a major cause of morbidity, disability, and amputation worldwide, yet many complications are preventable through effective self-care. Limited evidence is available on foot self-care knowledge and behaviours among adults with diabetes in Ras Al Khaimah, United Arab Emirates.

This study aimed to assess foot self-care knowledge and behaviours and identify factors associated with these outcomes among adults with diabetes mellitus in Ras Al Khaimah.

A cross-sectional study was conducted among 384 adults with diabetes attending selected primary healthcare centres and the Diabetes Centre at Ibrahim Bin Obaidullah Hospital in Ras Al Khaimah. Participants were selected using convenience sampling. Data were collected using a structured validated questionnaire comprising an eight-item knowledge scale and the 29-item Nottingham Assessment of Functional Foot Care. Data were analysed using SPSS version 22. Descriptive statistics, chi-square tests, multivariable logistic and linear regression analyses.

Most participants had poor foot-care knowledge (77.3%). Regarding foot self-care behaviours, 69.3% reported moderate behaviour, 26.0% poor behaviour, and 4.7% good behaviour. Knowledge category was significantly associated with foot self-care behaviour category (χ² = 9.784, p = 0.008; Cramer's V = 0.160). In multivariable logistic regression, females had lower odds of good knowledge than males (AOR = 0.45, 95% CI: 0.23-0.90, p = 0.023), and participants with type 2 diabetes had lower odds of good knowledge than those with type 1 diabetes (AOR = 0.43, 95% CI: 0.21-0.87, p = 0.020). In multivariable linear regression, female gender (B = 3.80, 95% CI: 1.99-5.61, p < 0.001), family history of diabetes (B = 1.89, 95% CI: 0.30-3.48, p = 0.020), and knowledge category (B = 1.83, 95% CI: 0.07-3.60, p = 0.041) were positively associated with foot self-care behaviour scores, while educational status (B = -1.57, 95% CI: -2.64 to -0.51, p = 0.004) and history of foot ulcer (B = -5.60, 95% CI: -7.81 to -3.38, p < 0.001) were negatively associated.

Gaps were identified in foot-care knowledge and self-care behaviours among participants. Factors associated with knowledge and foot self-care behaviours should be considered when developing targeted foot-care education and support for adults with diabetes in primary and secondary healthcare settings.

BACKGROUND We evaluated the effect of adjunctive anti-vascular endothelial growth factor (anti-VEGF) therapy on postoperative visual recovery and intraocular pressure in patients undergoing pars plana vitrectomy (PPV) for intravitreal hemorrhage as a complication of proliferative diabetic retinopathy. MATERIAL AND METHODS This retrospective observational cohort study included 149 eyes with proliferative diabetic retinopathy that underwent PPV at a tertiary ophthalmology center. Patients were divided into 2 groups according to the use of adjunctive anti-VEGF therapy: 33 eyes received anti-VEGF treatment and 116 underwent PPV without anti-VEGF administration. Best-corrected visual acuity (BCVA, logMAR), and intraocular pressure were assessed preoperatively and at 1 and 6 months after surgery. Changes in BCVA over time were analyzed using a linear mixed-effects model with time, anti-VEGF treatment, and their interaction as fixed effects and patient as a random effect. Arterial hypertension was included as a covariate. RESULTS At 1 month after surgery, patients receiving anti-VEGF therapy demonstrated significantly better BCVA values compared with untreated patients (P<0.05). However, no significant differences in BCVA were observed between groups after 6 months (P>0.05). In the adjusted mixed-effects model, follow-up time was significantly associated with BCVA improvement, whereas anti-VEGF treatment was not independently associated with visual outcomes, and no significant interaction between treatment and time was identified. No significant differences in intraocular pressure were observed between groups either before or after surgery. CONCLUSIONS Adjunctive anti-VEGF therapy may accelerate early visual recovery after PPV without influencing long-term visual outcomes or intraocular pressure, supporting its safety as a perioperative adjunct in vitreoretinal surgery.