Autonomic painful diabetic gastropathy is an uncommon and often overlooked cause of recurrent abdominal pain in individuals with diabetes. We describe a young man with type 1 diabetes who developed repeated episodes of severe epigastric pain and vomiting after a traumatic event, with all routine investigations failing to identify a structural, metabolic, or functional cause. His symptoms were resistant to standard therapies but showed rapid and sustained improvement with centrally acting sympatholytic treatment, and autonomic testing later supported underlying dysautonomia. This case highlights the importance of considering autonomic gastrointestinal involvement in unexplained, recurrent abdominal pain in diabetic patients, as early recognition can guide targeted therapy and help avoid unnecessary investigations and hospitalizations.

Bullying may have a considerable negative impact on health and well-being. Nevertheless, there is a lack of studies investigating exposure to bullying in the general population. Thus, we aimed to assess the prevalence of lifetime exposure to bullying in the adult Norwegian population and to compare health-related quality of life (HRQoL), and physical and psychological health problems between bullied and non-bullied.

We measured lifetime exposure to bullying in the general Norwegian population using a self-report questionnaire. The study was part of a cross-sectional national health survey (n = 1733) conducted in 2014-2015, to which a probability sample of people in the general population was recruited. Reports on socio-demographic data, HRQoL and a wide range of mental and somatic health problems provided the basis for a comparison of those who were bullied with those who were not. Chi square tests and logistic regression analyses were used to assess associations with lifetime exposure to bullying.

Across age groups, 28.2% reported exposure to bullying during their lifespan. Adjusted for other variables, the odds of bullying were higher in younger age groups, for those who lived as singles, and for those who were not working or in education. Respondents who had been bullied reported more mental problems such as depression, anxiety, insomnia, eating disorder, psychosis, self-harm, and suicide attempts, and they had lower HRQoL. They also reported more chronic pain, fibromyalgia, rheumatoid arthritis, diabetes mellitus, obesity, and musculoskeletal-, respiratory- and gastrointestinal diseases than people who had not been exposed to bullying.

Bullying is common in the general Norwegian population, where more than a quarter of respondents had experienced exposure to bullying during their lifespan. Substantial more mental and somatic health problems among those exposed to bullying require a broad effort against bullying in central arenas in society.

Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease (ESRD) worldwide. Blood pressure variability (BPV), especially diastolic BPV (DBPV), is closely linked to renal microcirculation but remains understudied in DKD. This study aimed to evaluate the association of DBPV with renal progression, identify an optimal risk threshold, and explore antihypertensive drug implications.

We conducted a retrospective cohort study of 2,143 DKD patients who underwent 24-hour ambulatory BP monitoring (ABPM) between 2018 and 2022, with a median follow-up of 4.8 years. Multiple DBPV parameters including standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and nocturnal dipping were analyzed. Dynamic changes in DBPV were assessed in 1,328 patients with serial ABPM data.

After full adjustment, 24-hour DBP ARV was the strongest predictor of renal outcomes. Each 1 mmHg increase was associated with 18% higher odds of rapid estimated glomerular filtration rate (eGFR) decline (OR = 1.18, 95%CI:1.13-1.23), 22% higher ESRD risk (HR = 1.22, 95%CI:1.15-1.29), and 20% higher composite renal event risk (HR = 1.20, 95%CI:1.14-1.26). ROC analysis determined the optimal threshold of 24-hour DBP ARV for ESRD prediction as 10.2 mmHg (sensitivity=76.2%, specificity=61.8%), above which ESRD risk increased 3.1-fold. Patients with increased DBPV over time had a 2.4-fold higher ESRD risk than those with decreased DBPV. Calcium channel blockers (CCBs) were associated with lower DBP ARV than RAAS inhibitors or beta-blockers. Adding 24-hour DBP ARV to traditional risk models significantly improved ESRD prediction (C-statistic: 0.73 to 0.80). The association was stronger in patients with advanced DKD or severely increased albuminuria, and combined high DBP ARV and SBP ARV conferred a 4.5-fold higher ESRD risk.

24-hour DBP ARV (threshold 10.2 mmHg) is an independent predictor of renal progression in DKD. Rising DBPV amplifies renal risk, and CCBs may better reduce DBPV. Incorporating ABPM-derived DBPV into DKD management improves risk stratification and supports personalized interventions.

Adverse birth outcomes (ABOs) are major public health concerns. While maternal steroid hormones are essential for fetal development, their individual and combined effects on ABO remain unclear.

This prospective cohort study included 364 pregnant women (30.7 ± 4.0 years) in Guangzhou, China. Nineteen steroid hormones were measured by LC-MS/MS. Regression and Qgcomp models were used to assess individual and combined associations with ABO, including low birth weight, macrosomia, small for gestational age (SGA), large for gestational age, and preterm birth.

Pregnant women with ABO had higher levels of androstenedione (A4) and testosterone (T) and lower levels of 11-deoxycortisol (11-DOF) and estriol (E3). In linear regression models, each 1-SD increase in cortisol (F) was associated with increases of 0.18 cm (95% CI: 0.02, 0.34) in birth length and 0.24 cm (95% CI: 0.04, 0.44) in head circumference, whereas estrone (E1) was inversely associated with gestational age (-0.20 weeks, 95% CI: -0.36, -0.05). In logistic regression analyses, each 1-SD increase in A4 (OR = 1.36, 95% CI: 1.07, 1.72), T (OR = 1.37, 95% CI: 1.08, 1.73), and dihydrotestosterone (DHT) (OR = 1.32, 95% CI: 1.03, 1.69) was associated with higher odds of ABO, whereas 11-DOF was inversely associated with ABO (OR = 0.70, 95% CI: 0.50, 0.98). For SGA, each 1-SD increase in A4 (OR = 1.40, 95% CI: 1.01, 1.94) and T (OR = 1.47, 95% CI: 1.08, 1.99) was associated with increased risk, whereas F (OR = 0.84, 95% CI: 0.72, 0.97) and 11-DOF (OR = 0.58, 95% CI: 0.35, 0.95) were inversely associated. In Qgcomp analyses, the androgen mixture was associated with ABO (OR = 1.40, 95% CI: 1.00, 1.97) and SGA (OR = 1.77, 95% CI: 1.04, 3.01), with A4 and T contributing the largest weights. Consistent directional patterns were observed for androgen-related hormones across outcomes and analytical approaches.

Maternal hormonal milieu in early pregnancy may be associated with fetal growth and ABO risk, with consistent patterns for androgen-related hormones. These findings are exploratory and require validation in larger cohorts.

This study aimed to examine the relationship between foot care behaviours, self-efficacy and diabetes self-care activities among individuals with and without diabetic foot wounds and to identify associated sociodemographic and disease-related factors.

A cross-sectional study was conducted with 120 patients presenting to the internal medicine, endocrinology, and diabetic foot outpatient clinics and wards of three different hospitals. Data were collected using a demographic and clinical characteristics form, the Foot Care Behaviour Scale, Diabetic Foot Care Self-Efficacy Scale, and Diabetes Self-Care Scale. Data were analysed using IBM SPSS version 22, with Mann-Whitney U, Kruskal-Wallis H, independent samples t-test, ANOVA and correlation analysis applied as appropriate.

Patients with and without diabetic foot wounds did not differ significantly in foot care behaviours or diabetes self-care scores (p > 0.05). However, diabetic foot care self-efficacy scores were significantly higher among patients without diabetic foot wounds (p < 0.05). In patients with diabetic foot wounds, prior foot care education was associated with significantly higher diabetic foot care self-efficacy and diabetes self-care scores (p < 0.05). Older age was negatively correlated with scale scores in both groups, whereas higher education level and certain preventive practices (e.g., foot self-examination, checking footwear) were significantly associated with better scores. Strong positive correlations were identified among foot care behaviours, diabetic foot care self-efficacy, and diabetes self-care across all participants (p < 0.05).

The strong positive associations among foot care behaviours, diabetic foot care self-efficacy, and diabetes self-care underscore the critical role of patient empowerment in disease management. The higher self-efficacy scores in patients without diabetic foot and those who were previously educated on their prevention demonstrate the importance of early, targeted nursing interventions. Implementing structured foot care education prior to the onset of complications may strengthen patient self-efficacy, improve self-care adherence and ultimately prevent the development of diabetic foot wounds.

The aim of this study was to identify the sociodemographic and systemic risk factors associated with diabetic retinopathy (DR) across varying durations of diabetes mellitus (DM) and to evaluate the potential effect of anemia on the occurrence of DR.

The retrospective cross-sectional study was based on the National Health and Nutrition Examination Survey (NHANES) 2005-2020, which included a total of 2,487 participants with Type 2 diabetes mellitus. Individuals were stratified into two groups based on DM duration: group 1 (≤ 10 years) and group 2 (> 10 years). Univariate weighted logistic regression and weighted multivariate logistic regression with adjustment for covariates (Models 1-3) were used to explore the risk of DR occurrence across different DM durations, as well as the synergistic effect of DM duration and anemia on DR occurrence.

Weighted univariate logistic regression analysis revealed that insulin use, diabetic nephropathy (DN), and education level were significantly associated with DR across both DM duration groups. In group 1, factors such as hemoglobin A1c, total cholesterol, low-density lipoprotein cholesterol, and fasting plasma glucose were positively correlated with DR, whereas an earlier age of DM diagnosis and higher family income were protective factors. In group 2, anemia and urinary albumin-to-creatinine ratio were positively associated with DR, whereas eGFR was negatively associated with DR (all p < 0.05). A DM duration of > 10 years is an independent risk factor for DR (Model 3: OR = 1.53, 95% CI 1.08-2.16, p = 0.017). The combination of prolonged DM duration and anemia significantly increased the risk of DR, with a synergistic effect observed even after full adjustment (Model 3: OR = 2.24, 95% CI 1.30-3.84, p = 0.004).

Sociodemographic and systemic risk factors for DR vary across DM duration groups. Insulin use, DN, and education level were significantly associated with DR in all DM duration groups. Notably, the combination of prolonged DM duration (> 10 years) and anemia significantly increased the risk of DR, demonstrating a synergistic effect.

Cachexia and sarcopenia are prevalent, inflammation-linked syndromes in chronic liver disease that worsen outcomes. To our knowledge, their coexistence in a single chronic liver disease cohort has not been systematically examined. In this study, we evaluated the prevalence, clinical features and prognostic impact of cachexia and sarcopenia-alone and combined-in chronic liver disease.

We retrospectively screened 776 patients with liver cirrhosis (LC) and/or hepatocellular carcinoma (HCC) at Hokkaido University Hospital (August 2014-May 2025). The inclusion criteria were grip strength, CT-based muscle mass and complete clinical data, yielding 307 patients; 469 did not meet one of the inclusion criteria. Cachexia was determined following the Asian Working Group for Cachexia criteria, and sarcopenia was determined following Japan Society of Hepatology guidelines. Patients were grouped as no cachexia/sarcopenia, cachexia only, sarcopenia only or cachexia+sarcopenia. The outcomes were overall survival, time to liver-related events and time to readmission (Kaplan-Meier and Cox-proportional models).

Among 776 patients, 307 were included in the final-analysis. Of 307 patients, 206 (67.1%) were male, the median age was 70 years (range, 19-90 years), 262 patients (85.3%) had LC and 188 patients (61.2%) had HCC. The patients were grouped as no cachexia/sarcopenia (213; 69.4%), cachexia only (54; 17.6%), sarcopenia only (17; 5.5%) and cachexia+sarcopenia (23; 7.5%). The combined group compared with the others had the lowest body mass index, psoas-muscle-index and grip strength (all p < 0.001). Overall survival (OS), liver-related events, LC progression and readmissions were compared between 246 patients with and without cachexia or sarcopenia, after excluding those who visited the hospital on or after July 2023 and had ≤ 3 months of follow-up. OS was shorter in the cachexia only (median 61.8 [95% CI 40.90-not reached (NR)] months, p = 0.046) and cachexia+sarcopenia (median 59.6 [95% CI 14.26-NR] months, p = 0.027) groups than in the no cachexia/sarcopenia group. Multivariable analysis showed that cachexia+sarcopenia (hazard ratio 2.48, p = 0.010), HCC (hazard ratio 3.40, p < 0.001) and diabetes mellitus (hazard ratio 1.80, p = 0.013) independently predicted mortality. The combined group compared with the other groups had a shorter time to liver-related events and readmission.

The coexistence of cachexia and sarcopenia-rather than either alone-can be used as an indicator for identifying patients with chronic liver disease at the highest risk of poor outcomes. Concurrent assessment and early, targeted interventions may improve outcomes in this population.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is commonly associated with obesity, insulin resistance, and type 2 diabetes mellitus (T2DM). Cushing's syndrome (CS), defined by chronic hypercortisolism, shares overlapping metabolic features with MASLD. However, the relationship between CS and MASLD remains underexplored. This study aimed to investigate the prevalence of hepatic steatosis and fibrosis in patients with CS using FibroScan and to examine their relationship with clinical and metabolic parameters.

This cross-sectional study included 44 patients with endogenous CS, along with 52 age-, sex-, and BMI-matched controls and 44 age- and sex-matched controls. Hepatic steatosis and fibrosis were assessed by controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) using vibration-controlled transient elastography.

MASLD was present in 56.8% of CS patients, with moderate-to-severe steatosis in 47.7%. CAP and LSM values were comparable between CS and metabolically matched controls, but CAP was higher than in healthy controls. CAP positively correlated with body mass index (BMI), waist circumference, triglycerides, and 24-hour urine cortisol (UFC), and negatively with growth hormone. LSM was positively correlated with BMI and GGT. No correlations were found with fasting glucose, HbA1c, or serum cortisol. Multivariate analysis identified UFC as an independent predictor of CAP, while BMI and GGT independently predicted LSM.

Hepatic steatosis was frequent in CS and similar to metabolically matched individuals, but more common than in healthy controls. UFC, BMI, and waist circumference contribute to liver fat accumulation, while diabetes was not an independent predictor of steatosis in CS.

Orthostatic hypotension (OH) is associated with adverse cardiovascular outcomes and may reflect underlying autonomic and vascular dysfunction. Arterial stiffness is a key determinant of cardiovascular risk; however, its relationship with OH in patients with diabetes mellitus (DM) remains unclear.

To evaluate factors associated with OH and investigate the relationship between arterial stiffness parameters and OH in patients with DM.

This single-center cross-sectional study included 193 patients with DM. Orthostatic blood pressure was measured in the supine position and 3 min after standing. Arterial stiffness was assessed using oscillometric pulse wave velocity (PWV) and related parameters with the Mobil-O-Graph device. Clinical, laboratory, and medication data were analyzed. Logistic regression analyses were performed to identify factors associated with OH.

OH was present in 56 patients (29%). Patients with OH had significantly higher central blood pressure and arterial stiffness parameters, including PWV, augmentation pressure, and augmentation index. In multivariate analysis, female sex, older age, diabetic neuropathy, and PWV were independently associated with OH. PWV remained significantly associated with OH after adjustment for confounders. No significant differences were observed between groups regarding antihypertensive medication classes.

In patients with DM, OH is independently associated with increased arterial stiffness and diabetic neuropathy. These findings suggest a link between orthostatic blood pressure dysregulation and adverse vascular characteristics. Prospective studies are needed to clarify causal relationships and clinical implications.

To identify patterns of complication burden among individuals with diabetes mellitus based on sociodemographic, behavioral, and clinical characteristics, and to examine their co-occurrence with diabetes-related comorbidities.

This cross-sectional study was conducted during a diabetes health campaign in a municipality in southern Bahia, Brazil, involving 1,542 patients. Data were obtained through a standardized questionnaire and ophthalmological examinations. Latent class analysis was applied to identify subgroups with similar clinical characteristics. Models with two to four classes were estimated, with the two-class model presenting the most parsimonious and interpretable solution according to BIC. Associations between classes and comorbidities were estimated using Poisson regression with robust variance, adjusted for age and sex.

Two classes were identified. Class 1 (86.6%) showed lower complication burden, with preserved vascular and sensory function. Class 2 (13.4%) was characterized by a higher frequency of ulceration, amputation, absent peripheral pulses, and impaired protective sensation. Individuals in Class 2 presented higher prevalence of cardiovascular disease (PR = 1.47), myocardial infarction (PR = 1.64), neurological disease (PR = 1.67), and retinopathy (PR = 1.63).

The identified classes primarily reflect differences in peripheral complication burden, with higher co-occurrence of vascular and microvascular conditions in the more affected group. These findings describe patterns of complication clustering within a screening population and may support population-level strategies for identifying individuals with greater healthcare needs.