To describe kidney health evaluation rates in patients with type 2 diabetes mellitus overall and compare outcomes by language preference.

Retrospective cohort analysis.

Adult patients with type 2 diabetes mellitus who had primary care visits between January 2021 and December 2022 at a large academic medical center with 15 primary care clinics in Boston, MA.  EXPOSURE(S)/PREDICTOR(S): Language preference as documented in the electronic health record, categorized as non-English language preference or English language preference.  OUTCOME(S): The primary outcome was evaluation of the Kidney Health Evaluation for Patients with Diabetes (KED) measure, defined as receiving both estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR) tests during 2023. The secondary outcome was cystatin C evaluation.

Generalized estimating equation logistic regression with clustering by primary care provider was used for adjusted analyses, controlling for patient demographics, clinical factors, medication use, and healthcare utilization. Stratified analyses examined outcomes by CKD severity, insurance status, and primary care engagement.

Overall, 88% of patients received eGFR evaluation, 57% received uACR evaluation, 56% achieved KED evaluation, and only 5.3% received cystatin C evaluation. Overall, there were no significant differences between NELP and ELP patients in any kidney health evaluation. However, stratified analyses revealed among patients with frequent engagement (≥ 4 visits), NELP patients received significantly more comprehensive screening than ELP patients (69% vs 64%, adjusted OR 1.22, 95% CI 1.01-1.48, p = 0.04).

Single-site study limiting generalizability. Electronic health record language preference may not reflect proficiency or language concordance.

While only half of patients received recommended kidney evaluation, language-based disparities were absent overall and reversed among highly engaged patients. These findings suggest misalignment between process measures and known downstream disparities in clinical outcomes. Our findings indicate missed opportunities for earlier detection and management of kidney disease.

Vascular tissue-resident macrophages (VRMs) maintain immune balance in blood vessels, but their role in abdominal aortic aneurysm (AAA) development remains unclear. Here we demonstrated that a specific group of VRMs located in the adventitia marked by expression of Lyve1, protected against AAA by secreting the extracellular matrix protein Sparcl1 (Sc1). Deletion of Sc1 in VRMs promoted dysfunctional lymphangiogenesis and led to the formation of tertiary lymphoid structures (TLSs), thereby accelerating AAA progression. Mechanistically, the calcium-binding domain of Sc1 acted as a trap for the growth factor FGF2, inhibiting FGF2-mediated dysfunctional lymphangiogenesis and expression of genes associated with TLS formation. A therapeutic peptide derived from Sc1 (Spa17) mitigated AAA progression in several AAA models. Our findings reveal that VRM-derived Sc1 has a protective role in AAA and identify a potential therapeutic approach.

Alzheimer's disease (AD) and Diabetes Mellitus Type II (DM2) share overlapping biological mechanisms, and diabetes increases the risk of developing AD. Treatments that modify the course of diabetes, such as metformin and semaglutide, have been proposed to protect the brain, but their effectiveness in preventing AD remains uncertain. This study aimed to systematically compare the potential of diabetes therapies to reduce the risk of AD.

We developed an integrative framework combining comparative network pharmacology to evaluate 39 diabetes therapies in relation to AD. The analysis examined how each treatment influenced shared molecular pathways between the two conditions and measured their comparative impact score and validated key findings using gene expression data.

Here we show that metformin is the most promising therapy for protection against AD, while semaglutide ranks among the least effective, based on comparative analysis within the DM2-AD pathway-pathway comorbidity network. Metformin's effects are mediated through AMPK, insulin, and adipocytokine signaling, that influence key Alzheimer's-related processes. In contrast, semaglutide, despite its growing clinical prominence as a weight loss therapy, exhibits minimal engagement with core neurodegenerative pathways within the DM2-AD comorbidity network. Certain combination therapies, such as insulin glargine with lixisenatide and insulin degludec with liraglutide, display effects comparable to metformin.

These findings reveal that diabetes therapies differ in their ability to protect against AD. Metformin shows the strongest potential, supporting its prioritization for targeted studies in people with diabetes who are at high risk of AD, and highlighting the importance of precision medicine in future prevention trials.

To examine within-class sulfonylurea safety, we compared risks of major adverse cardiovascular events (MACE) and severe hypoglycemia among adults with type 2 diabetes (T2D) and moderate cardiovascular risk following sulfonylurea initiation.

We conducted a target trial emulation including adults ≥21 years old with T2D and moderate cardiovascular risk who initiated glimepiride, glipizide or glyburide between 2014 and 2021, using claims data from Optum Labs Data Warehouse and the Medicare fee-for-service 100% sample. Study outcomes were MACE (primary), expanded MACE and its components and emergency department or hospital encounters for hypoglycemia, ascertained during follow-up through 2022. Inverse probability of treatment weighting (IPTW) was applied using propensity scores estimated using the super learner ensemble, and outcomes were examined using IPTW Cox proportional hazards models.

The weighted study cohort comprised 314 699 patients (mean age 66.9 years, 52.0% men, 76.6% non-Hispanic white). At 1 year, MACE was experienced by 2.5%, 2.7% and 2.8% of patients starting glimepiride, glipizide and glyburide, respectively. Compared with glimepiride, glyburide and glipizide were associated with higher risk of MACE (HR 1.10, 95% CI 1.05 to 1.16 for glyburide; HR 1.05, 95% CI 1.03 to 1.07 for glipizide). At 1 year, severe hypoglycemia was experienced by 0.3%, 0.3% and 0.4% of patients starting glimepiride, glipizide and glyburide, respectively. Glyburide was associated with a greater risk of severe hypoglycemia compared with glipizide (HR 1.43, 95% CI 1.23 to 1.65), while glipizide was associated with a lower risk compared with glimepiride (HR 0.82, 95% CI 0.77 to 0.87).

Among adults with T2D and moderate cardiovascular risk, glimepiride was associated with lowest risk of MACE and glipizide with lowest risk of severe hypoglycemia. These results can help inform treatment selection if sulfonylureas are used for glucose-lowering.

A complex relationship exists between diabetes, particularly type 2 diabetes, and breast cancer. Metformin can help reduce the incidence of cancer and the risk of death in individuals with type 2 diabetes. This study utilized bibliometrics to analyze the potential impact of diabetes drugs on the treatment of breast cancer, aiming to reveal research trends and provide references for future research directions.

This bibliometric study analyzed the intersection of diabetes, breast cancer, and metformin using data from the Web of Science Core Collection and PubMed (2004-2024). A total of 1080 relevant publications were included.

An initial slow growth in publications was noted, followed by a surge starting in 2008. The USA and China led these research efforts, with Goodwin PJ having the highest number of publications. The journal Diabetes Care was the most co-cited, with keywords such as "breast cancer," "risk," "metformin," and "growth" frequently appearing. The analysis identified 4036 institutions and 5214 active authors in the field.

Despite growing attention to the role of diabetes medications such as metformin in breast cancer treatment, research remains limited to mechanistic studies and retrospective clinical analyses. The optimal dose for clinical use remains unclear, which highlights the need for further experimental studies. This study provides valuable insights for both academic and clinical research, supporting the potential use of metformin to manage the relationship between diabetes and breast cancer.

Comprehensive assessments of the prevalence of prediabetes and glucose intolerance are scarce for acromegaly.

To estimate the prevalence of pre-operative glucose homeostasis in patients with acromegaly, including diabetes mellitus (DM), impaired fasting glucose, impaired glucose tolerance, and prediabetes.

The study encompassed patients diagnosed with acromegaly at Taipei Veterans General Hospital from 1977 to 2020. Known DM was defined as the use of anti-diabetic medication. Newly diagnosed DM was defined as any of the following conditions: a fasting PG concentration ≥ 126 mg/dL, 2-h glucose concentration ≥ 200 mg/dL during the OGTT, or HbA1c level ≥ 6.5%. Normal glucose tolerance (NGT) was defined as a fasting PG concentration < 100 mg/dL, 2-h glucose concentration < 140 mg/dL during the OGTT, HbA1c level < 5.7%, and not using anti-diabetic medication. Patients who did not meet the criteria for either DM or NGT were classified as having prediabetes.

Of 177 patients, 83 (46.9%) had diabetes-39 pre-existing and 44 newly diagnosed. Normal glucose tolerance (NGT) occurred in 32 patients (18.1%), while 62 (35.0%) had prediabetes. Among those with prediabetes, impaired fasting glucose was noted in 59 (39.3% of those with fasting data), impaired glucose tolerance in 47 (34.3% of those with OGTT data), and HbA1c levels of 5.7-6.4% in 19 (28.0% of those with HbA1c data).

Our findings on diagnosis and prevalence of various blood-glucose statuses in patients with acromegaly at the pre-operative stage may suggest novel mechanisms worthy of further investigation.

Tripterygium wilfordii Hook F. (TwHF) is a traditional Chinese medicine that has been used for centuries. Tripterygium glycoside (TG), a herbal agent extracted from the TwHF rhizome, is extensively used for the treatment of systemic lupus erythematosus, rheumatoid arthritis, nephrotic syndrome, and atopic eczema. However, its clinical application is hindered by its multi-target toxicity. Current literature highlights multiple TG-related complications, including acute liver and kidney injury, rhabdomyolysis, infertility, and lymphocyte suppression. Contrarily, concurrent severe rhabdomyolysis, acute kidney injury (AKI), and cardiogenic shock are rarely reported in cases of TG poisoning. Here, we present the case of a 50-year-old male with type 2 diabetes mellitus (T2DM) who experienced fatigue, nausea, vomiting, rhabdomyolysis, AKI, and cardiogenic shock after mistakenly consuming an excessive dose of TG. The patient consumed 20 tablets (10 mg/tablet) three times daily instead of the recommended therapeutic dose of 20 mg three times daily. Six months later, the patient developed TG-induced chronic complications, including chronic kidney disease (stage 2), polyuria, and irreversible nerve damage. Physicians must be vigilant about the potential for TG-induced life-threatening complications, and further studies are needed to elucidate the dose-effect relationship and establish a safe dosage.

This study aimed to evaluate the current prescribing patterns of statin therapy among outpatients with type 2 diabetes at Friendship Hospital, with a focus on alignment between treatment intensity with cardiovascular risk factors.

A retrospective cohort study was conducted at Friendship Hospital from December 2022 to December 2023. Patient aged 40-75 years with type 2 diabetes mellitus who attended follow-up visits were included using stratified random sampling by treatment department. Clinical data were extracted from medical records to assess cardiovascular risk based on the 2023 American Diabetes Association guideline and to document statin use, intensity, treatment continuity and related factors. Multivariate logistic regression was performed to identify factors associated with whether or not patients were prescribed statins.

Among 407 patients, 30.5% were classified as having established ASCVD, 55.6% as having high cardiovascular risk, and 99.8% of patients were eligible for indication of high intensity statin. Despite this, none received high-intensity statin. Most patients (77.4%) were prescribed moderate-intensity statins, 8.6% received low-intensity statins, and 14.0% were not prescribed any statin. A total of 58.5% of patients received uninterrupted statin prescriptions over one year, whereas 54.3% underwent changes in statin intensity during the follow-up period. Statin prescription (versus non-prescription) was significantly influenced by the treatment department, ASCVD status, and the presence of dyslipidemia (p < 0.05).

Although statin use was common, the intensity and continuity of treatment were often inconsistent with cardiovascular risks. The absence of high-intensity statin prescriptions in a population largely at very high risk may limit the potential benefits of lipid-lowering therapy. These findings highlight the need to strengthen adherence to guideline-directed statin therapy in the management of type 2 diabetes mellitus.

Penile prosthesis infection is a serious complication that often requires device explanation, leading to corporal fibrosis, penile shortening, and significant patient distress.

To evaluate long-term outcomes of salvage procedure outcomes using malleable penile prostheses (MP) after infected inflatable penile prosthesis (IPP) explantation within the United States Veterans Affairs (VA) healthcare system.

We conducted a real-world, retrospective review using the VA Informatics and Computing Infrastructure to identify men ≥18 years who underwent salvage procedures for infected penile prostheses between January 2012 and January 2023. Demographics, comorbidities, surgical details, culture results, and postoperative outcomes were analyzed. Washout protocols were categorized as Mulcahy or non-Mulcahy. Reinfection, MP retention, and IPP conversion were assessed.

The primary outcomes assessed were prosthesis reinfection, retention of the malleable implant, and subsequent elective conversion to an inflatable prosthesis.

A total of 76 patients underwent salvage procedures at 30 VA centers, with 61 (80.3%) receiving MP. Median age was 65 years, and 36% had diabetes mellitus. Reinfection occurred in 29.5% of cases, with a significantly higher rate among diabetics (45.5% vs. 20.5%, P = .0403). No significant difference in reinfection rates was found between Mulcahy and non-Mulcahy washout protocols. Among those without reinfection, 70% retained the MP, 28% underwent elective conversion to IPP, and 2% had device removal for non-infectious reasons. The majority of non-Mulcahy protocols included antiseptic and antibiotic combinations such as normal saline, gentamicin, betadine, hydrogen peroxide, and vancomycin.

These findings support malleable salvage as a definitive, low-morbidity treatment option for many patients, especially within a cost-independent system such as the VA.

This is the largest real-world, national multi-site analysis of MP salvage outcomes in a national healthcare system, with robust follow-up. Limitations include its retrospective design and variability in washout protocols across centers.

Salvage with malleable prostheses is a safe and effective strategy following penile prosthesis infection, with high rates of long-term device retention and functional satisfaction.

Numerous studies have demonstrated a pathogenic association between rheumatoid arthritis (RA) and type 2 diabetes mellitus (T2DM), 2 chronic inflammatory diseases. This study integrates transcriptomic and bioinformatic analyses to elucidate the shared molecular mechanisms underlying RA-associated T2DM, aiming to identify effective therapeutic strategies. RNA expression profile datasets for RA and T2DM were downloaded from the gene. Expression Omnibus and Gene Network (Grein) databases. Common differentially expressed genes shared between RA and T2DM were identified and subsequently subjected to gene enrichment analysis, protein-protein interaction network construction, GeneMANIA analysis, immune microenvironment evaluation, and drug prediction. Additionally, the diagnostic performance of hub genes was assessed using receiver operating characteristic curve analysis. Finally, molecular docking was employed to facilitate computer-aided drug design and to investigate drug-gene interactions. We identified 352 common differentially expressed genes, and functional analyses showed that they were mainly involved in the immune regulation of RA-associated T2DM. Thirteen key genes were confirmed through the protein-protein interaction network analysis and validation cohort. Receiver operating characteristic curves confirmed the reliability of their diagnostic value. GeneMANIA analyses suggested these genes were mainly associated with leukocytes, particularly neutrophils. Results from the immune microenvironment revealed abnormal levels of neutrophils in RA and T2DM. Among them, 10 key genes (LYN, TLR1, TLR2, TLR8, FCGR1A, FCGR2A, CCR1, CXCL1, FPR1, and SELL) were considered as neutrophil-related genes. Mechanistically, these genes activate pro-inflammatory signaling pathways, exacerbating tissue inflammation and promoting insulin resistance, ultimately leading to the onset of T2DM, neutrophils play a pivotal role in this process. Drug prediction and molecular docking results indicated that PD-169316 is a potential immunotherapeutic for patients with RA in combination with T2DM. This study concludes that neutrophil-driven inflammatory responses and their associated genes may accelerate the progression of type 2 diabetes caused by RA.