Residents of food-insecure areas (FIAs) experience worse cancer outcomes, but underlying mechanisms remain poorly understood. Prior studies have not determined whether inequalities result from differences in cancer characteristics, treatment delivery, adherence, or food insecurity (FI) itself. We hypothesized that patients with locally advanced breast cancer (LABC) residing in FIAs would demonstrate worse overall survival (OS) despite receiving similar cancer treatments with comparable treatment adherence.

This retrospective study analyzed 943 patients with LABC treated with comprehensive nodal irradiation from 2016 to 2023. χ² and Mann-Whitney U tests assessed differences in demographic, clinical, and treatment variables. Kaplan-Meier analysis and multivariable Cox regression models evaluated OS.

Median follow-up was 25.0 months for non-FIA and 28.8 months for FIA residents. FIA residents (n = 60; 6.4%) were more likely to identify as Black (P < .001), and have comorbidities including hypertension (P < .001), diabetes mellitus (DM; P < .001), and higher ECOG PS (P <.001). Although categorical obesity rates did not differ between groups at consultation (57.4% vs 42.3%; P = .153), they diverged significantly by follow-up (65.5% vs 40.9%; P < .001). Cancer and treatment characteristics did not differ between groups. Multivariable analysis identified FI (HR, 5.52; 95% CI, 1.76-17.27; P = .003), diabetes mellitus (HR, 2.96; 95% CI, 1.13-7.76; P = .027), and new pulmonary conditions at follow-up (HR, 9.57; 95% CI, 3.46-26.49; P < .001) as independent predictors of mortality. Hormone therapy delivery (HR, 0.12; 95% CI, 0.02-0.95; P = .045) and duration (HR, 0.96; 95% CI, 0.94-0.98; P < .001) were protective. Five-year OS was 74.9% for FIA versus 90.2% for non-FIA residents (P = .005).

Patients with LABC residing in FIAs had a 5.5 times higher mortality risk despite similar cancer characteristics, treatments, and adherence. Higher obesity rates among FIA residents that increased following treatment represent a novel characterization of the FI-obesity paradox in patients with breast cancer. These findings support residence in an FIA as an independent predictor of mortality and suggest that interventions must address nutritional quality and access.

Aspiration-related pneumonia can progress to empyema and massive hydropneumothorax, potentially fatal complications not frequently documented in the literature. Patients with structural lung disease and poor dentition can be particularly vulnerable to severe polymicrobial infections arising from seemingly minor aspiration events. We report the case of a man in his early 70s with chronic bronchiectasis, heart failure with reduced ejection fraction, coronary artery disease status post coronary artery bypass grafting, type 2 diabetes mellitus, chronic kidney disease, and poor dentition who presented with progressive dyspnea and acute hypoxemic respiratory failure. Imaging demonstrated a massive right-sided hydropneumothorax with complete right lung collapse and mediastinal shift. Pleural fluid cultures grew Streptococcus anginosus and Prevotella nigrescens, consistent with aspiration-related polymicrobial empyema. His hospital course was complicated by septic shock requiring vasopressor support, atrial flutter with rapid ventricular response requiring synchronized cardioversion, and pulseless ventricular tachycardia with successful return of spontaneous circulation. Management included chest tube drainage, broad-spectrum intravenous antibiotics followed by de-escalation, invasive hemodynamic monitoring, and multidisciplinary critical care support. Despite severe multiorgan compromise, the patient ultimately improved and was discharged home on prolonged oral antibiotic therapy. This case illustrates how a seemingly simple aspiration event can progress into catastrophic pleuropulmonary disease with life-threatening cardiopulmonary collapse. Early recognition, prompt source control, and multidisciplinary management were critical to improving the outcome for this patient.

Chronic ulcers, including diabetic foot ulcers, pressure ulcers, and venous leg ulcers, remain a major clinical challenge due to their progressive tissue deterioration and high recurrence rates. Current preventive strategies largely rely on intermittent assessment and often fail to detect early pathological changes before visible tissue damage occurs. Recent advances in flexible electronics and wearable biointerfaces have enabled smart dressings capable of continuous physiological surveillance. However, existing studies and reviews mainly focus on individual sensing technologies, while lacking an integrated framework for predictive ulcer prevention. Here, we systematically review the emerging transition from reactive wound monitoring toward predictive, closed-loop bioelectronic prevention systems. We summarize recent progress in smart dressings from four interconnected aspects: pre-ulcer biological transition, multimodal physiological sensing, AI-assisted data integration and risk prediction, and closed-loop preventive intervention. Particular emphasis is placed on the role of temporal physiological trajectories and multimodal signal fusion in identifying occult tissue deterioration prior to overt ulcer formation. We further discuss key translational challenges, particularly highlighting that the current evidence base predominantly relies on benchtop and preclinical animal models, while prospective clinical validation demonstrating measurable reductions in ulcer incidence remains largely absent. Finally, emerging opportunities in self-powered systems, edge AI, and autonomous therapeutic platforms are highlighted for next-generation ulcer prevention. This review is based on a structured search of PubMed, Web of Science, and IEEE Xplore (2015-2026) focusing on flexible bioelectronics, multimodal physiological sensing, AI-assisted prediction, and closed-loop preventive intervention. Throughout, we distinguish three prevention scenarios: primary prevention on intact high-risk skin, prevention of recurrence on healed skin, and prevention of deterioration in existing wounds. We emphasize that most supporting studies remain device-level, animal-based, or short-term feasibility investigations, and that prospective clinical validation of reduced ulcer incidence is still lacking.

To characterise the magnitude of glycaemic variability and to examine the factors associated with it, with particular attention to residual beta-cell function measured by fasting C-peptide, in children, adolescents, and young adults with diabetes in Bangladesh.

Prospective observational study at the BADAS Paediatric Diabetes Care and Research Centre, BIRDEM, Dhaka, using 14 days of blinded professional continuous glucose monitoring (CGM). Participants were enrolled between March and November 2024.

Ninety-seven participants aged 1-25 years (68 with Type 1 and 29 with Type 2 diabetes) had at least seven valid CGM days and a paired HbA1c within 2 weeks of CGM initiation. Fasting C-peptide was available for 46 participants.

The coefficient of variation (CV) of glucose as the primary metric of variability; time in range, time above range, and time below range as secondary metrics; and independent predictors of CV on multivariable regression.

Mean CV was 39.4% (SD 9.2), and 59 of 97 participants (60.8%) were at or above the recommended target of 36%. CV was higher in Type 1 than Type 2 diabetes (41.9% vs. 33.3%). Lower fasting C-peptide was independently associated with higher CV after adjustment for diabetes type, age, and insulin dose (-1.94 percentage points per ng/mL, 95% CI -3.35 to -0.53; model R-squared 0.52), with a graded relationship across pre-specified C-peptide categories for CV, time in range, and time below range.

Glycaemic variability substantially exceeds international targets in this setting. Fasting C-peptide, available for fewer than half of the cohort, showed a graded association with variability that is best regarded as hypothesis-generating; if confirmed in larger studies, it could offer a low-cost means of identifying children at highest variability risk where CGM access is limited.

The Australian Diabetes Foot Registry (ADFR) is a national prospective, longitudinal clinical quality registry established in 2020 to standardise data capture and reporting in Interdisciplinary Diabetes High Risk Foot Services. We describe the ADFR's methodology and early implementation outcomes. Stakeholder consultation informed development of the minimum dataset, governance framework and data-capture workflow. Centrally supported ethics and jurisdictional approvals facilitated site onboarding. Clinical, management and outcome data were collected, de-identified and amalgamated in a national repository. Implementation outcomes included recruitment metrics, case ascertainment, mandatory-field missing data, reporting cycles, conference presentations and inaugural report feedback. Seventy-four sites expressed interest and 49 sites completed implementation. Median time from application to commencement was 7 (IQR 4-12) months under a nationally recognised ethics approval. By mid-2025, 10 919 participants were registered, comprising 13 150 care episodes and 22 383 ulcerations. In 2024-2025, mean service-level case ascertainment was 80%, and the mandatory-field missing data rate was 0%-7%. Four annual reporting cycles have been completed, all services strongly endorsed participation after the inaugural report, and data informed 29 conference presentations. The ADFR demonstrates a feasible, scalable national registry model, enabling timely audit and benchmarking and actionable reporting to support quality improvement, research and collaboration.

Driving is a complex task that requires efficient integration of sensorimotor, visual, and cognitive systems. Although diabetic peripheral neuropathy (DPN) is associated with reduced driving performance, the impact of this condition when combined with aging is still poorly understood.

To assess braking time in older drivers with Type 2 diabetes mellitus (T2DM), with and without DPN, comparing them with a control group and investigating associations with motor, cognitive, and visual characteristics.

Cross-sectional study involving individuals aged 60-79 years, distributed into three groups: T2DM without DPN (n = 17), T2DM with DPN (n = 22), and control (n = 25). DPN was identified using the Michigan Neuropathy Screening Instrument, Brazilian version (MNSI-Brazil), with a cutoff score ≥ 2.5. Cognitive (Montreal Cognitive Assessment-MoCA, cognitive TUG), visual (acuity, stereopsis, color vision, and adaptometry), and motor assessments (handgrip strength and plantar flexor strength) were performed, along with a driving simulation.

Older adults with T2DM showed longer braking times than the control group (p < 0.01), regardless of the presence of DPN. Participants with DPN presented lower upper-limb strength (p = 0.01) and reduced strength of the right plantar flexor muscles (p < 0.01). Braking time was influenced by sex and plantar strength.

T2DM is associated with increased braking time in older adults, and reduced plantar flexor muscle strength, particularly among women, highlights the need for monitoring and targeted muscle strengthening to preserve driving safety and autonomy.

Immune checkpoint inhibitors (ICIs) have become an increasingly prominent therapeutic option in the management of a variety of cancers. As their clinical use expands, so too should our understanding of immune-related adverse events (irAEs) associated with these agents. By enhancing immune activation, ICIs can cause off-target inflammation in various tissues, including endocrine. We present a case illustrating a rare but life-threatening manifestation of ICI toxicity: simultaneous severe diabetes mellitus and thyrotoxicosis after just a single dose of ICI. This case highlights the importance of prompt recognition and timely intervention of acute, life-threatening endocrine irAEs. We discuss the pathophysiology, management, and clinical course of ICI-induced diabetes mellitus and thyroid disease, with brief discussion of endocrine irAEs as a surrogate of therapeutic efficacy.

To compare the physical activity, sleep quality and depressive symptoms between patients with diabetes and non-diabetes undergoing maintenance hemodialysis, and identify associated influencing factors.

A descriptive cross-sectional design was adopted. Maintenance hemodialysis patients were enrolled from two hemodialysis centers in Xi'an, China between April and May 2022. Sociodemographic and clinical data were collected, with physical activity assessed via Human Activity Profile, sleep quality via Pittsburgh Sleep Quality Index, and depressive symptoms via Beck Depression Inventory-II.

Of 286 participants, 113 had diabetes and 173 did not. Diabetic patients had lower adjusted activity scores (40.07 ± 22.94 vs. 55.94 ± 21.35, P < 0.01), higher PSQI global scores (9.04 ± 4.48 vs. 7.15 ± 4.47, P < 0.01), and higher BDI-II scores (17.32 ± 10.75 vs. 12.95 ± 9.26, P < 0.01) than non-diabetic patients. Multivariate logistic regression showed that age (OR = 1.02, 95% CI: 1.01, 1.04) and BDI-II score (OR = 1.04, 95% CI: 1.01, 1.07) were positively associated with diabetes, whereas AAS (OR = 0.98, 95% CI: 0.97, 0.99) and MHD duration (OR = 0.99, 95% CI: 0.98, 1.00) were negatively associated.

Diabetic patients receiving maintenance hemodialysis exhibit poorer physical activity levels, sleep quality, and depressive symptoms compared with non-diabetic counterparts. Accordingly, routine combined screening of physical activity, sleep disturbance and depressive symptoms should be embedded into daily dialysis nursing.

Type 2 diabetes mellitus (T2DM) and COVID-19 are independently associated with an elevated risk of dementia, and COVID-19 survivors with T2DM may represent a clinically vulnerable population in whom metabolic, inflammatory, and vascular factors coexist. However, whether antidiabetic treatment choice is associated with incident dementia risk in this population remains unknown.

In this target trial emulation using the TriNetX US Collaborative Network, we compared COVID-19 survivors aged ≥50 years with T2DM initiating glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy with those initiating dipeptidyl peptidase-4 inhibitor (DPP-4i) therapy between January 1, 2020 and December 31, 2024. We applied an active-comparator, new-user design with a 90-day survivor landmark and 1:1 propensity score matching. The primary outcome was incident all-cause dementia (a composite of vascular dementia, Alzheimer's disease, and other dementias). Secondary outcomes included dementia subtypes, mild cognitive impairment, glycemic outcomes, and all-cause mortality.

After matching, 25,263 patients per group were followed for up to 6 years (median, 919 days [GLP-1RA] vs 955 days [DPP-4i]). GLP-1RA initiation was associated with a lower hazard of incident dementia (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.58-0.72), vascular dementia (HR, 0.67; 95% CI, 0.52-0.85), and Alzheimer's disease (HR, 0.74; 95% CI, 0.59-0.93), as well as more favorable glycemic control and lower all-cause mortality (HR, 0.63; 95% CI, 0.59-0.68). The estimate for mild cognitive impairment was borderline (HR, 0.87; 95% CI, 0.75-1.00) and not consistently supported across sensitivity analyses. The association with incident dementia remained evident after the 6-month landmark analysis (HR, 0.66; 95% CI, 0.58-0.75) and was consistent across sensitivity and subgroup analyses.

Among COVID-19 survivors with T2DM, GLP-1RA initiation was associated with a lower hazard of incident dementia than DPP-4i initiation. These hypothesis-generating results warrant confirmation before they can be used to inform clinical decision-making.

The impact of SGLT2 inhibitors (SGLT2i), GLP-1 receptor agonists (GLP-1RA), and DPP-4 inhibitors (DPP-4i) on stroke risk in individuals with type 2 diabetes remains uncertain. Meta-analyses of randomised controlled trials (RCTs) show a protective effect for GLP-1RA but neutral findings for SGLT2i and DPP-4i, whereas observational studies often suggest broader stroke risk reductions. This study aimed to estimate the associations of SGLT2i, GLP-1RA, and DPP-4i with stroke risk in nationwide longitudinal data, and to contextualize these results within existing meta-analyses of RCTs and observational studies.

This was a nationwide longitudinal study including individuals with type 2 diabetes first registered in the Swedish National Diabetes Register between January 1, 2013, and December 31, 2019. Individuals with a prior stroke or insufficient data for multiple imputation were excluded. The primary outcome was ischemic stroke. Treatments, comorbidities, and laboratory values were updated over time. Marginal structural models with inverse probability of treatment weighting and weighted Cox regression were used to estimate hazard ratios (HRs) for ischemic, hemorrhagic and total stroke pooled across five multiply imputed datasets. To contextualise the findings, PubMed was searched from inception to June 23, 2026, for meta-analyses of randomised controlled trials and observational studies reporting stroke outcomes for the three drug classes.

We included 171,917 individuals with type 2 diabetes [59.2% males, baseline mean (SD) age 62.7 (11.6), mean (SD) follow-up 3.0 (1.9) years] contributing 1,617,462 clinical registrations. During follow-up, 2734 (1.59%) ischemic and 428 (0.25%) hemorrhagic strokes occurred. GLP-1RA use was associated with a lower risk of ischemic (HR 0.46, 95% CI 0.29-0.72) and total stroke (HR 0.51, 95% CI 0.33-0.79), whereas no clear associations were observed for hemorrhagic stroke. SGLT2i and DPP-4i showed no clear associations with any stroke outcome. The contextualisation identified 91 meta-analyses. RCT meta-analyses generally showed a protective effect for GLP-1RA and neutral effects for SGLT2i and DPP-4i, while observational meta-analyses suggested protective associations for GLP-1RA and SGLT2i.

In this nationwide study, GLP-1RA were associated with reduced stroke risk, while SGLT2i and DPP-4i showed neutral effects. The overall direction of findings was consistent with evidence from RCT meta-analyses. Future research should investigate how these therapies can be optimally incorporated into treatment strategies for stroke prevention in individuals with type 2 diabetes.

Sahlgrenska University Hospital's funds, the Swedish National Stroke Association, the Swedish Brain Foundation, the Swedish Heart Lung Foundation, the Bygg-Göta Foundation for scientific research, the Winberg foundation, and the Swedish state under the ALF agreement between the Swedish government and the county councils.