This study aimed to evaluate the influence of finerenone, a novel nonsteroidal selective mineralocorticoid receptor antagonist (nsMRA), on the hepatic fibrosis indicator FIB-4, as well as its safety profile in hospitalized patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) managed in the endocrinology department.

A single-center, retrospective cohort design was employed, enrolling 138 consecutive hospitalized patients who initiated finerenone therapy for the first time in our endocrinology department between June 2023 and December 2024. Baseline data and subsequent outpatient follow-up records were extracted to calculate the FIB-4 and assess changes in hepatic and renal function, serum potassium levels, and adverse events during treatment.

Of the enrolled cohort, 119 patients (85.6%) had complete baseline laboratory profiles, with a mean age of 63.1 years and 58% male. Baseline FIB-4 median 1.15. Among 52 patients (43%) who completed follow-up, the median follow-up duration was 6 months (range 1-16 months). The median follow-up FIB-4 declined to 1.10, representing an absolute reduction of 0.05. Patients with follow-up exceeding 12 months follow-up showed a further reduction to 0.96. Importantly, no cases of treatment discontinuation due to hyperkalemia were documented during follow-up.

In real-world clinical practice, finerenone in T2DM patients with CKD trended to lower FIB-4 values, especially with longer use. However, no statistical significance and study limitations preclude definitive conclusions on its antifibrotic activity. These findings are hypothesis-generating and need confirmation in large, prospective, long-term studies with robust endpoints and proper controls.

Diabetes mellitus presents complex constellation of multiple long-term conditions (MLTCs) including cardiovascular, renal, metabolic, and neuroinflammatory disorders. This leads to clinical heterogeneity, polypharmacy, therapeutic disinterest, adverse outcomes, societal challenges, and glycaemic control management strategies. Precision medicine-based approach address this intricacy through alignment of therapeutic interventions with consideration of biological profiles. In this, nanogenomic synergy is a breakthrough, that gives detailed insight of genomic and epigenomics in context to advanced nanotechnology-based drug delivery system for personalized diabetes care. Genomics and transcriptomic profiling approach stratified the patients based on molecular drivers of diabetes and treatment responses, whilst nanotechnology facilitated the targeted, controlled and tissue specific systemic effect with minimal toxicity and off-target effects. This mini review will present the current evidence and understanding of clinical and biological obstacles in management of MLTC associated with diabetes mellitus and investigate the role of nano genomics through shard pathogenic pathways across comorbid conditions. Many key evidence nanotechnology platforms for genomic guidance in therapeutics were also covered. A nanogenomic synergy is a very innovative concept that could potentially break through one-size-fits-all approaches by allowing the redefinition of diabetic care for people living with multiple long-term diseases. This is achieved through precision, innovation, and a more encompassing approach to care.

The growing coexistence of HIV infection and type 2 diabetes mellitus (T2DM) represents a major clinical challenge in the antiretroviral therapy (ART) era. Improved survival of people living with HIV (PLHIV) has unveiled an increasing burden of metabolic disorders, with T2DM emerging as a leading comorbidity linked to chronic inflammation, adipose dysfunction, hepatic steatosis, and gut-liver axis disruption. Epidemiological evidence indicates that PLHIV develop diabetes at younger ages and with greater cardiometabolic complications than the general population. Among adolescents and young adults with perinatally acquired HIV, lifelong ART exposure and early-life immune activation accelerate insulin resistance and β-cell stress, predisposing to early-onset T2DM. Sex differences further modulate this risk, as women with HIV exhibit disproportionate weight gain, altered fat distribution, and heightened inflammatory responses under specific ART regimens. The convergence of immunometabolic imbalance, hormonal factors, and social determinants creates a distinct pathophysiological landscape demanding tailored prevention and management strategies. Novel incretin-based and amylin therapies hold promise to address both dysglycemia and obesity, though data in PLHIV remain limited. Recognizing diabetes as a central and multifactorial complication of HIV is crucial to optimize long-term care, reduce cardiovascular and hepatic comorbidities, and improve quality of life across the HIV lifespan.

Percutaneous device closure of patent ductus arteriosus (PDA) in infants and children is a frequently performed procedure. However, transcatheter closure is rare in adults, especially in developed countries, as most ducts are typically closed in childhood. PDA in adults poses unique challenges due to age-related comorbidities and some morphological changes in PDA that occur with advanced age. This study analyzes the safety and procedural success of adult PDA transcatheter closure.

A retrospective single-center study analyzed 184 adult PDA device closures between July 2015 and July 2024. The study examined patient demographics, clinical aspects, procedural details, and immediate hospital outcomes. Outcome parameters focused on procedural success, complications, residual shunt, and improvement in symptoms.

Out of 184 patients, 183 adults with a mean age of 27 ± 13 years and a mean weight of 52 ± 16.5 kg underwent PDA device occlusion. Most patients were referred for evaluation of a murmur (n = 116, 63.3%). The most common comorbidity was type 2 diabetes mellitus (n = 20, 10.9%). The mean PDA diameter at its narrowest end was 6.17 ± 4.56 mm (1.2-17 mm). In total, 6.55% of patients exhibited duct calcification, and 2.73% presented with a PDA aneurysm. Severe pulmonary hypertension was present in 24 patients. Transcatheter intervention achieved a 100% success rate at 24 h postprocedure, with no residual flows at the 6-month follow-up. There was no mortality, device embolization, or aortic/pulmonary artery stenosis.

Percutaneous device closure is a safe and successful treatment option for PDA in adults.

Necrotizing fasciitis (NF) is a rapidly progressive and life-threatening soft tissue infection. Although it is known to occur in immunocompromised patients, NF following a single dose of chemotherapy has rarely been reported. We describe a 53-year-old woman with hormone receptor-positive, HER2-negative breast cancer and newly diagnosed type 2 diabetes mellitus who developed NF eight days after receiving her first cycle of dose-dense doxorubicin and cyclophosphamide. Initially mistaken for a drug eruption, her condition deteriorated rapidly despite surgical intervention and intensive care. She died of septic shock, and Group G Streptococcus was identified from blood cultures. This case highlights the need to consider NF in post-chemotherapy patients presenting with erythema and systemic symptoms, even after a single dose, particularly when risk factors such as diabetes and obesity are present. Prompt recognition and intervention remain essential to improve survival.

Neonatal diabetes mellitus (NDM) often requires insulin treatment to maintain adequate glycemic control and support growth and development. Conventional insulin treatment regimens are particularly challenging in NDM due to young age, developmentally appropriate feeding variation, and heightened insulin sensitivity leading to very small insulin dosing. We present this case as-to our knowledge-the earliest implementation of a hybrid closed-loop (HCLS) automated insulin delivery system in an NDM patient. HCLS with U10 significantly improved glycemic control compared to conventional insulin delivery with minimization of hypoglycemia. The adaptive capabilities of HCLS allowed for developmentally appropriate, ad libitum feeding without carbohydrate quantification, resulting in a meaningful quality of life improvement. This case adds to evidence supporting safe and effective use of diabetes technology in very young children. It demonstrates that the benefits seen in older populations can be achieved in neonatal patients and supports expanding clinical use of HCLS systems in this setting.

Poor glycemic control increases the risk of cardiovascular complications in patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD). The current study identified determinants of poor glycemic control in Iranian T2DM patients with CAD.

This case-control study included T2DM patients with CAD who were admitted to Golestan Hospital in Ahvaz (Iran) during 2 years. Demographic, clinical, and biochemical data were collected. According to their glycemic control status, patients were divided into two groups: uncontrolled glycemia (Group 1, n = 350; hemoglobin A1c [HbA1c] > 7%) and controlled glycemia (Group 2, n = 350; HbA1c ≤ 7%).

The study assessed 700 T2DM patients with CAD (458 males and 242 females). Their average age was 60.51 ± 9.76 years. Compared to patients with optimal glycemic control, those with uncontrolled glycemia were younger, had higher rates of dyslipidemia, previous myocardial infarction, smoking, chronic kidney disease, hypertension, peripheral artery disease, diabetes for a longer period, higher body mass index (BMI), lower ventricular ejection fraction, greater levels of total cholesterol, HbA1c, fasting blood glucose, triglycerides, triglyceride-glucose (TyG) index, and low-density lipoprotein cholesterol (p < 0.05). In addition, there were substantial differences in the prevalence of New York Heart Association (NYHA) functional class, angiographic findings (including severe calcification, type B2/C lesions, chronic total occlusion lesions, thrombotic lesions, and ostial lesions), as well as the use of oral glucose-lowering medications and insulin between the two groups (p < 0.05). Furthermore, 42.6% of patients exhibited triple vessel disease, and 60% of them had HbA1c level > 7%. Diabetes duration, BMI, and TyG index were significant independent predictors of glycemic control.

This study revealed that CAD patients with good glycemic control had better clinical and cardiovascular status. HbA1c may serve as a valuable parameter for risk stratification in these patients.

Subclinical myocardial injury (SMI) represents an early, asymptomatic stage of cardiac damage characterized by elevated high-sensitivity cardiac troponin T (hs-cTnT) levels in the absence of overt ischemia. Glycemic variability has been increasingly recognized as a cardiovascular risk factor beyond chronic hyperglycemia, but its relationship with SMI in type 2 diabetes mellitus (T2DM) remains unclear.

This retrospective cross-sectional analysis included 324 hospitalized patients with T2DM consecutively admitted between January 2021 and December 2023 at a tertiary hospital in Southwest China. SMI was defined as hs-cTnT > 14 ng/L without ischemic symptoms or electrocardiographic abnormalities. Clinical, metabolic, and laboratory data were extracted from electronic medical records. Short-term (in-hospital) glycemic variability was quantified using the standard deviation (SD) and coefficient of variation (CV) of all capillary glucose measurements obtained during hospitalization. Univariate and multivariate logistic regression analyses identified independent predictors of SMI. Model discrimination, calibration, and nomogram-based prediction were evaluated.

Among 324 patients, 128 (39.5%) exhibited SMI. In multivariate analysis, eight variables were independently associated with SMI: age (OR = 1.05, P = 0.001), BMI (OR = 1.10, P = 0.006), diabetes duration (OR = 1.06, P = 0.004), insulin use (OR = 1.72, P = 0.015), SD of glucose (OR = 3.11, P < 0.001), systolic blood pressure (OR = 1.02, P = 0.038), hs-CRP (OR = 1.08, P = 0.009), and eGFR (OR = 0.97, P = 0.003). The predictive model showed good discrimination (AUC = 0.832, 95% CI 0.787-0.877) and good calibration (Hosmer-Lemeshow P = 0.47). A nomogram based on these predictors provided individualized risk estimation with high clinical interpretability.

Short-term (in-hospital) glycemic variability, as reflected by the standard deviation of inpatient glucose readings, was independently associated with subclinical myocardial injury in hospitalized patients with type 2 diabetes. These findings suggest that glycemic variability may serve as a risk marker for subclinical myocardial injury in hospitalized patients with T2DM; however, causal relationships and temporal ordering cannot be inferred from this cross-sectional analysis.

Diabetes mellitus (DM) is a metabolic disorder marked by persistent hyperglycemia (HG), resulting from abnormalities in insulin secretion or insulin resistance. This condition represents a major public health concern since it causes multisystem complications, including microvascular diseases, macrovascular diseases, and neuropathy. Few effective therapies are currently available. Ferroptosis, an iron-dependent mode of regulated cell death triggered by lipid peroxidation (LPO), is intricately linked to the pathogenesis, progression, and complications of DM. It has been increasingly recognised as a key mechanism underlying peripheral insulin resistance and insulin deficiency resulting from β-cell dysfunction. In this study, we systematically summarised the primary regulatory mechanisms of ferroptosis and outlined current research advancements in mechanistic insights into its role in diabetic complications. Besides, we explored how inter-organelle interactions drive ferroptosis under diabetic conditions and play pathogenic effects in diabetes and its complications. Finally, we systematically reviewed the therapeutic drugs targeting ferroptosis from the perspectives of traditional Chinese medicine (TCM) and Western medicine, respectively. This interdisciplinary integrated overview may provide a theoretical basis for future clinical transformation.

Licorice (Glycyrrhiza spp.) is a traditional medicinal plant whose roots and rhizomes possess multiple pharmacological effects. Its core active components include flavonoids, triterpenoids such as glycyrrhizin, and polysaccharides. This paper focuses on licorice's gut microbiota-mediated mechanisms of action. Licorice enhances intestinal barrier integrity and protects gastrointestinal mucosa by upregulating tight junction proteins, activating repair pathways like epidermal growth factor receptor/extracellular regulated protein kinases (EGFR/ERK), and modulating inflammatory signaling via the tumor necrosis factor/nuclear factor-[Formula: see text]B (TNF/NF-[Formula: see text]B) pathway. At the systemic level, licorice modulates core pathways like Toll-like receptor 4 (TLR4)/NF-[Formula: see text]B and farnesoid X receptor/Takeda G protein-coupled receptor 5 (FXR/TGR5) through cross-organ axes such as the gut-immune, gut-liver, and gut-adipose axes to improve conditions including inflammatory bowel disease (IBD), obesity, type 2 diabetes mellitus (T2DM), and non-alcoholic fatty liver disease (NAFLD). However, licorice poses dose-dependent risks which raise concerns regarding its safety. Long-term high-dose use may induce pseudohyperaldosteronism and interactions with multiple medications, and thus necessitates strict clinical dose control. This study reveals the gut microbiota's central mediating role in licorice's efficacy, and thereby provides theoretical support for its rational clinical application.