Background Frequent attendees in primary healthcare settings pose significant challenges to healthcare delivery systems, impacting resource utilization and service quality. Understanding the characteristics and patterns of frequent attendance is crucial for developing targeted interventions and optimizing healthcare resources. Objective To determine the proportion of patients classified as frequent attendees (defined as ≥8 visits per year) among all patients attending the family medicine clinic and to examine their personal (age and gender) and health characteristics (comorbidities, visit purposes, and diagnostic patterns) at the Specialized Polyclinic-Primary Health Care Center (SPC-PHC), National Guard Health Affairs in Jeddah, Saudi Arabia. Methods A retrospective observational study was conducted using electronic health record data from patients attending the family medicine clinics at the Specialized Polyclinic-Primary Health Care Center (SPC-PHC), National Guard Health Affairs, in Jeddah, Saudi Arabia, during 2021. Frequent attendees were defined as patients with ≥8 visits within one year. Demographic characteristics, comorbidities, visit purposes, and ICD-10 diagnostic categories were analyzed descriptively. Results Frequent attendees represented 6.4% of all unique patients attending the family medicine clinics; however, they accounted for 16.6% of the total visits recorded in the primary healthcare system during the study period. Among frequent attendees, the mean number of visits during the study period was 10.6 (±2.7), while the median number of visits was 10 per patient. Frequent attendees were predominantly female (66.0%), with the majority aged 19-40 years (56.4%). The most common comorbidities were diabetes mellitus (21.3%), dyslipidemia (20.4%), and hypertension (15.4%). New complaints constituted the largest proportion of visits (37.41%), followed by laboratory result follow-ups (15.58%) and chronic issue follow-ups (13.12%). No-show visits accounted for 11.25% of all visits. Endocrine, nutritional, and metabolic diseases (16.65%) were the most prevalent diagnoses, followed by genitourinary (14.96%) and musculoskeletal disorders (14.37%). Associations were observed between visit purposes and patient demographics, with distinct patterns across age groups, gender, and comorbidity status. Conclusion The study identified frequent attendance mainly among females aged 19-40 years, with endocrine, genitourinary, and musculoskeletal conditions as leading diagnoses. These findings highlight the need for targeted interventions for frequent attendees, including structured chronic disease management and patient education programs, to improve service efficiency and optimize the use of primary healthcare resources.

Conflicting results have been published for the association between egg consumption and the risk of diabetes mellitus (DM). The present study was to assess the risk of incident DM in relation to egg consumption.

Study participants were 91005 non-diabetic adults who periodically received health check-ups. They were categorized into six groups by egg consumption (<1/week, ≥1 and <3/week, ≥3 and <7/week, ≥1 and <2/day, ≥2 and <3/day, ≥3/day) and followed for incident DM during median 6.9 years. The Cox proportional hazard model was used to longitudinally evaluate the hazard ratio (HR) and 95% confidence interval (CI) for incident DM according to the six groups of egg consumption [adjusted HR (95% CI)]. Subgroup analysis was conducted by sex and age (<45 years or ≥45 years). The risk of DM conferred by a daily increment of one egg consumption was also analyzed.

In all participants, egg consumption ≥1/week was not significantly associated with an increased risk of DM, compared with the reference [<1/week: reference, ≥1 and <3/week: 1.01 (0.91-1.12), ≥3 and <7/week: 0.96 (0.87-1.06), ≥1 and <2/day: 1.06 (0.95-1.19), ≥2 and <3/day: 1.04 (0.88-1.22), ≥3/day: 1.29 (0.98-1.70)]. This pattern of relationship was similarly observed across all subgroups. A daily increment of one egg consumption showed only a marginal association with the risk of DM in men [1.07 (1.02-1.13)] and younger individuals [1.07 (1.02-1.13)].

Egg consumption appears to have little association with the risk of incident DM.

Purpose: Natural polysaccharides have shown considerable potential in the management of type 2 diabetes mellitus (T2DM) due to their multi-target metabolic regulatory effects. However, their clinical translation is limited by poor oral stability and low intestinal permeability. Snow lotus polysaccharide (SIP), a representative plant-derived polysaccharide, exhibits promising metabolic benefits but suffers from these delivery barriers. This study aimed to develop an oral nanodelivery system to enhance the gastrointestinal stability and intestinal transport of SIP, thereby improving its in vivo efficacy. Methods: SIP-loaded chitosan-tripolyphosphate nanoparticles (SIP@CS-TPP) were prepared via ionic crosslinking and characterized in terms of particle size, surface charge, morphology, and structural features. In vitro release behavior under simulated gastrointestinal conditions was evaluated. Ex vivo intestinal permeation was assessed using an isolated intestinal sac model. The metabolic regulatory effects were further investigated in a high-fat diet/streptozotocin-induced T2DM rat model. Results: SIP@CS-TPP nanoparticles exhibited a uniform particle size of 188.9 ± 12.8 nm, a surface charge of 28.3 ± 5.1 mV, and good stability after freeze-drying. A pH-responsive and diffusion-controlled release profile was observed. Ex vivo studies demonstrated significantly enhanced intestinal transport, with an approximately 3.7-fold increase in apparent permeability compared with free SIP. In vivo, SIP@CS-TPP improved glycemic control, glucose tolerance, insulin resistance, lipid metabolism, oxidative stress, and inflammatory responses more effectively than free SIP at the same dose. Conclusions: The CS-TPP nanodelivery system effectively enhances the oral delivery and metabolic regulatory effects of SIP. This study highlights the potential of a delivery-oriented strategy to improve the in vivo performance of natural polysaccharides and provides a promising approach for their application in metabolic disease management.

Couples generally manage chronic diseases together and the management takes an emotional toll on both patients and their romantic partners. Consequently, recognizing the emotions of each partner in daily life could provide insight into their emotional well-being in chronic disease management. Currently, the process of assessing each partner's emotions is manual, time-intensive, and costly. Despite the existence of works on emotion recognition among couples, none of these works have used data collected from couples' interactions in daily life. In this work, we collected 85 h (1021 5-min samples) of real-world multimodal smartwatch sensor data (speech, heart rate, accelerometer, and gyroscope) and self-reported emotion data (n = 612) from 26 partners (13 couples) managing diabetes mellitus type 2 in daily life. We extracted physiological, movement, acoustic, and linguistic features, and trained machine learning models (support vector machine and random forest) to recognize each partner's self-reported emotions (valence and arousal). Our results from the best models-balanced accuracies of 63.8% and 78.1% for arousal and valence respectively-are better than the results from (1) chance, (2) prior work that also used data from German-speaking, Swiss-based couples, and (3) partners' perceptions of each other's emotions. This work contributes toward building automated emotion recognition systems that would eventually enable partners to monitor their emotions in daily life and enable the delivery of interventions to improve their emotional well-being.

Background: Gestational diabetes mellitus (GDM) is associated with metabolic disturbances extending beyond glucose homeostasis, including alterations in lipid metabolism. However, evidence on the fatty acid composition of maternal serum lipids in GDM remains inconsistent, and data on placental fatty acid transfer are limited. This study aimed to explore associations between maternal serum lipid fatty acid composition, selected FA indices, and transplacental transfer of fatty acids derived from maternal serum lipids in pregnancies complicated by GDM. Methods: A cross-sectional study was conducted among 139 pregnant women, including 104 healthy controls and 35 women with GDM. Maternal serum and umbilical cord blood samples were collected at delivery. FA composition was analyzed using gas chromatography. Selected FA indices and the transplacental transport index (TTI) were calculated. Statistical analyses included group comparisons, multivariable models adjusted for maternal age and pre-pregnancy BMI, and false discovery rate correction. Results: Modest differences were observed in selected fatty acids and FA indices, particularly palmitoleic acid (C16:1) and the C16:1/C16:0 ratio. Principal component analysis suggested partial separation between groups, although substantial overlap was present. A difference in transplacental transport was observed for α-linolenic acid; however, high variability was noted. No consistent associations between reported dietary patterns and fatty acid composition of circulating serum lipids were identified. Conclusions: This exploratory study suggests potential differences in fatty acid composition and selected indices in GDM; however, findings should be interpreted with caution. The observed patterns may reflect late-pregnancy metabolic adaptations rather than causal mechanisms. Further studies in larger and more diverse populations are required to confirm these findings.

Background/Objectives: This study evaluated whether a low-carbohydrate diabetes-specific enteral formula improves glycemic control and insulin requirement compared with a standard enteral formula in critically ill patients with type 2 diabetes mellitus (T2DM) under pandemic-related product accessibility constraints. Methods: This retrospective observational study included adult ICU patients with T2DM receiving enteral nutrition between August 2021 and August 2023. Patients were grouped according to enteral formula type as standard enteral formula or diabetes-specific enteral formula. All patients received continuous nasogastric enteral feeding according to routine ICU practice. Glycemic control was managed using intravenous insulin infusion protocols. One hundred eligible patients were analyzed. Results: Fifty patients were included in each group. Baseline characteristics were broadly comparable, although differences in BMI and feeding rate were observed. Mean glucose level, daily insulin requirement, hypoglycemia, hyperglycemia, and glycemic variability were similar between groups (all p > 0.05). However, the number and percentage of days within the target glycemic range were higher in the diabetes-specific formula group (both p = 0.021). Clinical outcomes were comparable between groups. In multivariable analysis, mean glucose level independently predicted insulin requirement and glycemic variability, whereas formula type did not. Product-related costs were lower in the diabetes-specific formula group (all p < 0.001). Conclusions: Diabetes-specific enteral formula did not improve mean glucose level or insulin requirement in critically ill patients with T2DM, although it was associated with better maintenance of the target glycemic range and lower product-related costs. Enteral formula choice should therefore be individualized rather than routinely determined by diabetes status alone.

Breast Milk Feeding (BMF) benefits mother and infant. However, women with select risk factors report shorter breastfeeding durations. Our previous prospective cohort observational study of a lactation-consultant-led telephone-based support program in the first month postpartum increased BMF rates up to 6 months. This post hoc study further evaluated the program for mothers at increased risk of early breastfeeding cessation.

We performed secondary analysis involving 762 mothers (control, n = 378; intervention, n = 384), recruited between 2018 and 2019. Infant feeding types, including BMF, were recorded at 1, 3 and 6 months. Feeding outcomes were analyzed in association with maternal risk factors. p-values, odds ratios and 95% confidence intervals were reported via both univariate (UVA) and multivariate regression analysis (MVA).

Via MVA, the intervention was associated with increased 6-month BMF rates in these groupings [OR (95%CI), p-value]: European [1.80 (1.07-2.96), p = 0.027]; South Asian [1.93 (1.19-3.13), p = 0.008]; employed [1.47 (1.02-2.12), p = 0.038]; unemployed [2.15 (1.33-3.50), p = 0.002]; married [1.71 (1.22-2.39), p = 0.002]; social support present [1.51 (1.05-2.16), p = 0.026]; chronic illness [1.93 (1.35-2.75), p = 0.001]; gestational diabetes mellitus [2.17 (1.19-3.95), p = 0.11]; overweight and obese [1.48 (1.03-2.12), p = 0.034]. A derived success score across the study period indicated via UVA associated increases in BMF rates with history of depression and anxiety (MI) [p = 0.044] and ongoing MI [p = 0.033], but these increases were smaller than that for no history of MI [p < 0.001]. No effect was observed in East/Southeast Asian mothers, Middle Eastern mothers, single or de facto mothers, older mothers, mothers without social support and mothers of any skill level.

Although early postpartum telephone support was associated with a number of positive findings of improved BMF at 6 months and over the course of the study, the results were mixed. This suggests that future breastfeeding telephone-based initiatives need to be multifaceted in order to target mothers at risk of early breastfeeding cessation.

Diabetic peripheral neuropathy (DPN) affects up to 50% of diabetes patients and is driven by hyperglycemia-induced oxidative stress, mitochondrial dysfunction, polyol pathway activation, advanced glycation end-product formation, and inflammation. Current management is largely symptomatic, prompting interest in metabolic/nutritional therapies. This review critically evaluates the mechanistic rationale and clinical evidence for alpha-lipoic acid (ALA) and benfotiamine as adjunctive treatments for DPN.

A structured narrative review of PubMed/MEDLINE was conducted using predefined keywords for DPN, oxidative stress, metabolic therapy, and thiamine derivatives. Randomized controlled trials, clinical studies, systematic reviews, and relevant experimental studies were included. Evidence was synthesized qualitatively with emphasis on mechanistic plausibility, clinical efficacy, intervention duration, and methodological rigor.

ALA consistently improves short-term symptoms across multiple randomized trials. The long-term NATHAN 1 trial reported a marginal, borderline significant effect on the primary composite endpoint (NIS-LL, p = 0.05) without significant improvements in nerve conduction studies; therefore, evidence for functional stabilization is very limited and inconclusive. ALA's effects are attributed to antioxidant activity, mitochondrial protection, and improved microvascular function. Benfotiamine has a strong biochemical rationale (transketolase activation, diversion of glycolytic intermediates from damaging pathways), but clinical evidence remains limited to short-duration, symptom-based studies, with no large-scale, long-term trials published.

Both agents target key pathways in DPN pathogenesis. ALA is the most established adjunctive metabolic therapy for symptomatic DPN, although no study has demonstrated structural nerve regeneration or a definitive disease-modifying effect. Benfotiamine is biologically plausible but requires further validation in long-term randomized trials with structural and biomarker-based endpoints. Outside of documented thiamine deficiency, its routine use cannot be recommended based on current evidence.

Background/Objectives: A 90-day randomized double-blind and placebo-controlled study was conducted to assess the effect of carob (Ceratonia siliqua L.) on glucose metabolism in subjects with confirmed prediabetes. Methods: The carob liquid concentrate containing inositols of the carob fruit (D-pinitol, myo-inositol, D-chiro inositol) was administered at a daily dose of 6.66 g, divided into two doses of 3.33 g each. Study variables included glucose- and insulin-related parameters obtained at fasting conditions and during a standard 2 h oral glucose tolerance test (OGTT) at baseline and after 45 and 90 days of administration of the study products. Results: The study population included 52 subjects (25 in the experimental group, 27 in the placebo group), 27 men and 25 women, with a mean age of 45.6 ± 13.9 years. Subjects who consumed the active product showed improvements in glycated hemoglobin (HbA1c) and glucose levels as compared with placebo (p < 0.001 of the time × group interaction). Fasting serum insulin showed within-group significant decreases in the experimental group, with insulin indexes (HOMA-IR and QUICKI) improving significantly in the experimental group only. In the OGTT, there were significant improvements in the AUC of glucose and insulin, as well as glucose peak in the experimental group only. The product was well tolerated and no adverse effects were recorded. Conclusions: The use of a specific carob-based liquid concentrate decreased HbA1c and glucose levels in subjects with prediabetes, which may suggest its potential clinical relevance in the prevention of the transition from prediabetes to overt type 2 diabetes.

Diabetes Mellitus is a chronic metabolic disorder characterized by elevated blood glucose due to defects in insulin secretion or action, or both, leading to serious short- and long-term complications if not effectively managed. However, there is limited qualitative evidence exploring how youths diagnosed with Type 1 Diabetes Mellitus (T1DM) experience disease onset, management, complications, emotional adaptation, and education within the South African public healthcare system. The study aims to investigate the lived experiences of youths living with T1DM in a selected public hospital in Limpopo province, South Africa. The objectives were to explore and describe the lived experiences of youths living with T1DM. A qualitative, explorative, descriptive, and contextual design was used to gain a thorough understanding of the experiences of youths living with T1DM. A non-probability sampling technique was used to select 12 participants using a pre-determined criterion. Data were collected through individual semi-structured interviews using an interview guide. The data were analyzed using Colaizzi's method, where themes and sub-themes were developed with the inclusion of an independent coder. Measures to ensure trustworthiness and ethical considerations were adhered to throughout the study. The findings revealed that, despite the participants sharing the same diagnosis, they experience multiple interrelated barriers that significantly hindered effective self-care management, such as limited access to diabetic diet, glucometers and supplies, treatment and informational-related barriers, school-related challenges, transportation constraints and inadequate social support. Furthermore, the findings highlighted gaps in early recognition of symptoms, standardized diabetes education, psychosocial support, and continuity of care. The study recommends the need for holistic, patient-centred, and contextualized interventions that do not only address medical management but the socioeconomic, educational, and psychological needs of youths.