To characterize macular microvascular alterations across the dysglycemia spectrum, from prediabetes (pre-DM) to early type 2 diabetes (T2DM), before clinically detectable diabetic retinopathy develops.

In this cross-sectional study, participants with pre-DM, recent-onset T2DM, and age-matched healthy controls underwent swept-source optical coherence tomography angiography. Quantified metrics included vessel density (VD), perfusion density (PD), foveal avascular zone acircularity, and choriocapillaris flow-deficit (FD) density and size. One eye per participant was analyzed. Feature importance was assessed using a random forest model with SHAP values.

Analysis of 309 eyes (79 controls, 85 pre-DM, 75 T2DM <3 years, and 70 T2DM 3-7 years) showed that microvascular impairment is evident from the prediabetic stage. Compared with controls, participants with prediabetes had lower VD and PD in both superficial and deep capillary plexuses, together with higher choriocapillaris FD density (all P < 0.05). Retinal capillary metrics were similar between pre-DM and early T2DM (all P > 0.05), whereas choriocapillaris impairment progressed across dysglycemia stages, with large-size FD density increasing from pre-DM to T2DM <3 years and T2DM 3-7 years (9.3 ± 0.9 vs. 9.7 ± 1.1 and 9.8 ± 1.0, P < 0.05). Among OCTA metrics, choriocapillaris FD density showed the strongest discriminatory ability and was the most influential feature in SHAP analysis.

Macular microvascular impairment begins in prediabetes. Retinal capillary changes plateau early, whereas choriocapillaris impairment progresses with worsening dysglycemia, suggesting greater sensitivity of choriocapillaris metrics for monitoring early metabolic disease.

Background and objective Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis and a powerful predictor of coronary and cerebrovascular events, yet it is frequently underdiagnosed, particularly in primary care and resource-limited settings. The ankle-brachial pressure index (ABPI) is an inexpensive, noninvasive, first-line test, whereas arterial duplex ultrasonography provides anatomical and hemodynamic information that can guide revascularization. The objective of this study was to correlate the ABPI and clinical findings with arterial duplex scan findings in the evaluation of lower-limb PAD. Materials and methods This descriptive cross-sectional study enrolled 50 patients with clinically suspected chronic lower-limb arterial occlusive disease admitted to the Department of Surgery, Dhaka Medical College Hospital, between September 2018 and March 2019. All patients underwent history taking, clinical examination, ABPI measurement, and arterial duplex ultrasonography of the affected limb. An ABPI of 0.90 or less, supported by clinical findings, was considered positive for PAD, and stenosis or occlusion on duplex was taken as the imaging finding of interest. Agreement between ABPI plus clinical findings and duplex was assessed, and the corresponding diagnostic performance was calculated. Analyses were performed using IBM SPSS Statistics for Windows, version 20.0 (released 2011; IBM Corp., Armonk, NY, USA), with P < 0.05 considered statistically significant. Results The mean age was 53.4 ± 11.5 years, and 82.0% of patients were male (male-to-female ratio, 4.5:1). Smoking (88.0%) was the most frequent risk factor, followed by diabetes mellitus (64.0%), hypertension (58.0%), and obesity (44.0%). Intermittent claudication and muscle cramping (68.0% each) were the most common symptoms, and all patients had tissue loss (gangrene or ulceration). ABPI indicated moderate disease (0.41-0.70) in 38.0% of patients, mild disease (0.71-0.90) in 28.0%, and severe disease (<0.40) in 16.0%. Duplex demonstrated stenosis or occlusion in 76.0% of patients. ABPI combined with clinical findings showed a sensitivity of 90.2%, specificity of 88.9%, positive predictive value of 97.3%, and overall accuracy of 90.0%, with a statistically significant association with duplex findings (P = 0.0001). Conclusions ABPI combined with clinical assessment correlated strongly with duplex ultrasonography and provided an accurate, accessible approach to the diagnosis of lower-limb PAD. The combined use of physiological and imaging data supports earlier diagnosis and rational treatment planning, an advantage that is especially relevant in resource-limited settings.

Diabetic orthostatic hypotension, associated with cardiovascular autonomic neuropathy, can be assessed using the coefficient of variation of the R-R interval (CVRR). We investigated whether CVRR during deep breathing could serve as a risk indicator for orthostatic blood pressure decline in patients with type 2 diabetes. This study included 88 hospitalized patients aged 51.5-71.4 years with type 2 diabetes undergoing diabetes education or glycemic control. Blood pressure changes during postural transitions were measured using a non-invasive beat-to-beat blood pressure monitoring device. Participants were divided into two groups based on CVRR values measured at rest and during deep breathing, using a cutoff of 2%. Blood pressure changes during postural transitions were compared. At rest, no significant differences in systolic or diastolic blood pressure changes were observed between the autonomic dysfunction group (CVRR ≤ 2%, n = 42) and the non-autonomic dysfunction group (CVRR >2%, n = 46; p > 0.05). However, during deep breathing, patients with CVRR ≤ 2% (n = 20) exhibited significantly greater decreases in systolic blood pressure at 0-30, 31-60, 61-90, 91-120, and 151-180 seconds after standing (p < 0.05). These findings suggest that a CVRR below 2% during deep breathing serves as a risk indicator for orthostatic systolic blood pressure decline in patients with type 2 diabetes.

Diabetic retinopathy (DR) is a leading cause of preventable blindness, particularly in regions with poor glycemic control and limited access to structured education. Theory-driven interventions such as the Theory of Planned Behaviour (TPB) may enhance self-care and improve clinical outcomes. To evaluate the effectiveness of a TPB-based self-care education programme on glycemic control, knowledge, self-care behaviours, and TPB constructs among patients with diabetic retinopathy. This quasi-experimental pretest-posttest-controlled study was conducted between September 2024 and August 2025 among 200 patients with diabetic retinopathy attending a tertiary diabetes centre in Erbil, Iraq. Participants were allocated to an intervention group (n = 100) receiving a structured three-session TPB-based education programme or a control group (n = 100) receiving standard care. Outcomes were assessed at baseline and 3 months. The primary outcome was HbA1c. Secondary outcomes included diabetes knowledge, self-care practices, and TPB constructs. Statistical analyses included paired and independent t-tests, chi-square tests, and effect size estimation. At 3 months, HbA1c significantly decreased in the intervention group (-0.50%) but increased in controls (+1.06%), yielding a significant between-group difference (-1.50%, 95% CI: -1.93 to -1.07; p < 0.001; d = 0.97). Significant improvements were observed in systolic blood pressure, total cholesterol, and LDL cholesterol. Diabetes knowledge improved markedly, with 56% achieving high knowledge versus 0% in controls (p < 0.001). Self-care behaviours and TPB constructs also improved significantly (all p < 0.001). A brief TPB-based education programme significantly improved glycemic control and self-management in patients with DR. This low-cost intervention offers a scalable strategy for reducing diabetes-related complications in resource-limited settings.

Type 1 diabetes (T1D) is associated with increased risk of dementias and other neurodegenerative diseases. Plasma biomarkers of neurodegeneration and neuroinflammation hold utility in risk prediction and diagnosis of neurodegenerative disease and other neuropathology, but there remains a paucity of data in the T1D population. This study quantified plasma levels of biomarkers of neurodegeneration and neuroinflammation [phosphorylated tau-181 (pTau-181), total tau (Tau), amyloid beta 42/amyloid beta 40 (Aβ42/40), glial fibrillary acidic protein (GFAP), and neurofilament light chain (NfL)], and tested associations with T1D and related characteristics.

This cross-sectional analysis of a subset of participants from the Coronary Artery Calcification in Type 1 Diabetes study included adults with and without T1D. Biomarker levels were quantified using Quanterix Simoa, then log-transformed and analyzed using linear regression models adjusted for age, body mass index (BMI), race and ethnicity, smoking status, and estimated glomerular filtration rate (eGFR). A subsequent sensitivity analysis included diabetic retinopathy (DR).

136 adults with T1D (n=90, age 52 years, 58% female, average HbA1c 7.7%) and without T1D (n=46, age 53 years, 57% female, average HbA1c 5.4%) were included. In fully adjusted models, T1D was associated with higher pTau-181 [estimate (pg/mL) 1.221, (95% confidence interval 1.003, 1.486) p=0.046], GFAP [1.296 (1.129, 1.489), p<0.001], and NfL [1.355 (1.162, 1.579), p<0.001], relative to adults without T1D. In the sensitivity analysis, relative to adults without T1D, T1D with moderate/severe DR was associated with higher pTau-181 [1.330 (1.063, 1.663), p=0.013], GFAP [1.369 (1.653, 1.608), p<0.001], and NfL [1.495 (1.252, 1.786), p<0.001], and T1D with none/mild DR was associated with higher GFAP [1.228 (1.046, 1.442), p=0.013] and NfL [1.235 (1.037, 1.470), p=0.018]. As compared to T1D with none/mild DR, T1D with moderate/severe DR was associated with higher NfL [1.211 (1.011, 1.451), p=0.038]. Across both models, eGFR was inversely associated with pTau-181, NfL, and Tau (p<0.05 for all).

T1D is associated with a greater burden of plasma biomarkers of neurodegeneration and neuroinflammation, and microvascular complications such as DR and impaired kidney function may contribute to this burden. Further study is needed to fully characterize the interplay between these biomarkers and neuropathology in T1D.

Dietary quality and physical activity are fundamental components of glycemic management in patients with type 2 diabetes mellitus (T2DM). However, glycemic responses to lifestyle behaviors may vary across individuals, suggesting a potential role of psychological self-regulation traits. This study aimed to assess the associations of dietary quality and physical activity with glycemic indicators among hospitalized patients with T2DM and to test whether the Act with Awareness dimension of trait mindfulness moderated these associations using interaction models.

This cross-sectional study included 400 hospitalized patients with T2DM at the Second Affiliated Hospital of Xuzhou Medical University between December 2023 and June 2025. Dietary quality was assessed using a structured dietary score, and physical activity was evaluated according to self-reported weekly exercise duration. Trait mindfulness was measured using the Five Facet Mindfulness Questionnaire. The primary outcomes were glycated hemoglobin (HbA1c) and fasting blood glucose (FBG), both of which were natural log-transformed before regression analyses. Multivariable linear regression models were used to estimate the associations of dietary quality and physical activity with log-transformed HbA1c and FBG. Multiplicative interaction terms were then included to test the moderating role of Act with Awareness, with adjustment for demographic characteristics, lifestyle factors, BMI, diabetes duration, sleep, comorbidities, medication use, and insulin use.

In fully adjusted models, higher dietary scores were associated with lower log-transformed HbA1c (β = -0.019, 95% CI: -0.032 to -0.005; P = 0.008) and FBG (β = -0.023, 95% CI: -0.042 to -0.003; P = 0.022). Physical activity scores were negatively associated with HbA1c (β = -0.002, 95% CI: -0.004 to 0.000; P = 0.034), but not with FBG. Significant interactions were observed between Act with Awareness and dietary score for both HbA1c and FBG, and between Act with Awareness and physical activity score for HbA1c.

Better dietary quality and higher physical activity were associated with more favorable glycemic indicators among hospitalized patients with T2DM. Act with Awareness may modify the strength of these associations. Given the cross-sectional design, these findings should be interpreted as observational associations rather than causal relationships.

The rising prevalence of early-onset type 2 diabetes (T2DM) has become a major public health concern, with these patients facing a particularly high risk of early diabetic kidney disease (DKD). Although continuous glucose monitoring (CGM)-derived metrics have shown promise in predicting complications in later-onset T2DM, their utility in early-onset T2DM, a more aggressive phenotype characterized by rapid β-cell decline and heightened complication risk, remains unclear. Moreover, the relationship between glycemic variability and renal injury, as well as the mechanisms underlying the associations between CGM metrics and DKD, have not been fully elucidated. This study aimed to evaluate the associations of time in range (TIR), coefficient of variation (CV), and glycemic risk index (GRI) with early DKD in Chinese patients with early-onset T2DM, and to explore the potential mediating role of triglycerides.

This cross-sectional study included 810 individuals with early-onset T2DM, defined as diagnosis before age 40. All participants underwent ≥7 days of CGM. Early DKD was defined as a urinary albumin-to-creatinine ratio (UACR) ≥30 mg/g with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73m². Multivariable logistic regression, restricted cubic splines, and mediation analysis were used to evaluate independent associations, nonlinear relationships, and the mediating role of triglycerides (TG), respectively.

Among the participants, 183 (22.59%) had early DKD. After full adjustment including HbA1c, higher TIR was associated with lower odds of early DKD (per 1% increase: OR 0.99, 95% CI 0.98-0.99, P < 0.001), whereas higher GRI was associated with increased odds (per 1-unit increase: OR 1.01, 95% CI 1.01-1.02, P < 0.001). A U-shaped relationship was observed between CV and early DKD risk, with the nadir observed at approximately 20-30% CV. In mediation analysis, TG statistically accounted for 13.01% of the association between TIR and early DKD, and 11.92% of the association between GRI and early DKD.

In Chinese patients with early-onset T2DM, CGM-derived metrics are independently associated with early DKD, with TIR and GRI showing opposite associations and CV exhibiting a U-shaped relationship. The observed association involving triglycerides suggests that lipid metabolism may be a correlate of glycemic control in relation to renal injury. These findings support a multidimensional strategy integrating glucose control, glycemic stability, and lipid management for renal protection in this high-risk population.

To evaluate the efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) in patients with diabetes mellitus and comorbid depression.

This study was registered in PROSPERO (CRD420261305439). Eight electronic databases were searched up to February 11, 2026 for randomized controlled trials comparing SSRIs plus usual care versus control. Outcomes included depressive symptoms (HDRS, BDI), anxiety (HARS), glycaemic control (HbA1c, FPG, PPG), and BMI. Meta-analyses were performed using random-effects models; subgroup analysis by follow-up duration and sensitivity analysis were conducted.

Nine RCTs (770 participants) were included. Overall, SSRIs did not significantly improve HDRS (MD = 0.16, 95% CI -0.69 to 1.01, P = 0.72) or BDI scores. However, subgroup analysis showed significant HDRS reduction when follow-up was ≥ 6 months (MD = -0.96, 95% CI -1.86 to -0.05, P = 0.04). SSRIs were associated with increased HARS scores (MD = 2.37, 95% CI 0.73 to 4.02, P = 0.005). No significant effects were observed for HbA1c, FPG, PPG, or BMI.

Preliminary evidence suggests that SSRIs may offer modest antidepressant benefits when used for ≥ 6 months in diabetic patients with depression, but they may be associated with a small increase in anxiety scores and do not appear to improve glycaemic control or BMI. However, the overall certainty of evidence is low to moderate. Monitoring of early anxiety symptoms is recommended, and further high-quality RCTs are needed.

https://www.crd.york.ac.uk/prospero/, identifier CRD420261305439.

Adipokines play an important role in metabolism, insulin sensitivity, and inflammation, and may provide distinct contributions to the pathophysiology of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). The differences in roles of the adiponectin-leptin ratio (ALR), visfatin, and tumor necrosis factor-alpha (TNF-α) in the various subtypes of diabetes are still not fully understood. This cross-sectional study involved 141 participants, divided into healthy controls (n = 47), patients with T1DM (n = 47), and patients with T2DM (n = 47). Serum adiponectin, leptin, visfatin, TNF-α, fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), and serum insulin levels were measured. The ALR was calculated. Insulin resistance and β-cell function were examined using homeostasis model assessment (HOMA) indices. We performed group comparisons, correlation studies, logistic regression tests, and receiver operating characteristic (ROC) curve analyses. The differences observed were all statistically significant. Participants with T2DM showed a more adverse metabolic profile, characterized by greater waist circumference and higher levels of FPG, HbA1c, serum insulin, leptin, and TNF-α, along with lower levels of adiponectin and ALR. Participants with T1DM also exhibited altered adipokine profiles compared to controls, notably with increased levels of leptin and TNF-α. All diabetic groups had decreased levels of visfatin, with the T2DM group showing the largest reduction. ROC analysis demonstrated effective discrimination of TNF-α, ALR, and visfatin in this group. This study highlights the different inflammatory and adipokine profiles across diabetes subtypes. The assessment of these biomarkers enhances the understanding of metabolic differences between T1DM and T2DM. However, these findings are exploratory and require validation in large, controlled studies.

Intimal hyperplasia (IH) is an important pathological mechanism underlying secondary arteriovenous fistula (AVF) failure in previously mature fistulas, yet the clinical and histopathological determinants that distinguish progressive IH leading to access loss from stable IH remain poorly characterized. This study aimed to identify clinical and histopathological predictors of secondary AVF failure due to IH in previously mature fistulas, and to develop a predictive nomogram for risk stratification.

This retrospective cohort study enrolled 320 patients with end-stage renal disease (ESRD) who underwent AVF creation between January 2020 and June 2025 and had histopathologically confirmed IH from surgical specimens. Patients were classified into a secondary failure group (n = 142, previously mature AVFs permanently abandoned due to IH-driven dysfunction) and a secondary patency group (n = 178) based on access outcomes. Clinical, laboratory, hemodynamic, and histopathological variables were compared between groups. Multivariable logistic regression was performed to identify independent predictors. A nomogram was constructed and internally validated using bootstrap resampling (1,000 iterations).

Multivariable analysis identified seven independent predictors of secondary AVF failure: diabetes mellitus (OR = 2.31, 95% CI: 1.42-3.76, P = 0.001), C-reactive protein ≥ 8.0 mg/L (OR = 1.89, 95% CI: 1.18-3.03, P = 0.008), intima-to-media thickness ratio > 1.5 (OR = 3.67, 95% CI: 2.18-6.17, P < 0.001), CD68⁺ macrophage density > 25 cells/HPF (OR = 2.54, 95% CI: 1.53-4.22, P < 0.001), α-SMA positive area > 40% (OR = 2.12, 95% CI: 1.31-3.43, P = 0.002), MMP-9 high expression (OR = 1.95, 95% CI: 1.21-3.14, P = 0.006), and neovascularization density > 15 vessels/HPF (OR = 1.78, 95% CI: 1.09-2.91, P = 0.021). The nomogram demonstrated good discrimination (C-index = 0.847, 95% CI: 0.803-0.891) and calibration. Decision curve analysis confirmed superior net clinical benefit compared with individual predictors.

Integration of clinical parameters and histopathological markers enables accurate prediction of secondary AVF failure due to IH. The proposed nomogram may facilitate individualized risk stratification and guide clinical decision-making regarding vascular access management in hemodialysis patients.