This study aimed to assess the current status of oral health-related quality of life (OHRQoL) and to identify associated factors among older adults receiving maintenance hemodialysis (MHD).

Between September 2024 and September 2025, a total of 107 older adults receiving MHD were recruited from a Grade A tertiary hospital in Guangdong Province using a convenience sampling method. Data were collected using a general information questionnaire, the Oral Health Impact Profile-14 (OHIP-14), and the Self-Efficacy Scale for Oral Self-care (SESS). Univariate analyses and stepwise multiple linear regression were performed to determine factors associated with OHRQoL.

The mean OHIP-14 score was 18.97 ± 8.00, and the mean SESS score was 43.52 ± 12.98. A statistically significant negative correlation was observed between OHIP-14 and SESS scores (r = -0.736, p < 0.01). Multivariate analysis identified dialysis frequency, dialysis duration, tooth brushing frequency, tooth brushing duration, pre-dialysis blood urea nitrogen, pre-dialysis serum creatinine, SESS score, and comorbid diabetes mellitus as independent factors associated with OHRQoL (p < 0.05).

Older adults receiving MHD demonstrated relatively low levels of both OHRQoL and oral self-efficacy. Enhanced clinical attention and the development of targeted interventions addressing the identified influencing factors may contribute to improvements in OHRQoL in this population.

To investigate the characteristics and determinants of muscle mass and muscle function in patients with type 2 diabetes mellitus (T2DM), stratified by sex, age, and body mass index (BMI).

This is a retrospective cross-sectional study included 838 T2DM patients treated at the Department of Endocrinology and Metabolism, Nanjing First Hospital. Data on body weight, grip strength, gait speed, and other relevant clinical parameters were collected. Regression analyses and subgroup comparisons were performed according to sex, age, and BMI categories to evaluate the features and associated factors of muscle mass and muscle function in T2DM patients.

The prevalence of sarcopenia was slightly higher in female T2DM patients than that in males. Binary logistic regression analysis showed that, in addition to advanced age and low BMI, decreased serum albumin (Alb), elevated alkaline phosphatase, and insulin use were also significant risk factors for sarcopenia in male patients with T2DM. Multivariate analysis showed that in males, decreased skeletal muscle index (SMI) was independently associated with older age, low Alb, low creatinine, and low BMI; in females, it was independently associated with older age, low triglycerides, and low BMI. Regarding handgrip strength, older age and higher HbA1c were associated factors in males, whereas older age and longer diabetes duration were associated factors in females. For gait speed, older age and low albumin were associated factors in males, whereas only older age was significant in females. Age-stratified analyses revealed that in males, SMI and handgrip strength remained stable between ages 40 and 60, then declined significantly after 60; in females, declines were observed from approximately age 50. Gait speed decreased after age 70 in both sexes. BMI-stratified analyses revealed that sarcopenia prevalence increases with lower BMI, particularly in males. In males, low handgrip strength and gait speed rose sharply at BMI <18.5; no such association was observed in females.

Older age and low BMI are common risk factors associated with sarcopenia in T2DM patients. In males, monitoring of muscle mass and functional decline is warranted after age 60, particularly in the presence of low serum albumin and low BMI. Preventive awareness and measures should be initiated when females reach age 50.

Type 2 Diabetes Mellitus (T2DM) management requires integrated and continuous care; however, service fragmentation remains prevalent in universal health coverage (UHC) systems.

This study examines how governance arrangements influence service integration and patient-reported experiences in T2DM care in Indonesia, to develop strategic recommendations for strengthening integrated governance.

A concurrent mixed-methods design, qualitative driven, was employed. Qualitative data were collected through in-depth interviews with policymakers, insurance representatives, hospital managers, clinicians, and primary care providers Quantitative data were collected from 107 adults with T2DM using structured questionnaires assessing knowledge, medication adherence, perceived service quality, and health-related quality of life. Findings were integrated using a joint display guided by Green's PRECEDE framework; strategic positioning was assessed through a SWOT and Internal-External matrix, and a TOWS matrix was developed to formulate recommendations.

Qualitative findings identified four governance barriers: fragmented primary-referral care pathways, misaligned financing arrangements, uneven facility and workforce capacity, and weak coordination and monitoring mechanisms. Quantitative findings indicated high patient knowledge (median 86.7%) and medication adherence (76.6% highly adherent), yet generally positive service quality perceptions, though reliability showed the largest gap. Physical quality of life remained suboptimal, particularly in energy and general health. Strategic positioning placed current T2DM governance in the grow-and-build quadrant, indicating capacity for proactive reform.

The development of an integrated governance strategy emphasizing structured referral pathways, aligned financing with chronic care needs, institutionalized diabetes educator roles, and accelerated health information system interoperability - offering actionable lessons for universal health coverage systems in low-and middle-income countries.

Diabetic peripheral neuropathy (DPN) is a common complication of diabetes in the Gulf Cooperation Council (GCC) region, associated with delayed diagnosis, significant pain burden, and preventable complications. This Delphi-based consensus aimed to identify regional gaps in screening and management to develop practical, evidence-based recommendations tailored to GCC healthcare systems.

A three-round Delphi process was conducted involving 12 diabetes experts from six GCC countries, who reviewed international guidelines, identified unmet clinical needs, and voted on consensus statements addressing epidemiology, screening, diagnosis, and treatment, with consensus defined as ≥75% agreement.

The panel reached strong agreement on shifting from symptom-driven to proactive care, recommending routine annual screening for all individuals with diabetes and prediabetes. Experts also emphasized early, integrated management combining lifestyle modification, cardiovascular risk reduction, pathogenetic therapies, and individualized pharmacologic treatment of neuropathic pain. Key barriers identified included limited consultation time, high clinical workload, suboptimal awareness of DPN among clinicians and patients, and restricted access to guideline-recommended therapies due to regulatory constraints.

This regional consensus highlights the need for standardized, proactive care of patients with DPN, across the GCC. Implementation of systematic screening, early multimodal management, and policy-level improvements in access to therapies may improve patients' quality of life and reduce complications.

Little is known about the prevalence and experiences of intermittent caloric restriction (ICR) among individuals with Type 1 diabetes mellitus (T1DM), despite its growing popularity.

From September to October 2023, patients diagnosed with T1DM aged 18-89 in Minnesota were invited via the M Health Fairview's electronic health record (EHR) to complete a 10-min online survey. The survey gathered patient-provided data on demographics, clinical data, and questions centered on weight and use of ICR. Out of 124 respondents, 39 reported participating in ICR and completed the survey. These participants, with a mean age of 42.8 years (SD = 12.0) and a mean BMI of 28.2 kg/m² (SD = 5.5), included 22 females and 17 males. Among them, 34 reported practicing time-restricted eating (TRE), whereas 5 reported practicing intermittent fasting (IF). TRE participants reported an average weight loss of 6.0 kg, whereas IF participants reported an average weight loss of 3.5 kg. Hypoglycemia was reported by five TRE participants and one IF participant, with no episodes of diabetic ketoacidosis (DKA) reported. Only six participants reported that their healthcare providers were aware of their fasting program.

Individuals with T1DM do engage in ICR, mainly TRE, with rare hypoglycemia and no DKA. Further research is needed on long-term ICR safety in T1DM patients.

BACKGROUND There is a lack of effective predictive methods for post-pancreatitis diabetes mellitus (PPDM-A) in clinical practice. This exploratory study aimed to identify candidate computed tomography (CT) and plasma proteomic features associated with subsequent PPDM-A and to assess their preliminary discriminatory performance. MATERIAL AND METHODS This retrospective single-center study compared CT imaging features and clinical data between post-pancreatitis normal glucose (PPNG-A, n=10) and PPDM-A (n=9) groups. Differential plasma protein expression was analyzed using proteomics. Correlations between CT features and protein features in patients with PPDM-A were also assessed. RESULTS The PPDM-A group showed higher incidences of pancreatic necrosis and elevated plasma complement factor I (CFI) levels compared with the PPNG-A group. Plasma coagulation factor XII (F12) and immunoglobulin heavy chain (IgH) levels were significantly decreased in the PPDM-A group. Enzyme-linked immunosorbent assay findings validated CFI; F12 and IgH remain proteomics-derived candidate markers. The combined 3-index model achieved an area under the curve of 0.989 for PPDM-A discrimination in the same discovery cohort. CFI was positively correlated with pancreatic necrosis (P=0.02, R=0.527). CONCLUSIONS Plasma CFI, F12, and IgH demonstrated potential predictive value for PPDM-A and may help identify at-risk patients. CFI and F12 were significantly correlated with pancreatic necrosis, suggesting a link between plasma molecular markers and imaging manifestations of PPDM-A. These exploratory findings provide a preliminary experimental basis for early discrimination of PPDM-A. Clinical utility requires confirmation in multicenter studies with larger sample sizes and both internal and external validation.

Throughout the 9-months of pregnancy, a woman with gestational diabetes (GDM) is expected to celebrate holidays, which makes coping with diabetes difficult and alters routine glucose control.

We hypothesized that delivery in the first week following a holiday, might be associated with altered glucose homeostasis, causing more neonatal hypoglycemia.

A retrospective study was conducted in a tertiary center between the years 2007-2023. Eligible patients were women with a term singleton pregnancy, diagnosed with GDM. Women were allocated into two groups based on the date of their delivery in relation to holidays, in the first week following a holiday (group 1) and at times unrelated to holidays (group 2). The primary outcome was the incidence of neonatal hypoglycemia, defined as a glucose level of less than 40 mg/dL (2.2 mmol/L) within 24 hours of birth.

We analyzed 332 cases of GDM and 3,179 GDM control cases. Diet-controlled GDM represented most of our cohort (85%), and the mean blood glucose was tightly kept around 100 mg/dl throughout the labor. Baseline maternal and neonatal demographics were comparable between the groups. The incidence of neonatal hypoglycemia did not differ between the two groups, reaching 3.3% in the study group and 4.9% in the control group (p=0.19). The mean neonatal blood glucose at the nursery was also comparable between the groups, 63 ± 10.1 versus 63.2 ± 10.9 (p=0.95), respectively. GDM patients in group 1 had a higher rate of third- or fourth-degree perineal lacerations than group 2 (1.8% vs. 0.8%, p=0.04).

Our findings reassure us that major holidays, when occurring within a week of delivery, do not adversely impact neonatal outcomes in women with GDM.

Management of gestational diabetes during holiday periods may be challenging; however, delivery close to holidays does not increase the risk of neonatal hypoglycemia. Delivery during holiday periods does not increase the risk of neonatal hypoglycemia in women with gestational diabetes.

Global glycemic control in diabetes is suboptimal, with persistent gaps between guideline recommendations and clinical practice.

To evaluate the effectiveness of a role-playing-based intensive training program for physicians in improving glycemic control among patients with type 2 diabetes.

This was an open-label, 2-arm parallel, cluster randomized clinical trial conducted at 205 centers in China, with enrollment from February 13 to September 19, 2023, and 12-month follow-up completed on October 25, 2024. In phase 1, 205 physicians from qualified diabetes centers across China were enrolled from February 13 to April 29, 2023, and randomly assigned to the intensive training group (n = 103) and the regular training group (n = 102). In phase 2, 2017 patients with type 2 diabetes were enrolled from February 28 to September 19, 2023. Data were analyzed from January 1 to June 1, 2025.

One-week on-site role-playing-based intensive training (involving simulating patient roles in experiencing diabetes-related health examinations, complication scenarios, lifestyle intervention, and face-to-face conversations) vs regular training.

The proportion of patients achieving a hemoglobin A1c (HbA1c) level of less than 7.0% at 6 months. The primary analysis was based on the intention-to-treat principle.

A total of 205 physicians (mean [SD] age, 36.2 [5.1] years; 155 women [75.6%]) and 2017 patients (mean [SD] age, 53.0 [7.0] years; 713 women [35.3%] and 1304 men [64.7%]) were enrolled, with 1009 patients in the intensive training group and 1008 patients in the regular training group. At 6 months, a significantly greater proportion of patients in the intensive training group achieved an HbA1c level less than 7.0% compared with the regular training group (58.0% [476 of 820] vs 42.9% [351 of 818]), with an adjusted between-group difference of 16.6% (95% CI, 7.2%-25.7%; P < .001). At 12 months, the difference between the intensive training group and the regular training group remained significant (60.9% [502 of 824] vs 44.6% [371 of 832]; adjusted between-group difference, 17.0% [95% CI, 7.0%-26.8%]; P < .001). The intensive group had greater reductions in body mass index (adjusted between-group difference, -0.3 [95% CI, -0.5 to -0.1]), waist circumference (adjusted between-group difference, -1.4 cm [95% CI, -2.1 to -0.8 cm]), fasting glucose (adjusted between-group difference, -6.3 mg/dL [95% CI, -10.7 to -1.9 mg/dL]), and systolic blood pressure (adjusted between-group difference, -1.5 mm Hg [95% CI, -2.9 to -0.1 mm Hg]). Serious adverse events were comparable between groups (intensive group, 2.6% [26 of 1009]; regular group, 2.4% [24 of 1008]).

In this cluster randomized clinical trial of role-playing-based intensive training for physicians managing type 2 diabetes, the intervention significantly improved patient glycemic control. These findings suggest a feasible strategy to narrow the guideline-implementation gap in diabetes care.

ClinicalTrials.gov Identifier: NCT05715307.

This multicenter retrospective study evaluated the impact of type 2 diabetes mellitus (DM) on clinical outcomes and immune-related adverse events (irAEs) in 450 patients with metastatic non-small cell lung cancer (NSCLC) treated with second-line nivolumab at 17 centers between 2016 and 2024. Among these patients, 118 (26.2%) had DM. Baseline demographic and clinical characteristics, including age, sex, smoking status, ECOG performance status, histology, and PD-L1 expression, were similar between patients with and without DM. Nivolumab demonstrated similar antitumor activity in both groups, with no significant differences in median progression-free survival (PFS), overall survival (OS), or objective response rates. However, the incidence of Grade 3-4 irAEs was significantly higher in patients with DM. HbA1c levels were not associated with survival outcomes in univariate analyses, and metformin or insulin use did not affect PFS or OS among patients with DM. These findings indicate that DM does not compromise immunotherapy efficacy but is associated with a higher risk of severe toxicity. Clinicians should consider metabolic status and closely monitor patients with DM receiving immunotherapy. Further prospective studies are needed to clarify underlying mechanisms and optimize treatment strategies for this population.

Type 2 diabetes mellitus (T2DM) affects over 415 million individuals globally, with excessive hepatic glucose production representing a primary contributor to hyperglycaemia. Fructose-1,6-bisphosphatase (FBP1), a rate-limiting gluconeogenic enzyme, has emerged as a promising therapeutic target. This review examines FBP1's molecular mechanisms, including its tetrameric structure and allosteric regulation by AMP. FBP1 dysregulation in diabetes involves transcriptional control by FOXO1, CREB, PGC-1α, and epigenetic modifications. Drug discovery efforts have yielded diverse inhibitor classes, including AMP-competitive inhibitors, covalent modulators targeting cysteines C128/C179, and natural products. Leading compounds demonstrate exceptional potency (IC₅₀ 0.029 μM) with favourable bioavailability and efficacy in preclinical models. Structure-based design and AI-driven approaches have accelerated optimisation. Clinical translation of FBP1 inhibitors represents a paradigm-shifting opportunity, potentially providing the first medication class specifically targeting hepatic gluconeogenesis for T2DM treatment.