Evidence relating sleep characteristics to type 2 diabetes mellitus (T2DM) has largely been based on single assessments. We examined whether transitions in a multidimensional healthy sleep score between two assessments were associated with incident T2DM and explored the relationship of the triglyceride-glucose (TyG) index to this association.

We conducted a landmark analysis among 60,249 UK Biobank participants with sleep assessed at visits 1 and 2. Visit 2 was defined as time zero for follow-up. Sleep pattern transitions were classified according to poor, intermediate, or healthy sleep status at each assessment. Cox proportional hazards models were used to estimate associations with incident T2DM. TyG analysis was treated as exploratory.

During a median follow-up of 4.2 years, 1284 incident T2DM cases occurred. Compared with stable healthy sleep, stable poor sleep was associated with higher risk (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.32-3.27). Baseline-stratified analyses did not show higher risk for improvement from poor or intermediate sleep relative to remaining in the same baseline category. The full-cohort spline showed evidence of nonlinearity (p for nonlinearity < 0.001), and TyG analyses were exploratory.

Sleep pattern transitions between the two assessments were associated with incident type 2 diabetes, and the association differed by baseline sleep status. Repeated sleep assessment may complement single-time-point evaluation in understanding the role of sleep in diabetes risk.

This study aligns with Sustainable Development Goal 3, Good Health and Well-being, which seeks to promote mental health and reduce premature mortality from non-communicable diseases. The research focuses on stimulant consumption, particularly energy drinks, as a significant risk factor affecting sleep quality among university students. In the local academic context, consuming these beverages has become a widespread and normalized practice. The study aims to address this issue by fostering healthy habits and promoting informed, responsible consumption within the university community. Accordingly, the primary objective is to determine the relationship between energy drink consumption and sleep quality among university students in Chiclayo in 2025.

A quantitative, non-experimental, cross-sectional design was employed. The population consisted of 12,100 university students in Chiclayo, with a probabilistic sample of 373 participants. Data were collected using two Likert-scale questionnaires, validated by experts and tested for internal reliability.

Findings indicate that energy drink consumption is prevalent among the student population, with most reporting moderate to high intake. Sleep quality was generally acceptable but not optimal, with many participants exhibiting medium to low sleep quality levels. Correlation analyses revealed a strong, negative, inverse relationship between energy drink consumption and sleep quality. Specifically, both the frequency of consumption and the reasons for intake were strongly associated with impaired sleep. Immediate perceived effects after consumption also correlated inversely with restorative sleep, suggesting that short-term energy gains compromise subsequent rest.

The study confirms a strong negative relationship between energy drink consumption and sleep quality among university students in Chiclayo. These findings highlight that stimulant intake constitutes a significant risk factor that undermines restorative sleep, emphasizing the need for interventions promoting healthier consumption habits and improved well-being in the academic community.

Diabetic kidney disease (DKD) is a common complication of type 2 diabetes mellitus (T2DM) and a leading cause of end-stage renal disease, posing substantial health and economic burdens. Early self-management interventions targeting modifiable risk factors are crucial to prevent or slow DKD progression. However, most studies focus on later stages of DKD, leaving a gap in early prevention for high risk of DKD individuals.

To evaluate the effectiveness of a structured self-management intervention on clinical outcomes among T2DM patients at high risk of DKD.

A prospective, two-arm, randomized controlled trial.

A tertiary hospital in Shandong Province, China.

134 patients with T2DM who were classified as being at high risk of DKD using a validated DKD risk prediction model.

134 participants were randomized 1:1 to the intervention or control group. The intervention group received a 12-week a structured self-management program and 12-week follow-up. The control group received usual care. Clinical outcomes included hemoglobin A1c (HbA1c), urinary albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), body mass index (BMI), waist circumference (WC) were collected at baseline (T0), after the 12-week intervention (T1), and at 24 weeks (T2). Generalized estimating equations and intention-to-treat analyses were performed. Sensitivity analyses using multiple imputation were conducted.

All participants completed the intervention phase. During the follow-up visits period, 7 participants in the intervention group and 9 participants in the control group were lost to follow-up at T1 (attrition rate: 11.94%), while 5 participants in the intervention group and 4 participants in the control group were lost to follow-up at T2 (attrition rate: 6.71%). No significant differences in baseline sociodemographic or clinical indicators between participants retained and those lost to follow-up (p > 0.05), suggesting data were missing at random. Baseline comparisons between the intervention and control groups revealed no significant differences in demographic or clinical indicators (p > 0.05). Compared with the control group, the intervention group demonstrated significant improvements in HbA1c, eGFR, SBP, and LDL-C, while no significant differences were observed for UACR, BMI, or WC. Sensitivity analyses yielded consistent results.

The self-management intervention effectively improved HbA1c, eGFR, SBP and LDL-C among T2DM patients at high risk of DKD. These findings suggest that integrating structured self-management into routine diabetes care may help improve modifiable risk factors and support early DKD prevention.

China Clinical Trial Registry (ChiCTR2400092745; registered on 22 November 2024).

Elevated amphotericin B (AmB) minimum inhibitory concentrations (MICs) in Aspergillus spp. may compromise empirical therapy. We describe three aspergillosis cases caused by distinct species with AmB MICs >16 µg/mL.

The first case involved postoperative invasive pulmonary aspergillosis due to A. fumigatus. Conventional AmB was used initially because renal impairment and bowel ischaemia limited voriconazole use; the patient later died with multiorgan failure, invasive aspergillosis and nosocomial infections. The second case involved traumatic A. flavus keratitis with newly diagnosed diabetes mellitus. The ocular infection resolved after voriconazole-based therapy and therapeutic keratoplasty, but graft failure and severe visual impairment persisted. The third case involved an infected corneal hydrops with exogenous endophthalmitis due to A. versicolor complex. Despite keratoplasty, vitrectomy and voriconazole-based therapy, the eye progressed to phthisis bulbi.

These cases highlight clinically diverse aspergillosis with elevated AmB MICs, supporting early species identification, timely antifungal susceptibility testing and access to active antifungal therapy.

Introduction Septic arthritis (SA) is a potentially destructive joint infection requiring timely diagnosis and treatment. Published adult data from Cambodia are limited, and local microbiological patterns may differ from those reported in other settings. Objective The objective of this study is to describe the demographic, clinical, laboratory, and available microbiological characteristics of adults treated for SA in a tertiary hospital in Cambodia. Materials and methods We conducted a small, single-center retrospective descriptive case series of 25 adults admitted to Medicine Ward B-A5, Calmette Hospital, from January 1, 2023, through December 31, 2024. Data were abstracted from medical records. Microbiological results were recorded as documented in the charts; detailed specimen-processing, organism-identification, and antimicrobial-susceptibility methods were not consistently available. Prior antibiotic exposure before presentation and treatment outcomes were also not consistently documented and were not analyzed. Results Among 25 patients, 15 (60%) were male, and the mean age was 49.52 ± 12.24 years. Ten (40%) were farmers and 21 (84%) lived outside Phnom Penh. Diabetes mellitus and alcohol use were each documented in 12 patients (48%). Joint pain (20/25, 80%), fever (16/25, 64%), and joint swelling (15/25, 60%) were common. The knee was affected in 17 patients (68%). An organism was reported from blood and/or synovial fluid culture in 13 patients (52%). Burkholderia pseudomallei was reported in five patients, methicillin-susceptible Staphylococcus aureus in three, Mycobacterium tuberculosis in two, and Escherichia coli, methicillin-resistant S. aureus, and Acinetobacter baumannii in one patient each. These organism frequencies should be interpreted as record-based observations rather than estimates of pathogen distribution. Conclusion This small single-center series describes the clinical experience of 25 adults with SA at a Cambodian tertiary referral hospital. The frequent recording of B. pseudomallei is clinically notable in the context of recognized melioidosis in Cambodia, but the small sample, referral setting, culture-negative cases, and incomplete microbiological documentation preclude conclusions about national pathogen prevalence. Larger multicenter studies using standardized microbiological methods and systematic treatment and outcome data are needed.

Hyperglycemic hyperosmolar state (HHS) is a rare but life-threatening hyperglycemic emergency in children and adolescents. It is characterized by severe hyperglycemia, hyperosmolality, and dehydration, with absent or limited ketoacidosis. Although more commonly associated with type 2 diabetes mellitus, HHS may also occur as the initial presentation of type 1 diabetes mellitus in pediatric patients. We report the case of a previously healthy 13-year-old boy presenting with a three-week history of polydipsia and nocturnal polyuria. Initial evaluation revealed profound hyperglycemia (>1,000 mg/dL), hyperosmolality, clinical dehydration, and only mild acidosis. During treatment, the patient experienced marked fluctuations in blood glucose, requiring repeated adjustments of insulin and dextrose infusions, electrolyte replacement, and pediatric intensive care monitoring. This case highlights the diagnostic challenges of pediatric HHS and emphasizes the importance of early recognition, prioritizing fluid resuscitation, cautious insulin administration, and close biochemical monitoring to prevent complications.

Painful diabetic peripheral neuropathy (DPN) is common and often inadequately controlled with pharmacological therapy. This study evaluated a clinician-directed, prescription home-use dual-wavelength low-level laser therapy device for temporary relief of painful DPN.

In this prospective, randomized, double-blind, sham-controlled trial conducted at four independent U.S. clinical sites, 64 adults with painful DPN were randomized 1:1 to active treatment (n = 33) or sham treatment (n = 31). The active device emitted simultaneous 640 red and 405 nm violet coherent laser light. Participants self-administered treatment twice daily for 3 weeks, with each session consisting of 5 min per foot. The primary endpoint was the proportion of participants achieving at least a 30% reduction in visual analog scale (VAS) foot pain score from baseline to Week 3. Secondary outcomes included VAS change, neuropathic pain symptoms, treatment satisfaction, durability through Week 7, adherence, blinding integrity, and safety. Participants were required to maintain a stable analgesic and neuropathic-pain regimen throughout, so the intervention was delivered in addition to existing standard care. The primary endpoint was analyzed in the intent-to-treat population, with single imputation for the four participants who withdrew before receiving a device.

At Week 3, 72.7% of active-treated participants met the primary responder criterion compared with 32.3% of sham-treated participants, a between-group difference of 40.5 percentage points (95% CI 18.1 to 62.9) (p = 0.0024). Mean VAS reduction was greater with active treatment than sham treatment (-33.4 vs -20.0 points; p = 0.026). Improvements were sustained through Week 7, with favorable symptom trends, higher satisfaction, and no serious device-related adverse events. Improvement on the neuropathic pain symptom inventory was greatest for paresthesia/dysesthesia, paroxysmal pain, and burning pain and was not evident for evoked pain.

Prescription home-use dual-wavelength laser therapy was well tolerated and produced clinically meaningful short-term reductions in foot pain in adults with painful DPN at four independent clinical sites. Because assessment ended four weeks after treatment completion, the findings support short-term pain relief, and the intervention is best positioned as a complementary, nonpharmacological modality used alongside standard care.

ClinicalTrials.gov identifier: NCT05291975.

Diabetes is associated with elevated risk of Alzheimer's disease and related dementias (ADRD). Disease management with pharmaceutical therapies may mitigate this increased risk, but access and use of diabetes therapies are limited, especially for persons at highest risk of ADRD.

Using 10 years of data on Americans aged 51 and older with diabetes, we employed dynamic microsimulation to analyze the impact of increased utilization of glucagon-like peptide 1 receptor agonists (GLP1s) and sodium-glucose cotransporter-2 inhibitors (SGLT2s) on ADRD incidence.

Over 10 years, utilization of GLP1s and SGLT2s by people with diabetes and HbA1c > 7 could avert 76,000-201,000 ADRD cases. The risk reduction is largest for Black and Hispanic individuals and individuals with HbA1c > 8.

This study shows that improving diabetes management can lead to large reductions in ADRD risk. Improved adherence and access for those with higher HbA1c and higher risk of ADRD will have the largest benefit.

Diabetic foot ulcers (DFUs) are serious complications of diabetes associated with delayed healing, infection, and limb amputation. Modelling DFU progression remains challenging because publicly available image datasets generally contain independent single-timepoint images rather than longitudinal follow-up sequences. This study proposes a texture-aware conditional diffusion framework for generating severity-conditioned, progression-like synthetic DFU images from a single RGB input. Instead of claiming patient-specific temporal prediction, the framework models plausible population-level visual transitions across ordinal pseudo-stages derived from clinically relevant severity cues. The full model achieved an SSIM of 0.851 ± 0.020, PSNR of 24.76 ± 1.12 dB, and FID of 44.33 ± 5.02, with higher observed SSIM and PSNR and lower FID values than the evaluated GAN and VAE baselines across structural fidelity and distributional realism. The GAN baseline achieved SSIM 0.782 ± 0.031, PSNR 21.98 ± 1.56 dB, and FID 59.13 ± 6.59, while the VAE baseline achieved SSIM 0.738 ± 0.038, PSNR 19.63 ± 1.83 dB, and FID 69.77 ± 7.44. The framework also obtained a Texture Consistency Score of 0.79 ± 0.04 and a Granulation Tissue Fidelity Score of 0.76 ± 0.05, indicating preservation of fine-grained texture and granulation-related appearance patterns. Ablation results confirmed the contribution of texture conditioning and cross-attention to image fidelity. Advanced severity-state analysis produced SSIM values of 0.674, 0.804, and 0.726 across three pseudo-stages, supporting severity-aligned structural consistency. Since true longitudinal future-state images were unavailable, these metrics indicate synthetic image fidelity and distributional realism, not longitudinal progression accuracy. Longitudinal DFU cohorts and larger clinician-centred validation remain necessary before clinical decision-support use or temporal progression claims can be justified. To assess generalization beyond the primary 493-image dataset, external validation was additionally performed on an independent DFU dataset under a zero-shot setting, demonstrating stable cross-dataset performance with only modest degradation in image fidelity and texture consistency. Therefore, the proposed framework should be interpreted as modelling cross-sectional severity-conditioned appearance interpolation across independent cases, rather than true patient-specific future progression prediction.

Galectin-3 (Gal-3) is a galactose-binding lectin released from immune cells that modulates the immune response and plays a role in type 2 diabetes mellitus (DM) and related vascular complications. This study aimed to investigate the relationship between serum Gal-3 levels and infection and inflammatory processes among patients with type 2 DM, diabetic foot infection (DFI), and healthy controls.

Patients with DFI, patients with type 2 DM without signs of infection, and healthy controls without comorbidities admitted to our clinic were included in the study. Serum Gal-3 levels were measured using an enzyme-linked immunosorbent assay (ELISA). Data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 21.0. Statistical significance was set at p < 0.05 for all tests.

Thirty-six patients with DFI, 24 patients with type 2 DM without signs of infection, and 24 healthy controls were included in the study. The median Gal-3 level was 232.54 pg/mL among patients with DFI, 209.14 pg/mL among patients with type 2 DM without infection, and 277.85 pg/mL among healthy group. No statistically significant difference in Gal-3 levels was found among the three groups (p > 0.05). Sixteen (44.4%) patients with DFI were classified as PEDIS grade 4, 11 (30.6%) as PEDIS grade 3, and 9 (25%) as PEDIS grade 2. No statistically significant difference in Gal-3 levels was observed across PEDIS grades (p > 0.05). There were no statistically significant associations between Gal-3 levels and C-reactive protein, procalcitonin, leukocyte count, or erythrocyte sedimentation rate (p > 0.05).

In our study, Gal-3 levels did not differ significantly among patients with DFI, patients with type 2 DM without infection, and healthy controls. More comprehensive studies are needed to clarify the potential diagnostic and severity-assessment value of Gal-3 in DFI.

Graphical Abstract.