Managing multiple chronic conditions often requires people to make treatment decisions, particularly when faced with competing demands. This usually leads to condition prioritisation, where one condition is prioritised over the other. Considering that diabetes and hypertension are closely linked, prioritising medication for one condition over the other can have serious health implications. This study aimed to explore condition prioritisation in people with coexisting diabetes and hypertension, and its impact on medication adherence.

A qualitative study was conducted with adults on medications to manage coexisting diabetes and hypertension, residing in Australia. Thirty participants were asked to indicate the condition they considered more important to manage and discuss their prioritisation. Thematic analysis was used to identify key factors influencing condition prioritisation. The Adherence to Refills and Medication Scale questionnaire was used to assess medication adherence for each condition.

Medication adherence scores varied in most cases, with diabetes and hypertension scores ranging from 12 to 21 and 12 to 26, respectively. Participants who prioritised one condition over the other demonstrated better medication adherence for the condition they perceived as more important. The key themes influencing disease prioritisation emerged primarily as patient-related and condition-related factors. Most participants prioritised diabetes due to its immediate perceived risks, fear of complications and previous experience with the condition.

Participants' perceptions of a condition and observed effects of the condition influenced condition prioritisation. This in turn influenced medication adherence, as participants were more vigilant in managing the condition they prioritised. These findings emphasise the need for tailored interventions that address the challenges of managing multiple conditions and medications.

People living with diabetes and hypertension took part as study participants but were not involved in the design, analysis, or dissemination stages of this research. A lay summary of the results will be shared via email with participants who expressed interest in receiving the findings of the study.

Diabetes-related foot ulcers (DFUs) are associated with depression, impaired health-related quality of life, an increased risk of cardiovascular disease and early mortality. To inform holistic care pathways, this qualitative study explored the experiences and unmet needs of adults living with type 2 diabetes mellitus (T2DM) and DFUs.

Semi-structured interviews were conducted with 25 adults with T2DM and current or previous DFUs, and 20 healthcare professionals with experience treating DFUs. Topic guides were underpinned by the Theoretical Domains Framework. Data were analysed using reflexive thematic analysis.

Four themes and three sub-themes were created relating to the impact of DFUs. DFUs were perceived as a 'wake-up call'; the experience often came as a shock, prompting individuals to consider what was responsible for their development. DFUs impacted individuals' behaviours in multiple ways: for some, they were a catalyst for positive change; for others, they fostered behaviours that were unhealthful and/or discordant with professionals' advice. DFUs negatively affected the physical and psychosocial well-being of individuals with DFU; sedentary behaviours instigated by DFUs led to changes in mood and mental health, in addition to increased weight, mobility problems and an amplified risk of health complications. Regarding the unmet needs of people with T2DM and DFUs, three themes were developed, capturing the need for treatment plans created through shared decision making and improving access to physical well-being and psychological support.

These findings identify several important areas of unmet need regarding care for adults with T2DM and DFUs, which can help inform improved support for this population.

Diabetes-related foot disease (DFD) is a leading cause of disability worldwide. In Australia, DFD affects approximately half a million people and is the primary driver of diabetes-related hospitalisations, amputations and costs. Guideline-based multidisciplinary footcare can halve these rates and improve quality of life, yet access remains inequitable, particularly for rural and remote communities for whom DFD hospitalisation and amputation rates are persistently high. Geographic isolation, workforce shortages and fragmented service delivery are barriers to DFD care, with Aboriginal and Torres Strait Islander Peoples experiencing additional cultural and systemic challenges. Telehealth-enabled models of care offer a promising solution to reducing inequities in access without compromising effectiveness. Four 'Foot Hubs' have been established across Queensland (Australia) to deliver specialist multidisciplinary footcare via a hub-and-spoke model, combining telehealth, outreach, and local partnerships to improve access for people living with DFD in rural and remote areas. This commentary provides an introductory overview of these Foot Hub services and how implementation science (the scientific study of methods and strategies to promote the systematic and sustainable uptake of new practices) can support the uptake and sustainability of these new models of care.

Diabetes mellitus remains a major public health concern in East Africa, and poor glycaemic control continues to drive avoidable complications, deaths and pressure on already stretched health systems.

To estimate the prevalence of poor glycemic control and describe the main factors associated with it among people living with diabetes in East Africa.

This review synthesized evidence from observational studies, cross-sectional surveys and regional health databases identified through PubMed, Scopus and Web of Science, following PRISMA guidance. Sociodemographic, clinical and behavioural indicators were examined to identify common patterns and predictors of poor glycaemic control. The review also considered how measurement approaches shaped reported estimates.

Fifty records were identified across PubMed (10), Scopus (23) and Web of Science (17). After screening, 37 records were eligible for full-text review, and 15 studies met the inclusion criteria for evidence synthesis. Across the region, poor glycemic control was consistently high, ranging from 60% to 85%. Most studies were facility-based and cross-sectional. Glycemic control was assessed mainly using HbA1c, commonly defined as ≥ 7% or > 7.5%, and less frequently by fasting blood glucose, typically ≥ 7.2 mmol/L or > 130 mg/dL. Type 2 diabetes was the dominant population studied, with fewer mixed cohorts and only one study focused on type 1 diabetes. Factors repeatedly linked to poor control included older age, longer duration of diabetes, poor medication adherence, limited access to care, low health literacy, inadequate diabetes education, insulin use, comorbidities, diabetic complications, unhealthy diet, physical inactivity, sedentary behaviour, substance use and limited self-management support.

Poor glycemic control is alarmingly common among people with diabetes in East Africa and reflects intertwined clinical, behavioural and health-system challenges. Region-specific strategies are needed to strengthen primary care, improve diabetes education, expand affordable monitoring and treatment and enhance surveillance to guide policy and resource allocation.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown neuroprotective and anti-inflammatory effects in cerebrovascular disease, and previous studies suggest reduced stroke risk and overall mortality. This study compared post-intracerebral hemorrhage (ICH) outcomes in patients with type 2 diabetes mellitus (T2DM) receiving GLP-1RAs vs other hypoglycemic drugs including insulin.

We conducted a retrospective cohort study using the global TriNetX network database. Patients with ICH and T2DM were stratified by GLP-1RA exposure, initiation between 5 years before and the day of the ICH and compared with patients treated with other hypoglycemic agents. After 1:1 propensity matching, 3600 patients per cohort were included in the analysis. Outcomes were assessed at 7, 30, and 90 days (all-cause mortality, seizures, craniectomy/craniotomy procedures, and external ventricular drain placement) and at 1 and 5 years post-ICH (all-cause mortality, seizures, palliative care, and respiratory failure).

GLP-1RA use was associated with lower 7-day mortality (adjusted hazard ratio [AHR] 0.831, 95% CI 0.703, 0.983), 30-day mortality (AHR 0.835, 95% CI 0.741-0.942), and 90-day mortality (AHR 0.805, 95% CI 0.725-0.894). External ventricular drain insertion was not significantly different at any time point. Craniectomy/craniotomy and seizure risk were not significantly different at 7 or 30 days but were lower by 90 days (craniectomy/craniotomy: 2.8% vs 3.6%; AHR 0.763; seizures: 6.4% vs 7.7%; AHR 0.804). The mortality and seizure benefit persisted at 1 and 5 years. At 1 and 5 years, GLP-1RA use was also associated with reduced need for palliative care (1 year: 10.4% vs 13.1%; AHR 0.754; 5 years: 13.1% vs 16.1%; AHR 0.775) and respiratory failure (1 year: 19.8% vs 22.7%; AHR 0.825; 5 years: 25.2% vs 28.1%; AHR 0.854).

In this cohort of patients with ICH and T2DM, GLP-1RA use was associated with improved outcomes. Prospective trials are warranted to confirm these observations.

When a patient's presentation raises suspicions for conditions other than diabetic kidney disease (DKD), such as sudden onset proteinuria <5 years after the onset of type 2 diabetes, proteinuria without retinopathy or neuropathy, acute kidney injury, active urinary sediment, or hematuria, clinically indicated kidney biopsies are typically carried out. Consequently, a high incidence of non-DKD (NDKD) in clinical biopsies from diabetes individuals is not unexpected. The purpose of the study is to investigate the clinical predictors, prevalence and histopathological spectrum of NDKD in patients with type 2 diabetes mellitus.

Dayanand Medical College and Hospital in Ludhiana conducted this cross-sectional observational study. After taking informed consent, 43 patients with diabetes who were suspected of having NDRD had kidney biopsies based on either or both of the following criteria: (1) Hematuria (red blood cell [RBC] casts, RBC >5/hpf). (2) Unexpected elevations in serum creatinine of more than 2 mg/dL. (3) Nephrotic syndrome with sudden onset. (4) Renal failure without diabetic retinopathy (DR). (5) DM duration <5 years. (6) Nephrotic range massive proteinuria with normal renal function. (7) Normal or negligible proteinuria along with severe renal insufficiency (serum creatinine >2 mg/dL) (<500 mg/dL).

(1) Of the 43 patients, 24 (56.0%) had pure NDKD. Four patients (9.3%) had mixed renal disease, while 15 patients (35%) had DKD. (2) The most prevalent NDKD was acute interstitial nephritis (AIN) (12%), which was followed by immunoglobulin A (IgA) nephropathy, localized proliferative glomerulonephritis and crescentic glomerulonephritis (7.0% each). The most prevalent pathology observed in mixed renal disease was DN with AIN. (3) The duration of hypertension was 4.98 ± 2.86 years in the group without DKD and 8.07 ± 4.65 years in the group with DKD, both of which were statistically significant. (4) Compared to the DKD group, more patients in the NDKD group had shorter DM duration (<5 years). A greater proportion of individuals in the DKD group had DM for more than 10 years. (5) Compared to the NDKD group, there were more NPDR patients in the DKD group.

Since several diseases, including MN, IgA nephropathy and AIN, are frequently treatable or even curable, our study demonstrated the need for early suspicion and diagnosis of NDKD.

Diabetic eye disease, the leading microvascular complication of diabetes mellitus (DM), is one of the leading causes of blindness worldwide, whose disease burden and demographics are only expected to grow in the coming decade. Advances in molecular biology techniques have enabled the identification and study of several proteins and transcription factors believed to play key roles in the underlying disease pathogenesis. A majority of these factors work together, contributing to both angiogenic (formation of new blood vessels) and inflammatory processes underlying diabetic retinopathy (DR).As a result, emerging therapies are increasingly targeting specific molecular mechanisms. In parallel, nonpharmacological interventions are being proposed to inform the development of appropriate clinical diagnostic and treatment guidelines. These approaches aim to address the early stages of disease and slow or prevent progression to chronic, later stages that may result in vision loss. This review synthesizes foundational and recent evidence using a qualitative narrative approach, focusing on hypoxia-driven molecular pathways rather than quantitative meta-analysis. Although numerous studies have consistently identified key molecular factors that contribute to the pathogenesis of diabetic eye disease, additional details regarding the specific roles of some factors listed herein, as well as the discovery and involvement of other factors in the pathway, remain to be fully explored and understood.

Our previous studies have demonstrated that the activated pancreatic stellate cell (PSC) could induce islet damage in type 2 diabetes mellitus (T2DM). While tissue-type plasminogen activator (tPA) is significantly reduced in T2DM, its subsequent effects are unclear. The purpose of this experiment was to observe the impact of tPA on PSC activation, with the aim to better understand the potential role of tPA in T2DM.

50 type 2 diabetic patients and 50 healthy persons were included in the diabetic group and the control group, respectively. Fasting blood was collected separately, and the tPA-level was detected by ELISA. Rat PSCs were isolated from pancreatic tissue using standard explant techniques. The PSCs were then characterized by staining them with Oil Red O to visualize lipid droplets and using immunofluorescent markers (α-smooth muscle actin (α-SMA), vimentin, and glial fibrillary acidic protein (GFAP)). After characterization, the PSCs were treated with tPA, then the proliferation of PSCs was measured using the cell counting kit-8 (CCK-8), the apoptosis was observed by the caspase-3 fluorometric assay kit, and the migration ability was assessed using the wound-healing assay and the transwell migration assay. Finally, a Western blot was used to identify the extracellular matrix (ECM) component synthesized by PSCs.

The diabetic patients had significantly lower levels of tPA compared to the controls. Rat PSCs treated with tPA exhibited more lipid droplet accumulation, and their ability of proliferation, migration, and ECM synthesis were significantly inhibited.

This study demonstrated that tPA can play a crucial role in significantly inhibiting the activation, proliferation, migration, and ECM synthesis of PSC. Therefore, we speculate that the significant reduction of tPA in T2DM may exacerbate the detrimental effect of PSC on β-cell function.

Internal carotid artery fenestration is a rare vascular anomaly that may present with transient ischemic attack symptoms due to localized flow disturbances. It is important to report such cases, as they present unique diagnostic challenges and clinical implications, particularly when associated with systemic vascular risk factors such as diabetes and hypertension. Differentiating internal carotid artery fenestration from other conditions, such as internal carotid artery dissection, is crucial for appropriate management and patient outcomes.

A 78-year-old Iranian female patient with a medical history of uncontrolled diabetes mellitus and hypertension presented to the emergency department with sudden-onset double vision, dizziness, and weakness in her left limbs. Symptoms lasted for 15 minutes and fully resolved. Neurological examination revealed mild weakness in the left upper and lower limbs but no sensory deficits. A bruit was detected over the left carotid artery, raising suspicion for carotid artery disease. Blood tests showed elevated blood glucose, and imaging studies, including carotid Doppler ultrasound, revealed irregularities and increased intima-media thickness, suggesting early vascular changes. Brain computed tomography scan was normal, and computed tomographic angiography of the head and neck revealed an incidental finding of internal carotid artery fenestration at the cervical segment. The fenestration appeared as a mild fusiform dilation of internal carotid artery with no signs of dissection or thrombosis. The patient was started on dual antiplatelet therapy (aspirin and clopidogrel) and optimized for blood pressure and lipid control. She was discharged with no residual neurological deficits, and follow-up was arranged for continued management of her cardiovascular risk factors.

This case highlights the diagnostic challenges and clinical relevance of internal carotid artery fenestration, particularly in patients with systemic vascular risk factors. Although internal carotid artery fenestration is often asymptomatic, it can be associated with cerebrovascular complications, such as ischemic events. In this case, the transient symptoms likely resulted from localized hemodynamic disturbances due to the fenestrated artery. While there is no established consensus on the management of asymptomatic internal carotid artery fenestration, dual antiplatelet therapy and risk factor optimization remain key strategies. Further research is needed to better understand the implications of internal carotid artery fenestration and to refine diagnostic and management protocols for these rare vascular anomalies.

Pneumonia is a common infection that leads to frequent hospitalizations and primary healthcare visits. Previous smaller studies have indicated high prevalence of undiagnosed diabetes mellitus (DM) and increased subsequent risk of coronary heart disease (CHD) among patients with pneumonia. However, previous studies have not used nationwide data that include diagnoses from primary healthcare settings, where most pneumonias are treated. The aim of this study was to examine whether pneumonia is associated with subsequent DM and CHD.

This was an open nationwide cohort study of adults 35–75 years of age in Sweden 2007–2018, including national registers and population-based primary healthcare data. The outcomes were DM and CHD, and individuals with outcomes diagnosed before the index date (including 2002–2005) were excluded. The index date was set as the first pneumonia diagnosis or the first healthcare contact (in those without pneumonia) during the study period. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) while adjusting for potential confounders.

A total of 4,580,606 individuals without previously diagnosed DM and 4,661,052 individuals without previously diagnosed CHD were included; of these, 348,024 individuals were diagnosed with DM and 295,592 with CHD during follow-up, respectively. Pneumonia preceded DM in 104,598 (30.1%) and CHD in 94,087 (31.8%) individuals. Compared with no diagnosis, pneumonia was associated with an age-adjusted HR of 1.12 (95% CI 1.11–1.13) for DM and 1.18 (95% CI 1.17–1.19) for CHD. In the full model, pneumonia was associated with a HR of 1.11 (95% CI 1.10–1.12) for both outcomes. Several complementary analyses were conducted, showing significant associations across most age-groups, in both sexes, across different follow-up periods (e.g. <1 year and ≥ 10 years), and in patients diagnosed with pneumonia in primary healthcare settings.

This nationwide study found that pneumonia is associated with subsequent DM and CHD. The findings indicate that pneumonia has a potential role as a clinical predictor of DM or CHD, including in primary healthcare settings, which warrants further clinical studies.

The online version contains supplementary material available at 10.1186/s41479-026-00199-x.