To identify determinants of visually significant cataract among type 2 diabetes mellitus patients attending a tertiary eye care center hospital in south Ethiopia.

An unmatched case-control study was conducted at Hawassa University Comprehensive Specialized Hospital-Tertiary Eye Care and Training Center from February to April 2024. We enrolled 80 cases and 160 controls. The data were collected through interviews, physical measurements, and medical records revision using a pretested questionnaire. Variables with a P-value < 0.2 in a Pearson's chi-square test were included in a multivariate logistic regression model, where a P-value < 0.05 was used to declare statistical significance of the predictors.

The response rate was 91.95%. Significant predictors of visually significant cataract were urban residence (AOR = 3.58, 95% CI 1.53-7.42), current substance use (AOR = 6.29, 95% CI 3.16-9.28), diabetes duration of 2-5 years (AOR = 2.88, 95% CI 1.30-6.74), diabetes duration > 5 years (AOR = 4.35, 95% CI 2.14-7.38), and comorbid hypertension (AOR = 4.01, 95% CI 2.15-8.19).

Urban residency, current substance use, longer duration of diabetes mellitus, and hypertension were statistically significant predictors of visually significant cataract. Early and periodic eye screening for these high-risk groups is essential for timely intervention.

Current UK guidelines recommend measurement of symphyseal fundal height and measurement of maternal blood pressure and urinalysis, with the aim of detecting women at increased risk of fetal growth restriction (FGR) and pre-eclampsia. Between 2008 and 2013, we conducted a prospective cohort study recruiting 4512 nulliparous women at the Rosie Hospital, Cambridge, where we performed serial ultrasonic imaging and serial blood sampling and generated a novel screening test for pre-eclampsia and FGR. The method involved measuring the ratio of two placental biomarkers (soluble fms-like tyrosine kinase receptor-1 and placenta growth factor) at ~36 weeks of gestational age (wkGA) and combining the result with maternal characteristics and ultrasonic imaging. Women who screened positive had a ~50% risk of a composite outcome, consisting of pre-eclampsia±delivery of a baby with a birth weight <3rd percentile for sex and gestational age±perinatal morbidity or death. It is plausible that screening and intervention using this method might improve pregnancy outcome.

Nulliparous women with an apparently normal singleton pregnancy will be recruited at their dating ultrasound scan. Blood will be obtained at this visit, at their anomaly scan (20 wkGA), and at two research appointments (28 wkGA and 36 wkGA) when research ultrasound scans will be performed. Blood for DNA will be obtained from the father of the baby where possible and the placenta will be sampled following birth. At 36 wkGA, women will be consented for participation in the randomised controlled trial (RCT) element of the study and their risk of term pre-eclampsia and FGR will be assessed using the novel approach. Women who screen high-risk will then be randomly allocated to either having the result revealed or masked. Women randomised to having the result revealed will be offered early delivery and/or enhanced monitoring. Where the result is masked, there will be no communication between the research team and the participant, and she will continue to receive routine care at the Rosie Hospital. The primary outcome is a composite of pre-eclampsia, FGR and perinatal morbidity and mortality. The study will also generate data and biological samples to support future research in novel screening methods and disease mechanisms.

The study received ethical approval from the East of England Research Ethics Committee. All women provide written informed consent to participate in the cohort. Women provide a second written informed consent to participate in the RCT. The study results will be disseminated by presentation at international conferences and publication in peer reviewed journals.

ISRCTN1218142.

BackgroundEar infections affect millions worldwide, causing significant hearing loss, particularly in developing countries. Bacterial infections play a major role, necessitating studies on causative agents, risk factors, and antibiotic resistance.ObjectiveThis study aimed to assess the prevalence, associated factors, and antibiotic susceptibility of the bacterial isolates among patients in suspected ear infections at the University of Gondar Hospital, Ethiopia.MethodsA hospital-based prospective cross-sectional study was conducted from May to July 2023, involving 303 participants with clinical diagnosis of having ear infections. Ear discharge samples were cultured on blood agar, chocolate agar, and MacConkey agar. Antibiotic susceptibility was determined using the Kirby-Bauer disk diffusion method. Cefoxitin disc and double-disc synergy tests detected methicillin-resistant Staphylococcus aureus and extended-spectrum beta-lactamase (ESBL) production in Enterobacterales respectively. Data were analyzed using SPSS version 27, with logistic regression to identify associations. A p-value < 0.05 was considered statistically significant.ResultsBacterial culture was positive in 48.5% (147/303; 95% CI: 42.8-54.3) of cases, yielding 172 isolates with Proteus mirabilis 30.2 % (52/172), Pseudomonas aeruginosa 13.9% (24/172) and S. aureus 13.9% (24/172) as the common isolated pathogens. Multidrug resistance was observed in 64.5% (111/172) of isolates, while 29.2% (7/24) of S. aureus exhibited methicillin resistance. ESBL production was detected in 19.1% (14/82) of Enterobacterales, particularly Klebsiella pneumoniae 27.3% (3/11). Associated factors included age under five (AOR = 1.19, p = 0.013) and upper respiratory tract infections (URTI) (AOR = 3.27, p < 0.001) in children. Among adults, diabetes mellitus (AOR = 2.73, p = 0.032), URTI (AOR = 1.97, p < 0.001), and frequent earphone use (AOR = 11.4, p < 0.001) were significantly associated.ConclusionP. mirabilis, P. aeruginosa, and S. aureus were predominant and exhibited high antibiotic resistance. Targeted antimicrobial stewardship, culture-based therapy, and public health interventions are essential, particularly for high-risk groups.

Despite advancements in digital health coaching (DHC) for type 2 diabetes self-management, a persistent digital divide limits access among underserved populations, necessitating low-tech, telephone-based alternatives.

This formative qualitative study explored the lived experiences of type 2 diabetes mellitus (T2DM) self-management challenges among adults in Alabama and elicited preferences for telephone-based DHC to inform intervention optimization.

This study was part of a larger National Institutes of Health clinical trial (5R01DK129378) that examined the feasibility and needs of a telephone-based DHC intervention for self-management of T2DM. The study employed a qualitative, phenomenological approach to assess patients' needs surrounding digital coaching. Twelve patients diagnosed with T2DM were recruited between August and December 2022. Data collection involved in-depth, semistructured interviews conducted via telephone calls or secure Zoom sessions. All interviews were audio-recorded, professionally transcribed, and verified for accuracy. Two independent coders analyzed the data using NVivo software version 14 Plus.

Two themes emerged: (1) multifaceted barriers to diabetes self-management spanning behavioral (dietary adherence and nutritional gaps), physical/environmental (mobility limitations and weather constraints), and structural domains (medication shortages, insurance coverage limiting continuous glucose monitoring); (2) expectations for telephone-based DHC, including targeted education (meal planning, exercise adaptations, and medication effects), health coaches as accountability partners, daily reminders and check-ins via texts/calls, and incentives as extrinsic motivators to adherence. Insights from the study directly shaped the intervention components of a pilot feasibility trial (NCT05344859).

Key challenges in day-to-day T2DM management included diet, physical activity, medication unavailability, and lack of insurance coverage for continuous glucose monitors. Expectations for a potential telephone-based DHC intervention included targeted education on diet, exercise, and medication effects; perceptions of health coaches as accountability partners; reminders via texts/calls as beneficial; and monetary incentives as extrinsic motivators for adherence to the intervention.

Diabetes mellitus is a chronic disease that significantly affects global mortality rates, particularly among critically ill individuals. While previous studies have highlighted the role of glucose regulation and platelet activity in mortality risk, the combined impact of blood glucose and platelet levels remains underexplored. This study aims to investigate the relationship between the blood glucose-to-platelet ratio (BPR) and all-cause mortality in critically ill diabetic patients. A retrospective analysis was conducted using the MIMIC-IV database, which included 21,145 critically ill diabetic patients admitted to the intensive care unit. Patients were categorized into quartiles based on their BPR. Mortality rates at 28 and 360 days post-admission were assessed. Cox proportional hazards models were used to evaluate the association between BPR and hospital mortality, adjusting for potential confounders such as age, sex, comorbidities, and illness severity scores. Restricted cubic spline analysis was applied to assess the nonlinear relationship between BPR and hospital mortality. The median age of patients was 69 years (interquartile range, 60-78), with 58.41% male. The crude 28-day and 360-day hospital mortality rates were 10.83% and 15.57%, respectively. Higher BPR quartiles were associated with increased mortality rates at both 28 days and 360 days (P < .001). The hazard ratio for 28-day hospital mortality between the highest (Q4) and lowest (Q1) quartiles was 1.69 in the unadjusted model and 1.36 after adjusting for confounders. Analysis using restricted cubic splines suggested a nonlinear relationship between BPR and hospital mortality, with an increase in risk observed as BPR levels increased. Subgroup analyses revealed consistent associations across different patient demographics and comorbid conditions, including age, sex, and sepsis. BPR appears to be a potential marker for predicting all-cause mortality in critically ill diabetic patients, with a moderate association between BPR and mortality risk. While the blood glucose-to-platelet ratio could serve as a useful tool for identifying high-risk patients, its clinical applicability in intensive care unit settings requires further investigation. Future studies should explore its role in dynamic monitoring and therapeutic interventions, as well as address the limitations of our current findings, such as the observational nature of the data and potential confounding factors.

Mid-upper arm circumference (MUAC) is a simple anthropometric measure proposed as a marker of adiposity and cardiometabolic risk, but its relationship with diabetes and prediabetes in children and adolescents has not been fully characterized. This study assessed the association between MUAC and glycemic status in a nationally representative pediatric sample. We performed a cross-sectional analysis of pooled data from the 1999 to 2018 NHANES cycles, including 27,543 children and adolescents (age 6-19 years), of whom 2165 were classified as having diabetes or prediabetes by standard laboratory and self-report criteria. MUAC was measured at the midpoint of the right upper arm. Survey-weighted logistic regression models evaluated MUAC as both a continuous and categorical (quartiles) predictor of diabetes/prediabetes, adjusting for age, sex, race, education, poverty‑income ratio, body mass index, elevated blood pressure, and dyslipidemia. Restricted cubic spline analysis examined nonlinearity; subgroup analyses tested robustness. Higher MUAC was independently associated with higher odds of diabetes/prediabetes: per 1‑cm increase odds ratio: 1.04 (95% confidence interval [CI]: 1.01-1.08; P = .020). Versus Q1, adjusted odds ratios were Q2 2.57 (95% CI: 1.81-3.67), Q3 2.40 (95% CI: 1.60-3.61), Q4 2.49 (95% CI: 1.57-3.97) (all P < .001). Restricted cubic spline revealed a significant non‑linear association (P‑nonlinearity <.001) with an inflection near MUAC ≈ 25.6 cm, above which odds increased more steeply. Subgroup analyses indicated stronger associations in females and in children <14 years. Associations remained consistent across the analyses. In this large, nationally representative sample of children and adolescents, elevated MUAC was independently associated with higher odds of diabetes and prediabetes, with evidence of a nonlinear dose-response and a threshold near 25.6 cm. Prospective studies are needed to validate cutoffs and explore the potential role of MUAC as a risk marker for dysglycemia.

Anemia commonly accompanies chronic kidney disease, but the direction of the association between anemia and diabetic kidney disease remains uncertain. We examined the association using cross-sectional NHANES data and explored potential causal associations using 2-sample Mendelian randomization. We conducted a cross-sectional analysis of adults with type 2 diabetes from the 2009-2018 NHANES cycles. Survey-weighted logistic regression and restricted cubic spline analyses were used to evaluate the associations of anemia and hemoglobin levels with presumed DKD, albuminuria, and reduced eGFR. Two-sample Mendelian randomization was subsequently performed to explore potential causal associations between anemia-related phenotypes and DKD. Anemia was more prevalent among participants with presumed DKD than among those without presumed DKD (21.6% vs 9.6%). In survey-weighted regression models, anemia was associated with higher odds of presumed DKD, albuminuria, and reduced eGFR, whereas higher hemoglobin levels were inversely associated with these outcomes. Restricted cubic spline analyses indicated L-shaped associations. Mendelian randomization estimates suggested potential associations of genetically predicted general anemia, iron deficiency anemia, and vitamin B12 deficiency anemia with DKD; however, significant heterogeneity was observed across SNP-specific estimates. Anemia was associated with higher odds of presumed DKD, albuminuria, and reduced eGFR among adults with type 2 diabetes. Mendelian randomization analyses provided suggestive evidence of potential causal associations between anemia-related phenotypes and DKD. However, the cross-sectional design, relaxed SNP-selection threshold, and significant heterogeneity warrant cautious interpretation and independent validation.

This study aimed to develop and internally validate a multivariable prediction model for early postoperative corneal edema following phacoemulsification by integrating patient-related and intraoperative parameters. This retrospective cohort study included 912 consecutive eyes from 912 patients who underwent standard phacoemulsification at a tertiary ophthalmic center in Southwest China between January 2021 and January 2023. Early postoperative corneal edema was defined as either a ≥5% increase in central corneal thickness from baseline on postoperative day 1 or the presence of clinically significant stromal haze on slit-lamp examination. Demographic, systemic, preoperative, and intraoperative variables were evaluated using univariate logistic regression, followed by multivariable logistic regression for model development. Model performance was assessed in terms of discrimination and calibration. Discrimination was quantified using the area under the receiver operating characteristic curve, whereas calibration was evaluated using calibration plots, calibration intercept and slope, and the Hosmer-Lemeshow goodness-of-fit test. A nomogram was constructed based on the final multivariable model to estimate individualized risk. Early postoperative corneal edema occurred in 138 of 912 eyes (15.1%). In the multivariable model, older age, diabetes mellitus, lower preoperative endothelial cell density, and greater cataract and intraoperative complexity, reflected by higher lens nucleus hardness, longer operative duration, higher cumulative dissipated energy, and greater irrigation volume, were associated with early postoperative corneal edema. Intraoperative anterior chamber instability and capsular rupture or vitreous loss were also associated with an increased risk. The final model achieved an area under the receiver operating characteristic curve of 0.892 (95% confidence interval: 0.865-0.919) and demonstrated acceptable calibration in internal validation. Both systemic and intraoperative factors were associated with early postoperative corneal edema after phacoemulsification. The internally validated prediction model demonstrated good discrimination and calibration and may support preliminary perioperative risk estimation in similar clinical settings. However, external validation is required before the nomogram can be recommended for routine clinical implementation.

The impact of short-term atherogenic burden and long-term cumulative lipid exposure on the risk of incident T2DM with CKD remains unclear. This study examines the longitudinal associations between the Atherogenic Index of Plasma (AIP) and Cumulative Atherogenic Index of Plasma (CumAIP) with the development of T2DM complicated by CKD in middle-aged and older adults.

A total of 5,779 participants from the CHARLS cohort were included. AIP and CumAIP were used to represent short-term and long-term lipid burdens, respectively. Multivariable logistic regression and restricted cubic spline models were applied to assess the dose-response relationships, adjusting for 11 conventional covariates. ROC curve analysis was conducted to evaluate predictive performance. An exploratory analysis further evaluated incident CKD among participants with T2DM at baseline (n = 494).

Both AIP and CumAIP were significantly associated with incident T2DM with CKD, with the highest quartiles showing modest but statistically significant associations with the outcome (AIP-Q4: OR: 1.013; 95% CI: 1.004-1.022; p < 0.05; CumAIP-Q4: OR: 1.017; 95% CI: 1.008-1.026; p < 0.001). Linear dose-response associations were observed across logistic regression and RCS regression models. ROC analysis showed that CumAIP demenstrated better discrimination than AIP (AUC 0.683 versus 0.650). In an exploratory analysis of participants with T2DM at the baseline (n = 494), both indices showed suggestive associations with incident CKD (AIP-Q4: OR: 1.050; 95% CI: 1.009-1.145; p = 0.025; CumAIP-Q4: OR: 1.081; 95% CI: 1.015-1.152; p = 0.016).

AIP and CumAIP is significantly associated with incident T2DM with CKD among Chinese middle-aged and older adults. CumAIP demonstrated superior predictive performance over single AIP measurement. These findings support the potential value of long-term lipid monitoring for identifying indivuduals at increased risk of T2DM with CKD. An exploratory analyses also suggested a similar associations with progression from T2DM to CKD; however, these findings require confirmation in larger cohorts.

Diabetes is a major global public health problem. Inequity in access to healthcare services represents a significant challenge for healthcare management and particularly affects vulnerable populations, understanding the intersectionality of these social determinants of health is essential.

To evaluate the adequacy of care provided to individuals with diabetes in Brazil, considering the intersection of gender, race, and socioeconomic profile.

This study was based on data from the Brazilian National Health Survey (2019-2020). 6,967 individuals self-reported a diagnosis of diabetes and composed the study sample. The "adequacy of care" outcome variable was analyzed according to sociodemographic characteristics. The intersection of gender, race and socioeconomic profile was considered according to the intersectionality theory. Descriptive and multivariate analyses were conducted using Poisson regression (prevalence ratio [PR]) with robust variance and corresponding 95% confidence intervals (95%CI).

Black women with low income was the predominant profile of people with diabetes (22.0%; 95%CI: 20.5 to 23.3). Prevalent gaps in care delivery encompassed a lack of care for diabetic foot and failure to refer patients to a specialist doctor. The highest prevalence of low adequacy of care was observed in black men (79.6%; 95%CI: 75.7 to 83.1) and women (79.1%; 95%CI: 76.2 to 81.8) with low income. In the multivariate model, low adequacy of care was associated with black women and men with low income (PR = 1.09 [95%CI: 1.00 to 1.20] and 1.10 [95%CI: 1.00 to 1.21]), absence of diabetes-related complications (PR = 1.18 [95%CI: 1.11 to 1.25]), and no history of diabetes-related hospitalization (PR = 1.12 [95%CI: 1.03 to 1.22]).

Baseline challenges of living with diabetes in Brazil are further exacerbated for socially vulnerable groups. Our findings highlight structural racism and poverty as critical social determinants of health. Adopting an intersectionality approach enables a more nuanced understanding of health inequities.