Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among patients with Type 2 diabetes mellitus (T2DM). Although various noninvasive assessment tools for MASLD are currently available, few have been specifically validated in T2DM populations. Furthermore, the role of sex hormones in MASLD and their potential influence on cardiovascular and renal outcomes remain incompletely understood.

In this cross-sectional study of 731 Chinese patients with T2DM, we evaluated associations of testosterone and estradiol with MASLD, cardiovascular risk, and renal function. Sex hormone-based logistic regression models were constructed and compared with established noninvasive MASLD scores to assess their discriminative performance.

In male patients, higher testosterone, T/E2 ratio, FSH, and LH levels were inversely associated with MASLD, whereas higher DHEA levels were associated with an increased likelihood of MASLD. In female patients, higher DHEA levels were positively associated with MASLD, whereas prolactin showed a modest inverse association. After multivariable adjustment, testosterone remained independently and inversely associated with MASLD in males. Sex hormone-based models demonstrated better discriminative performance than conventional noninvasive scoring systems for MASLD. Additionally, testosterone was inversely associated with the ApoB/ApoA1 ratio in males, whereas estradiol was positively associated with eGFR in females.

In patients with T2DM, testosterone and estradiol showed sex-specific associations with metabolic outcomes. Sex hormone-based models may provide a useful noninvasive approach for MASLD screening and risk assessment in T2DM patients.

Doxycycline is a widely used antibiotic for commonly encountered infections and is generally well tolerated. However, it is associated with rare, drug-induced severe thrombocytopenia, which, if not promptly recognised and managed, could prove fatal. We present a case of doxycycline-induced severe thrombocytopenia in a 63-year-old man with a background of type 2 diabetes mellitus, left ventricular systolic dysfunction, and hypothyroidism. The platelet count dropped to a critical level of 6 x 10⁹/L following a one-week course of doxycycline, which improved with drug withdrawal, platelet transfusions, and a course of high-dose steroid therapy over three weeks. This was evidenced by a Naranjo Adverse Drug Reaction Probability Scale score of 8/13, which is the upper limit for a probable adverse drug reaction. This rare but life-threatening side effect of doxycycline highlights the need for a follow-up blood test shortly after commencing therapy for early detection and prompt management.

Androgenetic alopecia (AGA) is the most common non-scarring alopecia, and its prevalence increases with age. Previous meta-analyses of AGA and metabolic syndrome (MetS) have focused mainly on associations and risk estimates. We quantified the prevalence of MetS and its components among patients with AGA.

PubMed, Embase, Web of Science, the Cochrane Library, CNKI, VIP, and WanFang Data were searched from inception to July 2026 for cross-sectional and cohort studies. Prevalence estimates were pooled using logit-transformed random-effects models with restricted maximum likelihood estimation. We report 95% confidence intervals (CIs), I², τ², and 95% prediction intervals (PIs) when estimable. Examined subgroups included region, sex, AGA severity, MetS definition, and study quality. Sensitivity analyses assessed robustness. Egger's test was performed to assess outcomes derived from ≥10 studies.

Twenty-eight studies were included. MetS prevalence was 23.7% (12 studies; 3,623 participants; 95% CI, 15.5%-34.5%; I² = 95.4%; 95% PI, 3.7%-71.7%). Prevalence estimates for abdominal obesity, hypertension or elevated blood pressure, diabetes mellitus, dyslipidemia, hypertriglyceridemia, elevated low-density lipoprotein cholesterol, and low high-density lipoprotein cholesterol were 36.0%, 30.7%, 13.3%, 24.5%, 23.6%, 30.0%, and 28.8%, respectively. Heterogeneity was substantial across outcomes; the elevated low-density lipoprotein cholesterol estimate was based on only two studies. MetS prevalence was 19.7%, 30.8%, and 44.2% in mild, moderate, and severe AGA, respectively, although grading systems varied. In leave-one-out analyses, the pooled MetS estimate ranged from 21.1% to 25.9%; other outcomes with at least seven studies were also broadly unchanged; however, heterogeneity persisted. Evidence from female patients was limited (4 studies, 765 participants).

MetS and several metabolic abnormalities are common among patients with AGA, although estimates vary substantially across studies. Early assessment may support comprehensive health management in this population.

Early-onset Type 2 Diabetes Mellitus (T2DM), defined as diabetes diagnosis before 40 years old, is associated with substantial lifetime cardiometabolic risk. Although many challenges of living with T2DM are shared across adulthood, diagnosis during young adulthood may shape how this condition is perceived, prioritised and managed during a formative stage of life. This narrative review aimed to synthesize how adults diagnosed with T2DM between 18 and 39 years of age experience, understand and manage their condition, and the implications for developmentally appropriate clinical care.

We conducted a structured narrative review of English-language qualitative, mixed-methods and observational quantitative studies identified in PubMed, MEDLINE (via Ovid) and EMBASE (via Ovid) from database inception to 31 August 2025. Direct evidence from adults diagnosed at 18 to 39 years was prioritised. Studies of adults aged ≥18 years with youth-onset T2DM were used as closely related supporting evidence, and broader adult T2DM studies as contextual evidence. Study selection, extraction and appraisal followed predefined procedures, with reporting informed by SANRA.

Recurring themes included difficulty integrating diabetes into identity, stigma, competing work and family demands, material hardships, family and sociocultural influences and healthcare services perceived as not aligned with young adults' priorities. Young adults valued practical and age-appropriate communication, flexible appointment scheduling, credible digital education and peer support. However, much of this evidence was cross-sectional or derived from small, single-site qualitative studies and intervention evidence was limited.

Although many challenges overlap with the broader T2DM population, they may have particular significance when diabetes develops during young adulthood. Developmentally appropriate care should combine cardiometabolic risk management with flexible, collaborative and non-stigmatizing support. Prospective studies are needed to test whether such models improve patient-reported, clinical and health-service outcomes.

Evidence on glucagon-like peptide 1 receptor agonists (GLP-1RAs) in lipodystrophies is limited. We evaluated the effects of liraglutide on metabolic control and satiety in patients with congenital generalized lipodystrophy (CGL).

In this case series, patients with CGL received liraglutide 1.8 mg/day for 12 weeks. Metabolic parameters, satiety, and body composition were assessed at baseline, week 12, and after a 12-week post-treatment follow-up (week 24). Liver imaging was performed at baseline and week 12.

Eight patients were enrolled (aged 24-45 years; 75% female), and three discontinued treatment due to gastrointestinal adverse events during the dose-escalation phase. Among the five participants who completed the 12-week intervention, liraglutide significantly reduced HbA1c (median change, -2.5%; p=0.012) and total daily insulin dose (-20%; p=0.042), whereas the reduction in triglyceride levels was not statistically significant. Twelve weeks after liraglutide discontinuation, median HbA1c and body weight increased by 2.2% (p=0.026) and 3.7% (p=0.001), respectively. Triglyceride levels increased in 80% of participants, with a median increase of 421.5 mg/dL (p=0.334). Insulin requirements also increased overall: one participant resumed insulin therapy, while the remaining participants increased their insulin dose by a median of 22% (p=0.024).

This first study of liraglutide in CGL provides an exploratory signal of improved glycemic control and reduced insulin requirements, but treatment tolerability remains a limitation. Larger, controlled, and longer-term studies are needed to confirm these effects and assess potential benefits on satiety, body composition, and liver disease.

Diabetic retinopathy (DR) remains the leading cause of blindness among working-age adults. With the rising prevalence of diabetes, the burden of DR continues to escalate, substantially impairing patients' quality of life. Identifying clinical factors associated with prevalent DR may help refine risk-based ophthalmic assessment. Using a large cross-sectional dataset, this study examined associations between routinely available clinical indicators and the presence of DR. Particular attention was given to heart rate (HR), an understudied and readily available vital sign, and to diabetes treatment histories.

Leveraging data from the China DiaChronic Study, this cross-sectional analysis included data from 1,477 patients with diabetes. Categorical variables (sex, smoking and alcohol status, education) were analyzed by chi-square tests; continuous variables by independent-samples t-tests or Wilcoxon rank-sum tests. Binary logistic regression estimated factors associated with prevalent DR after adjustment for demographic, metabolic, diabetes-duration, and treatment-history variables; variance inflation factors (VIFs) were used to assess multicollinearity; ROC curves described cross-sectional discrimination; formal interaction terms assessed whether selected associations differed by HbA1c category; and Spearman correlation assessed relationships between HbA1c and other parameters.

Among 1,477 patients, 259 (17.5%) had DR. After additional adjustment for diabetes duration and medication histories, higher systolic blood pressure (SBP), heart rate (HR), HbA1c, blood urea nitrogen (BUN), urinary albumin-creatinine ratio (UACR), and longer diabetes duration were associated with prevalent DR (all P < 0.05), with VIFs ranging from 1.07 to 1.59. HbA1c showed the greatest cross-sectional discrimination (AUC 0.672, 95% CI 0.637-0.707), followed by UACR (AUC 0.655, 95% CI 0.617-0.692), although both AUCs were modest. Exploratory stratification by HbA1c <6.5% (n = 446, DR = 37) versus ≥6.5% (n = 1,031, DR = 222) showed different within-stratum patterns, but formal interaction tests for SBP, HR, BUN, and UACR were not statistically significant (all P for interaction >0.05). Spearman correlation showed FBG, HR, BUN, and UACR positively correlated with HbA1c (r = 0.094-0.641, P < 0.05), with UACR exhibiting the strongest association after FBG (r = 0.216, P < 0.001).

Higher SBP, HR, HbA1c, BUN, UACR, and longer diabetes duration were associated with prevalent DR after multivariable adjustment. Among these, the association with HR is the most potentially novel and may reflect cardiac autonomic dysfunction rather than a direct causal effect. Although HbA1c and UACR showed only modest cross-sectional discrimination, the findings support integrated cardiometabolic, renal, and diabetes-history assessment to complement guideline-recommended retinal screening. Prospective validation is warranted.

Diabetic sarcopenia is associated with functional impairment and metabolic abnormalities in patients with type 2 diabetes mellitus (T2DM). Real-world evidence regarding structured exercise combined with dietary and microbiota-targeted care remains limited.

This retrospective cohort study included 128 patients with T2DM and sarcopenia between January 2022 and December 2024. Based on the treatment received, patients were divided into a control group receiving conventional diabetes management (n = 63) and an intervention group receiving conventional management combined with structured exercise, dietary and microbiota-targeted care (n = 65). Outcomes were assessed at baseline and months 1, 3, 6, 9, and 12. The primary outcome was the longitudinal change in skeletal muscle index (SMI). Secondary outcomes included handgrip strength, gait speed, Short Physical Performance Battery (SPPB) score, glycated hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and homeostasis model assessment of insulin resistance (HOMA-IR), as well as the incidence of adverse events. Adjusted generalized estimating equation models were used to evaluate longitudinal trajectories.

Significant group × time interactions were observed for SMI (P = 0.017), handgrip strength (P < 0.001), gait speed (P < 0.001), and SPPB score (P = 0.015). At month 12, adjusted between-group differences favoring the intervention group were 0.282 kg/m² for SMI (95% CI, 0.177-0.387), 3.348 kg for handgrip strength (95% CI, 2.718-3.983), 0.129 m/s for gait speed (95% CI, 0.109-0.149), and 1.225 points for SPPB score (95% CI, 0.895-1.556; all P < 0.001). Group × time interactions were not significant for HbA1c, HOMA-IR, or FPG. No significant difference in adverse-event incidence was detected (Risk ratio: 1.171; P = 0.478).

Structured exercise combined with dietary and microbiota-targeted care was associated with more favorable muscle-related trajectories but not superior overall glycemic control. The observational design precludes causal inference or separation of individual component effects, warranting confirmation in prospective randomized trials.

Exercise management is important in type 2 diabetes mellitus (T2DM). However, individual variability in exercise-related knowledge, attitudes, and practices (KAP) is significantly associated with behavioral adherence yet is often overlooked in average-based analyses. This study applied Latent profile analysis (LPA) to characterize this heterogeneity and explored associations between the resulting behavioral profiles and clinical indicators.

We conducted a multicenter cross-sectional study of 516 adults with T2DM in China. LPA was performed using standardized exercise-related KAP indicators. Candidate solutions were evaluated using fit indices, classification diagnostics, interpretability, and bootstrap reproducibility. Clinical associations were examined using adjusted regression and posterior-probability pseudo-class analyses.

Four exploratory profiles were identified: Favorable Engagement (7.0%), Average Engagement (59.7%), Knowledge-Constrained (21.7%), and Attitude-Practice Constrained (11.6%). After covariate adjustment, BMI differed across profiles; only the Average Engagement contrast remained significant after accounting for classification uncertainty. Glycemic indicators and diabetes-related complications did not differ robustly. The adjusted association with other chronic disease was sensitive to classification uncertainty.

Exercise self-management heterogeneity included distinct knowledge-related and attitude-practice constraints. These exploratory patterns may inform tailored support, but profile instability and cross-sectional data require independent prospective validation.

Cardiovascular diseases (CVDs) remain the foremost cause of morbidity and mortality worldwide, accounting for a substantial burden on healthcare systems, economies, and society. Traditional risk factors do not fully explain residual cardiovascular risk, highlighting the role of insulin resistance (IR) as a key pathophysiological link between metabolic disorders and CVD. The triglyceride-glucose (TyG) index, a simple surrogate marker derived from fasting triglyceride and glucose levels, has emerged as a practical tool for assessing IR and cardiovascular risk. This review summarizes current evidence on the role of the TyG index in the development, progression, and prognosis of CVD. The TyG index reflects both hepatic and adipose tissue insulin resistance and has shown comparable or superior performance to traditional markers such as homeostatic model assessment of insulin resistance (HOMA-IR) but is easier to calculate and more feasible for routine clinical use. Large epidemiological and cohort studies have consistently demonstrated associations between elevated TyG values and increased risk of type 2 diabetes mellitus, coronary heart disease, myocardial infarction, stroke, peripheral arterial disease, and heart failure in both general and high-risk populations. Evidence suggests a dose-response relationship between TyG and cardiovascular outcomes, with higher TyG levels or adverse longitudinal trajectories conferring greater risk. Importantly, TyG has been linked to subclinical atherosclerosis, coronary microvascular dysfunction, and adverse cardiac remodeling, indicating its relevance in early disease stages. Sex-specific differences have been reported, with several studies showing stronger associations between TyG and cardiovascular risk in women. In addition, TyG has demonstrated prognostic value across diverse clinical settings, including acute and chronic coronary syndromes, myocardial infarction with nonobstructive coronary arteries, and heart failure. Despite these findings, the clinical implementation of the TyG index remains limited. Its incremental value beyond that of established risk models is inconsistent, and its predictive performance varies across populations, age groups, and ethnicities. Most available data are observational, with underrepresentation of non-Asian populations and younger individuals, and standardized clinical cutoff values have not been universally established. In conclusion, the TyG index is a simple, inexpensive, and widely accessible marker of insulin resistance with considerable potential for cardiovascular risk stratification. While current evidence supports its association with incident CVD, atherosclerotic burden, and adverse outcomes, further prospective, multiethnic studies are needed to define optimal thresholds, clarify its role alongside existing risk models, and determine whether TyG-guided strategies can improve clinical outcomes.

In response to Huang et al., we clarify the take-home message of our study on autoimmune polyendocrine syndrome (APS) in type 1 diabetes mellitus (T1DM). Existing guidelines recommend screening T1DM patients for thyroid and celiac diseases. When positive, there is a lack of guidance on how to proceed. Nevertheless, if T1DM patients do have AITD or celiac disease, they qualify for an APS diagnosis, which signals a high pretest probability for additional autoimmunity. Our data show that among 198 patients meeting APS criteria at baseline, only 17/198 (8.6%) had a formal APS diagnosis documented in their medical records. Extended screening uncovered new autoantibody positivity in 39% and new autoimmune diseases in 11.5% of patients. In the end, this led us to signal an under-recognition of APS in T1DM. Based on this evidence, we do not advocate for universal, broad screening panels in routine practice. Instead, we argue that formal diagnostic recognition and medical record documentation of APS are essential first steps to prevent fading clinical awareness and trigger lifelong vigilance.