Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists (GLP-1/GIP RAs) effectively manage type 2 diabetes mellitus (T2DM). Recent medication shortages have impacted patient access to treatment. The objectives of this study were to evaluate the effect of incretin therapy shortages on glycemic control and adverse patient outcomes. This retrospective cohort study evaluated the impact of interruptions in therapy on patients receiving maintenance doses of incretin therapy for at least three months. Patients were excluded if they were not on adequate maintenance doses, had missing hemoglobin A1c (HbA1c) levels, discontinued therapy due to side effects or cost, or had a history of chronic glucocorticoid use or organ transplant. The primary outcome was HbA1c levels before and after therapy interruption. Secondary outcomes were the incidence of gastrointestinal issues, hyperglycemia, and hypoglycemia-related hospital/clinic visits. A total of 71 patients were included. The median therapy duration was 9 months. Patients had a baseline HbA1c of 6.9%. Following interruption, 25.4% of patients had glucose-lowering therapy additions to their regimen, 35.2% dosage adjustments, and 39.4% no changes. HbA1c increased significantly to 7.2% at 12 months (P < 0.001). No significant differences were observed in adverse events or clinic/hospital visits (P = 0.571 and P = 1.00). Shortages of incretin therapy significantly increased patients' HbA1c levels up to 12 months post interruption. Long-term shortages or restrictions of these agents are likely to lead to adverse clinical outcomes. Further studies are needed to assess the outcomes of prolonged shortages or restrictions of these therapies.

Introduction: Pancreaticoduodenectomy is a complex surgical procedure involving meticulous resection and reconstruction steps. Materials and Methods: We analyzed the first 15 laparoscopic pancreaticoduodenectomies performed for ampullary, periampullary, and cephalic pancreatic tumors at the Fundeni Clinical Institute, Bucharest, a high-volume center with extensive expertise in hepatopancreatobiliary surgery. Patient demographics, medical history, intraoperative parameters, early postoperative outcomes, and oncological results regarding radical resection were evaluated. Results: The mean patient age was 59.4 years, with 53.33% males. Cardiovascular comorbidities were present in 60% of patients, while 26.66% had controlled type 2 diabetes mellitus. Previous cholecystectomy was noted in 46.66% of cases, and 60% presented with jaundice at diagnosis. The mean operative time was 360 minutes. Pancreaticogastrostomy was performed in 66.66% of cases and pancreaticojejunostomy in 33.33%, with 26.66% of procedures being fully laparoscopic. Biochemical leakage occurred in 13.33% of cases, while grade B pancreatic fistula developed in 6.67% of cases and was managed conservatively. Moderate biliary fistula occurred in 13.3% of the patients, with remission under conservative treatment. All resections achieved negative margins (R0). The mean number of retrieved lymph nodes was 15.6, and the average hospital stay was 18.7 days. Discussions: Laparoscopic pancreaticoduodenectomy provides oncological outcomes comparable to the open approach and may improve postoperative recovery in experienced centers. Conclusions: Our results are encouraging, with potential for further improvement through careful patient selection and refinement of surgical technique.

Proximal lower extremity weakness in patients with diabetes mellitus presents a diagnostic challenge due to overlapping etiologies, including diabetic amyotrophy, lumbar radiculopathy, and chronic inflammatory demyelinating polyneuropathy (CIDP). This report presents the case of an 80-year-old male with a history of type 2 diabetes mellitus who experienced recurrent falls, progressive right thigh weakness, and muscle atrophy. Although the clinical presentation initially suggested diabetic amyotrophy, electrodiagnostic studies and imaging failed to support this diagnosis. Instead, findings were more consistent with peripheral neuropathy and possible focal L5 radiculopathy. This case highlights the limitations of current diagnostic frameworks for diabetic amyotrophy, particularly in atypical presentations that lack classic features such as pain and characteristic electromyographic abnormalities. The absence of standardized diagnostic criteria necessitated a diagnosis of exclusion, emphasizing the importance of clinical judgment. This report underscores a structured approach to evaluating diabetic patients with lower extremity weakness, including the role of a comprehensive workup, the exclusion of diagnoses with similar presentations, and the potential for recovery through supportive care.

Automated insulin delivery (AID) systems aim to safely optimize glycemic outcomes; however, data in the new-onset type 1 diabetes (T1D) period are limited. We evaluated safety and glycemic outcomes of Omnipod 5 AID System use in the new-onset period.

This was a retrospective observational analysis of youth at a single center who initiated Omnipod 5 within 90 days of T1D diagnosis. Safety outcomes included diabetic ketoacidosis (DKA) and severe hypoglycemia. Continuous glucose monitoring (CGM) metrics and insulin delivery data were analyzed across the first 3 months of use and between pediatric age groups (<6-year-olds, 6 to <12-year-olds, and 12 to <18-year-olds).

Among 74 youth initiating Omnipod 5 within 90 days of T1D diagnosis, there was no occurrence of DKA or severe hypoglycemia in the first 3 months of AID system use. The time-weighted average glucose target value on the device setting was 118.8 mg/dL (6.6 mmol/L) with a median of 97% time in Automated Mode over 3 months. Median total daily insulin was 7.4 units (45.5% basal) in <6-year-olds, 11.4 units (48% basal) in 6 to <12-year-olds, and 25.7 units (45% basal) in 12 to <18-year-olds. The median glucose management indicator (GMI) was 7.1% (54 mmol/mol) and time in range (70-180 mg/dL, 3.9-10.0 mmol/L) was 72.1% with minimal hypoglycemia: 1.0% Level 1 time below range (TBR, 54-69 mg/dL, 3.0-3.8 mmol/L) and 0% Level 2 TBR (<54 mg/dL, <3.0 mmol/L).

These real-world observational data from youth with new-onset T1D using a tubeless AID system indicate safety and favorable glycemic outcomes with AID system initiation early after diagnosis. Future studies should assess the long-term glycemic and quality of life impact of early AID system adoption.

Amyloidosis encompasses a spectrum of disorders characterized by the extracellular accumulation of insoluble amyloid fibrils in various tissues, with peripheral neuropathy emerging as one of the most significant clinical manifestations. Peripheral sensory neurons are highly susceptible to amyloid-induced injury due to their long axonal projections and the relatively weaker neurovascular barrier of the dorsal root ganglia compared with the blood-brain and plasma-nerve barriers. Resulting nerve damage contributes to painful and disabling peripheral neuropathy, which affects millions worldwide. While hereditary amyloidosis polyneuropathies and type 2 diabetes are well-recognized conditions linked to amyloid deposition and neuropathy, similar pathogenic mechanisms may also be implicated in certain autoimmune and chronic metabolic disorders. A unifying histopathological feature across these diverse conditions is the deposition of amyloidogenic proteins. These fibrillar aggregates, composed of self-assembled peptides and proteins, disrupt tissue homeostasis, impair cellular function, and promote progressive nerve damage. Both inherited and acquired forms of amyloidosis are capable of triggering neuropathic complications, suggesting that amyloid-related mechanisms represent a convergent pathway in neuropathy of varied etiologies. In particular, type 2 diabetes mellitus stands out as a common condition in which amyloid accumulation significantly contributes to peripheral nerve injury. Collectively, these observations highlight the molecular and cellular parallels between different forms of amyloid-associated neuropathies and emphasize the need for deeper investigation into shared mechanisms that link protein aggregation with neuronal dysfunction.

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.