Diabetes mellitus significantly impacts health-related quality of life (HRQoL). Data from urban primary care settings in South India remain limited. This study assessed HRQoL among type 2 diabetes mellitus (T2DM) patients and identified demographic and clinical determinants associated with EuroQol five-dimension five level (EQ-5D-5L) index and EQ visual analogue scale (EQ-VAS) scores.

A hospital-based cross-sectional study was conducted (April-July 2025) at the urban health training center (UHTC), Coimbatore, Tamil Nadu, India. A total of 279 T2DM patients (aged ≥18 years) were enrolled using consecutive sampling. HRQoL was assessed using the licensed Tamil and English EQ-5D-5L questionnaire. Data were analyzed using R software; Chi-square tests and independent t-tests were applied (P < 0.05).

Mean EQ-5D-5L index was 0.63 ± 0.37 and EQ-VAS was 72.6 ± 18.0. Pain/discomfort (52.1%) and anxiety/depression (43.2%) were the most affected dimensions. Microvascular complications (neuropathy P = 0.001; nephropathy P = 0.001; retinopathy P = 0.003), longer disease duration (P = 0.001), hospitalization (P = 0.001), and lower income (P = 0.003) were significantly associated with poorer HRQoL.

Pain/discomfort and psychological distress are the most impaired HRQoL domains in urban South Indian T2DM patients. Microvascular complications, longer disease duration, hospitalization, and lower socioeconomic status are key determinants. These findings support integrating HRQoL monitoring within primary care non-communicable diseases (NCD) programmers under the National Programmed for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) framework.

Background and objective Recurrent urinary tract infection (UTI) is a common and clinically important complication among patients with type 2 diabetes mellitus (T2DM), contributing to increased morbidity, antimicrobial resistance, and healthcare utilization. This study aimed to evaluate the clinical characteristics, microbial profile, and factors associated with recurrent UTIs among patients with T2DM. Methodology This retrospective comparative observational study was conducted at the Fatima Memorial Hospital, Lahore, Pakistan, using medical records of patients managed between March 2023 and March 2026. A total of 455 adult patients with T2DM and at least one culture-confirmed UTI were included. Patients were categorized into recurrent UTI (n = 196) and non-recurrent UTI (n = 259) groups. Demographic characteristics, clinical features, microbiological findings, laboratory parameters, and potential associated factors were extracted from medical records. Univariable and multivariable binary logistic regression analyses were performed to identify factors independently associated with recurrent UTI. Results Of the 455 patients, 196 (43.1%) had recurrent UTI and 259 (56.9%) had non-recurrent UTI. Patients with recurrent UTI were older, had a longer duration of diabetes, had higher HbA1c levels, and a greater proportion were female. Diabetic nephropathy, nephrolithiasis, previous antibiotic use, and urinary catheterization were more common in the recurrent UTI group. Escherichia coli was the predominant uropathogen in both groups, while multidrug-resistant organisms (MDROs) were significantly more frequent among patients with recurrent UTI (98 (50.0%) vs. 75 (29.0%); p <0.001). In multivariable analysis, poor glycemic control (adjusted OR 2.41, 95% CI 1.58-3.67), previous antibiotic use (adjusted OR 2.08, 95% CI 1.36-3.19), diabetic nephropathy (adjusted OR 1.76, 95% CI 1.12-2.78), urinary catheterization (adjusted OR 2.69, 95% CI 1.57-4.61), and MDROs (adjusted OR 1.82, 95% CI 1.20-2.76) were independently associated with recurrent UTI. Conclusion Recurrent UTI among patients with T2DM was associated with poor glycemic control, diabetic nephropathy, previous antibiotic exposure, urinary catheterization, and infection with MDROs. These findings may facilitate early identification of high-risk patients and support targeted strategies for optimizing glycemic control, antimicrobial stewardship, and prevention of recurrent UTI.

Diabetes burnout is a serious and often overlooked condition marked by emotional exhaustion, detachment, and a sense of helplessness in managing diabetes. This qualitative content analysis study seeks to uncover the underlying factors that contribute to the onset and persistence of diabetes burnout. Understanding these factors is essential for informing targeted interventions and supportive policies to improve the well-being of individuals living with Type 1 diabetes.

Eleven adults with T1D in Shahrekord, Iran, were recruited using purposive sampling to ensure diverse perspectives. Fourteen semi-structured interviews (50-60 minutes each) were conducted in Persian, with two participants completing follow-up sessions. Interviews were recorded, transcribed verbatim, and analyzed using Elo and Kyngäs's three-step process: open coding, categorization, and abstraction. Trustworthiness was ensured through prolonged engagement, peer debriefing, member checking, and application of Lincoln and Guba's criteria.

Qualitative analysis revealed four interrelated themes contributing to burnout: (1) disruptions in self-management routines (e.g., sleep, exercise, diet); (2) external stressors and resource limitations (e.g., economic instability, healthcare access, medication shortages); (3) fluctuations in physical and emotional well-being; and (4) the role of interpersonal and social support. Many of these challenges were exacerbated by the COVID-19 pandemic, which disrupted healthcare routines and increased psychosocial stress. Participants likened their experience to navigating a suspension bridge-requiring constant adaptation amid instability. These findings highlight the need for holistic diabetes care that addresses both medical and social dimensions, especially during times of crisis.

This study reveals diabetes burnout as a critical but often overlooked barrier to effective diabetes management. Disruptions in daily routines, compounded by crises, heighten burnout risks. Aligning with global health policy benchmarks, our findings support the need for integrated care that addresses both medical and psychosocial aspects of diabetes. Health systems should prioritize mental health support, routine stability, and access to essential resources to improve long-term outcomes for people with type 1 diabetes.

Whether pre-existing glucose-lowering therapy influences outcomes after sepsis remains uncertain. We compared clinical outcomes among patients with type 2 diabetes (T2D) who developed sepsis according to prior GLP-1 receptor agonists (GLP-1RAs) or SGLT2 inhibitors (SGLT2is) use.

We conducted a retrospective cohort study using the TriNetX US Collaborative Network. Adults with T2D who developed sepsis had received a GLP-1RA or an SGLT2i within 3 months before sepsis were identified. After 1:1 propensity score matching, 11,969 patients were included in each group. The primary outcome was 90-day all-cause mortality. Secondary outcomes included major adverse cardiovascular event (MACE), major adverse kidney event (MAKE), intensive care unit (ICU) admission, major adverse cardiac and cerebrovascular event (MACCE), septic shock, and acute respiratory failure.

Compared with prior SGLT2i use, prior GLP-1RA use was associated with lower 90-day all-cause mortality (incidence rate, 48.6 vs 60.6 per 100 person-years; HR, 0.81; 95% CI, 0.75-0.88; E-value: 1.6) and lower risks of MACE (HR, 0.77; 0.65-0.91; E-value, 1.7), myocardial infarction (HR, 0.82; 0.67-0.99; E-value, 1.7), ICU admission (HR, 0.89; 0.84-0.94; E-value, 1.4), and MACCE (HR, 0.86; 0.74-0.99; E-value, 1.5). No significant difference was observed for septic shock (HR, 0.87; 95% CI, 0.74-1.02), acute respiratory failure (HR, 0.94; 95% CI, 0.83-1.06), or MAKE (HR, 1.08; 95% CI, 0.92-1.27). The mortality benefit remained consistent through 365 days and across all prespecified subgroups. After Holm correction for multiple comparisons across the seven secondary outcomes, only the associations with MACE (adjusted P=0.012) and ICU admission (adjusted P<0.007) remained statistically significant, while those with MACCE, myocardial infarction, MAKE, septic shock, and acute respiratory failure did not.

Among patients with T2D who developed sepsis, prior GLP-1RA use was associated with lower mortality and select cardiovascular/renal risks than prior SGLT2i use, though roughly half of secondary outcomes showed no significant difference. Exposure was defined at the drug-class rather than individual-agent level, and modest E-values alongside baseline imbalances before matching suggest residual confounding cannot be excluded. These hypothesis-generating findings warrant confirmation in prospective studies.

Cryptococcus neoformans infection presenting as a rapidly reaccumulating unilateral pleural effusion in a non-immunocompromised host is a rare presentation of pulmonary cryptococcal disease. We present a rare case of recurrent unilateral pleural effusion as the initial presentation of cryptococcal disease in an immunocompetent patient. An 85-year-old male with a past medical history of hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease stage IIIb, and coronary artery disease s/p stent placement in the second obtuse marginal branch of the circumflex artery presented to the emergency department with dyspnea on exertion and an unintentional 30-pound weight loss over two to three months. His prior occupation included work in a tire factory; he denied exposure to asbestos. He chewed tobacco and had a dog. A chest radiograph showed a large right-sided pleural effusion. He had undergone repeated thoracentesis and pigtail chest tube placements over four hospital admissions. Review of the initial cytology, extensive serology, pleural fluid analysis, Gram stain, culture, HIV testing, and adenosine deaminase testing was negative. Given the recurrent hospitalizations and reaccumulation of the right pleural effusion, the decision was made to proceed with endobronchial ultrasound, which demonstrated lymphocytosis without evidence of malignancy. Bronchoalveolar lavage grew 100 colonies of Cryptococcus neoformans. The patient underwent lumbar puncture with an opening pressure of 37 and a negative cryptococcal antigen. He was started on fluconazole 400 mg daily upon discharge, with a suspected treatment course of 12 months and close outpatient pulmonology follow-up. This report highlights a rare initial presentation of Cryptococcus neoformans manifesting as recurrent unilateral pleural effusion.

To examine the association between estimated glucose disposal rate (eGDR) and study-defined chronic kidney disease (CKD) among elderly patients with type 2 diabetes mellitus (T2DM) in Zhejiang Province, China.

This cross-sectional study included 713 elderly T2DM patients (≥60 years) from Zhejiang Province, conducted between March and November 2018 as part of the China National Diabetic Chronic Complications Study. Study-defined CKD was operationally defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² and/or a urinary albumin-to-creatinine ratio (UACR) ≥30 mg/g. Multivariable logistic regression was used to assess the association of eGDR with study-defined CKD. Restricted cubic spline (RCS) analysis examined the shape of the association. Generalized additive models evaluated associations with UACR and eGFR, and receiver operating characteristic (ROC) analysis assessed discrimination.

Among 713 participants, 245 (34.36%) met the study-defined CKD criteria. Each 1-unit increase in eGDR was associated with lower odds of study-defined CKD after multivariable adjustment (OR = 0.78, 95% CI: 0.70-0.86; p < 0.001). Compared with the lowest eGDR tertile, the adjusted ORs (95% CIs) were 0.51 (0.35-0.76) for the middle tertile and 0.31 (0.20-0.48) for the highest tertile (both p < 0.001). RCS analysis demonstrated an approximately linear inverse association between eGDR and study-defined CKD (p for nonlinearity > 0.05). eGDR was inversely associated with UACR (ρ = -0.277, p < 0.001) whereas the association between eGDR and eGFR was not statistically significant. The discriminative ability of eGDR for study-defined CKD was modest (AUC = 0.65, 95% CI: 0.61-0.70). The direction of the association was generally consistent across subgroups, with no significant interactions.

Lower eGDR was associated with a higher prevalence of study-defined CKD in elderly patients with T2DM, with an approximately linear cross-sectional association. Prospective studies are needed to establish temporality and assess whether eGDR adds information beyond established CKD assessment.

This study aimed to compare the safety and efficacy of rotational atherectomy combined with drug-coated balloon angioplasty (RA+DCB) versus DCB alone in patients with superficial femoral artery chronic total occlusions (SFA CTOs) and to evaluate the influence of lesion complexity and vascular access site (femoral or popliteal) on procedural success and 12-month clinical outcomes.

This single-center retrospective cohort included 98 consecutive patients (117 SFA CTOs) treated between December 2022 and January 2024. All patients presented with lifestyle-limiting claudication or chronic limb-threatening ischemia (Rutherford 3-6). The primary outcome was 12-month primary patency on duplex ultrasound; secondary outcomes were technical success and freedom from target-lesion revascularization (TLR). Multivariable logistic regression identified predictors of loss of primary patency and TLR, and Kaplan- Meier analysis compared patency across treatment groups and access sites.

Successful lesion crossing was achieved in 109 of 117 CTOs (93.2%). Technical success was similar for RA + DCB (94.3%) and DCB alone (94.6%). At 12 months, primary patency (67.3% vs. 50%, p = 0.16) and freedom from TLR (70.2% vs. 54.2%, p = 0.26) did not differ between treatment modalities, nor between femoral and popliteal access. Diabetes mellitus independently reduced the odds of primary patency (odds ratio [OR], 0.30, 95% confidence interval [CI], 0.11-0.88) and TLR-free survival (OR, 0.28, 95% CI, 0.09-0.86). Longer occlusion length predicted crossing failure (p = 0.008) but not loss of patency. No procedure-related major adverse limb events occurred.

Routine addition of RA to DCB angioplasty for all SFA CTOs is not supported. RA-facilitated DCB may confer benefit only in selected heavily calcified lesions. Mid-term outcomes are driven primarily by diabetes and lesion length, rather than the access route, underscoring the importance of a risk-adapted, lesion-specific treatment strategy.

A 42-year-old antibiotic-naïve man with previous laparoscopic cholecystectomy and poorly controlled type 2 diabetes mellitus (HbA1c 9.7%) presented with Charcot's triad 7 days after a formally documented normal hepatobiliary evaluation (alanine aminotransferase [ALT] 22 U/L; total bilirubin 0.7 mg/dL [12 μmol/L]; common bile duct [CBD] ≤ 5 mm on ultrasound). Admission findings satisfied all three Tokyo Guidelines 2018 (TG18) diagnostic domains. Severity was Grade II on two of the five TG18 severity criteria-leukocytosis (14.2 × 10³/μL) and hyperbilirubinaemia (26 mg/dL, 445 μmol/L); temperature (38.9°C), age (42 years), and albumin (3.4 g/dL, 34 g/L) did not meet their thresholds, and no Grade III organ dysfunction was identified on the recorded variables. Grade II severity established the indication for early biliary drainage at presentation. Computed tomography (CT) showed only mild intrahepatic ductal dilatation with 3-4 hyperattenuating distal CBD filling defects (greatest ≈4 mm) and no dominant calculus. Immediate endoscopic retrograde cholangiopancreatography (ERCP) was not feasible because of endoscopy-suite and anesthetic availability; antimicrobial and supportive therapy continued, and persistent clinical and biochemical abnormalities at 48 h (ALT 837 U/L; bilirubin 24 mg/dL, 410 μmol/L; C-reactive protein 86 mg/L) reinforced the urgency of drainage during that interval. ERCP on Day 3, at the earliest available opportunity, showed macroscopic purulent bile at ductal entry, distal CBD filling defects, and copious biliary sludge on balloon sweep. Fever resolved within 24 h, and hepatobiliary and inflammatory markers normalized by 3 months (ALT 38 U/L; bilirubin 0.9 mg/dL, 15 μmol/L; C-reactive protein < 5 mg/L). This case illustrates that current severity, not antecedent normality or unimpressive imaging, should govern the timing of biliary drainage, and it reports transparently an interval to drainage imposed by resource availability.

Gestational diabetes (GDM) is frequently associated with adverse neonatal outcomes, but the underlying mechanisms linking maternal hyperglycemia to fetal harm are not fully understood. Oxidative stress has been suggested as a key pathway; however, studies simultaneously evaluating multiple oxidative and antioxidant biomarkers in umbilical cord blood are limited. This study aimed to investigate the impact of GDM on the fetus by comprehensively evaluating oxidative stress and antioxidant defense mechanisms in umbilical cord blood and to examine their potential associations with neonatal clinical outcomes.

Umbilical cord blood samples were analyzed for malondialdehyde (MDA), membrane attack complex (MAC), total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), ischemia-related modified albumin (IMA), 8-hydroxy-2'-deoxyguanosine (8-OHdG), advanced glycation end products (AGEs), reduced glutathione (GSH), and glutathione peroxidase (GPx). Neonatal clinical outcomes were recorded and compared between pregnancies with and without GDM.

After correction for multiple biomarker comparisons, MAC, 8-OHdG, and TOS differed significantly between the GDM and non-GDM groups. MAC and 8-OHdG levels were higher in the GDM group, whereas TOS was lower. OSI was higher in the Mann-Whitney analysis but did not remain significant after BH-FDR correction. Exploratory multivariate analyses supported a group-level difference in the combined oxidative-stress biomarker profile, as confirmed by MANOVA and permutation testing. The Spearman heatmap showed that maternal HbA1c was most prominently associated with OSI and also correlated positively with 8-OHdG and GSH. Although neonatal complications were more frequent in the GDM group, oxidative-stress markers were not consistently associated with specific neonatal complications.

These findings suggest that GDM is associated with a selective fetal redox-related biomarker pattern rather than a uniform global increase in oxidative stress. The combined biomarker profile and HbA1c-related heatmap correlations indicate that long-term maternal glycemic exposure may influence fetal oxidant-antioxidant balance and oxidative DNA-damage signals, while antioxidant-related responses may remain partially preserved. The comprehensive evaluation of multiple oxidative and antioxidant biomarkers, particularly the inclusion of rarely studied AGEs and IMA, provides a broader perspective on fetal exposure to GDM and its pathophysiological mechanisms.

Introduction Periodontitis and diabetes are closely related, but the influence of periodontal disease severity on perioperative glycemic outcomes during dental procedures under general anesthesia remains unclear. This study evaluated the association between periodontal disease severity and perioperative glycemic outcomes in diabetic patients. Materials and methods This retrospective study included 72 patients with diabetes who underwent elective dental procedures under general anesthesia between January 2015 and December 2018. The patients were categorized into mild periodontitis (n = 43) and severe periodontitis (n = 29) groups. Demographic, diabetic, periodontal, anesthetic, and perioperative data were retrieved from the electronic medical records. Periodontal parameters included plaque index, bleeding on probing, probing pocket depth, clinical attachment loss, and the number of remaining teeth. Perioperative glycemic outcomes were assessed using preoperative, intraoperative, and postoperative blood glucose levels; glycemic variability; and the incidence of hyperglycemia and hypoglycemia. Postoperative complications were also assessed. Statistical analysis was then performed. Results Patients with severe periodontitis had significantly higher glycated hemoglobin (HbA1c) levels than those with mild disease (8.9 ± 1.3% vs. 7.6 ± 1.2%; p < 0.001). Mean preoperative (185.6 ± 42.4 vs. 142.3 ± 38.1 mg/dL), intraoperative (210.8 ± 48.2 vs. 155.4 ± 41.5 mg/dL), postoperative (225.1 ± 52.3 vs. 161.2 ± 45.8 mg/dL), and mean perioperative blood glucose levels (207.2 ± 43.5 vs. 153.0 ± 38.2 mg/dL) were significantly higher in patients with severe periodontitis (all p < 0.001). Glycemic variability was also significantly greater (41.3 ± 14.2 vs. 28.5 ± 10.1; p < 0.001). Perioperative hyperglycemia was observed in 22 (75.9%) patients with severe periodontitis compared with 12 (27.9%) patients with mild periodontitis (p < 0.001). Surgical site infection occurred in 9 (31.0%) and 3 (7.0%) patients (p = 0.014), delayed wound healing in 11 (37.9%) and 4 (9.3%) patients (p = 0.006), and hospital stay exceeding 24 hours in 15 (51.7%) and 8 (18.6%) patients (p = 0.004), respectively. The periodontal destruction and perioperative glycemic parameters showed a significant positive correlation (r = 0.58-0.67; all p < 0.001). Conclusion Severe periodontitis was associated with poorer perioperative glycemic control, greater glycemic variability, and more frequent postoperative complications in diabetic patients undergoing dental procedures under general anesthesia. These findings indicate an association between periodontal disease severity and perioperative outcomes but do not establish a causal relationship. Prospective studies are needed to determine whether periodontal management can improve perioperative outcomes.