This study aimed to evaluate the preparedness of diabetes educators (DEs) to support the use of MiniMed™ 780G in clinical practice, identifying knowledge gaps, onboarding barriers, success factors, and regional variations to inform a standardized training pathway for type 1 diabetes mellitus (T1DM) care.

A cross-sectional, multiregional survey was conducted among 82 DEs from Africa, the Arabian Peninsula (Gulf States), Central and Eastern Europe, Türkiye, and Central Asia (June-July 2025). The questionnaire, adapted from a validated Delphi-derived tool, assessed knowledge and confidence, training challenges, success factors, educational needs, and professional development. Responses were collected using Likert scales, multiple-choice, and free-text fields. Quantitative data were analyzed descriptively, with graphics generated in Excel. Item-level missing data were handled by listwise deletion; all 82 participants completed the survey (100% response rate).

A 23-question survey was shared with 82 DEs from four regions to assess their knowledge and confidence with MiniMed™ 780G, training challenges, success factors, educational needs, and educational pathways. Most DEs reported high confidence in key MiniMed™ 780G topics; however, confidence in managing high-fat/protein meals was lower (56.1%), highlighting the need for targeted education. Key professional development drivers included mentorship (24.9%) and strong educator networks (21.0%), with accreditation priorities emphasizing international certification bodies (25.6%) and continuing education (20.3%). Common challenges included managing patient expectations (33.6%), explaining SmartGuard™ (20.4%), lack of structured materials (17.1%), troubleshooting alarms (12.5%), and teaching device settings (11.8%).

Specialist healthcare professionals are competent in the use of advanced diabetes technologies; however, standardized, personalized, and patient-centered educational programs are essential to fully realize their potential and ensure high-quality care for individuals with T1DM.

Purpose To evaluate the effects of a monthly 5-day fasting-mimicking diet (FMD) for 1 year on left ventricular (LV) geometry and function in individuals with type 2 diabetes (T2D). Materials and Methods This secondary analysis of the prospective Fasting In diabetes Treatment trial (ClinicalTrials.gov identifier no. NCT03811587) included individuals with T2D randomized to monthly 5-day FMD or usual care for 12 months (November 2018-July 2020). MRI (3.0 T) was performed at baseline, 6 months, and 12 months. LV geometry and systolic function were assessed from two-dimensional cine images, and diastolic function was assessed from four-dimensional flow MRI. Intention-to-treat linear mixed models and linear regression were used to evaluate treatment effects and LV-metabolic associations. Results A total of 82 participants (mean age, 62.9 years ± 8.5 [SD]; 43 female) were included. FMD reduced LV mass at 6 months (mean difference, -5.47 g [95% CI: -9.19, -1.75]; P = .005) but not at 12 months (P = .83). End-diastolic volume remained stable in the FMD group versus controls (mean difference, 7.75 mL [95% CI: 0.19, 15.32]; P = .045). Both the early-to-late peak filling ratio (E/A) (mean difference, 0.27 [95% CI: 0.04, 0.50]; P = .02) and the mitral annular early peak velocity (Ea) (mean difference, 0.84 cm/sec [95% CI: -0.02, 1.67]; P = .04) increased at 12 months. No other treatment effects were observed (all P > .05). ∆E/A was positively associated with change in hemoglobin A_1c (HbA_1c) level (standardized β = 0.47, P = .01) and negatively associated with changes in high-density lipoprotein cholesterol levels (standardized β = -0.55, P = .01). Conclusion FMD positively influenced LV diastolic function by increasing E/A and Ea in participants with T2D; E/A improvements were associated with reduced HbA_1c levels. Keywords: MR Imaging, Cardiac, Left Ventricle, Outcomes Analysis, Metabolic Disorders, Diet, Fasting-mimicking Diet, Left Ventricle Function, Type 2 Diabetes, Cardiac Magnetic Resonance ClinicalTrials.gov identifier number NCT03811587 Supplemental material is available for this article. © RSNA, 2026.

Little is known about the long-term risk of developing cirrhosis in patients with alcohol use disorder (AUD).

This was a retrospective cohort of patients with AUD presenting to healthcare centers between January 2006 and June 2017. Individuals ≥18 years old with a diagnosis of AUD based on ICD-9 and ICD-10 codes were included. Patients with concurrent cirrhosis were excluded. Then, patients were followed until August 2021 for the development of complications or mortality.

A total of 32,808 patients with AUD were included in the final analysis. During an average follow-up of 5.7 years, 12.3% of patients developed incident cirrhosis, and the overall mortality was 20.2%. The risk of cirrhosis increased in patients with diabetes mellitus (DM) [hazard ratio (HR), 1.52; 95% CI, 1.41-1.63; p<0.001] and hepatitis C (HR, 3.15; 95% CI, 2.93-3.39; p<0.001), whereas African American (AA) race had a protective effect (HR, 0.76; 95% CI, 0.7-0.82; p<0.001). Development of cirrhosis doubled the mortality rate (HR, 2.55; 95% CI, 2.39-2.72; p<0.001). The presence of DM, concomitant hepatitis C infection, and non-AA race collectively conferred a greater risk of cirrhosis and mortality in individuals with AUD.

Patients presenting with AUD are at high risk for developing incident cirrhosis and mortality. Concurrent DM and hepatitis C increase the risk of cirrhosis and mortality. Early intervention in patients presenting with AUD is urgently warranted.

Atherosclerosis of the middle cerebral artery (MCA) is a major contributor to ischemic stroke, and infarcts confined to the perforator territory can produce considerable neurological dysfunction even when the affected volume is comparatively small. As the severity of luminal narrowing measured by conventional methods does not, on its own, account for the variety of observed infarction patterns, additional contributions from plaque remodeling and plaque vulnerability are likely. High-resolution magnetic resonance imaging (HR-MRI) permits fine-grained characterization of intracranial plaques. The present work was undertaken to examine how the positive remodeling index (PRI) of MCA atherosclerotic plaques relates to perforator-territory infarction and to provide a preliminary appraisal of the value of PRI for stratifying the risk of this infarct subtype.

Patients admitted to our institution between January 2021 and December 2024 with acute ischemic stroke attributable to MCA atherosclerosis were reviewed retrospectively, yielding 283 cases. Each patient completed both conventional MRI and HR-MRI vessel wall imaging. Based on where the infarct was located, patients were separated into a perforator-territory infarction group (n = 127) and a non-perforator-territory infarction group (n = 156). The cross-sectional vessel area at the culprit lesion and at the reference segment were quantified from HR-MRI, from which the PRI was derived. Clinical and imaging variables showing an independent relationship with perforator-territory infarction were identified through univariate followed by multivariable logistic regression. The apparent discrimination of PRI was summarized using receiver operating characteristic (ROC) analysis, and the stability of the derived cutoff was examined by bootstrap resampling together with stratified 10-fold cross-validation. The added value of the PRI was judged using net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA).

PRI values were greater among patients with perforator-territory infarction than among those without. In the multivariable model, perforator-territory infarction was independently linked to the PRI (odds ratio [OR] = 8.67, 95% confidence interval [CI]: 3.42-21.98, p < 0.001), diabetes mellitus (OR = 2.18, 95% CI: 1.21-3.92, p = 0.009), homocysteine (OR = 1.03, 95% CI: 1.00-1.05, p = 0.032), severe stenosis (OR = 2.45, 95% CI: 1.38-4.35, p = 0.002), marked enhancement (OR = 2.32, 95% CI: 1.28-4.21, p = 0.006), and intraplaque hemorrhage (OR = 1.95, 95% CI: 1.09-3.49, p = 0.025). Used alone, the PRI achieved moderate discrimination, with an area under the curve (AUC) of 0.728 (95% CI: 0.670-0.786). After internal validation, the bootstrap-corrected AUC was 0.716 (95% CI: 0.654-0.775) and the stratified 10-fold cross-validated AUC was 0.714 (95% CI: 0.650-0.777). A Youden-based cutoff of PRI = 1.12 was identified post hoc from the ROC curve, and bootstrap resampling located this threshold predominantly within the 1.10-1.14 interval. Incorporating the PRI into the base model raised the AUC from 0.794 to 0.832 (p = 0.018), accompanied by a continuous NRI of 0.318 (95% CI: 0.154-0.482) and an IDI of 0.061 (95% CI: 0.028-0.094) (both p < 0.001).

Among patients with MCA atherosclerotic stroke, a higher PRI was independently related to perforator-territory infarction. Within this single-center retrospective cohort, the PRI demonstrated moderate discriminative capacity and may represent a candidate HR-MRI vessel wall imaging marker for risk stratification. Confirmation of its threshold and its place in clinical practice will require multicenter prospective investigation and validation in independent samples.

Thrombotic microangiopathy (TMA) is a process characterized by thrombocytopenia, microangiopathic hemolytic anemia, and end-organ injury. Malignancy-associated TMA is uncommon and may resemble primary TMA syndromes, particularly when renal dysfunction predominates and peripheral smear findings are limited. We present a case of biopsy-confirmed renal TMA in the setting of newly diagnosed metastatic squamous cell carcinoma (SCC) following significant diagnostic uncertainty. A 59-year-old man with insulin-dependent diabetes mellitus presented with worsening headache, neck pain, dysphagia, shortness of breath, poor oral intake, and significant weight loss. Initial evaluation demonstrated acute hypoxic respiratory failure, progressive renal failure, thrombocytopenia, and a newly identified right-sided neck mass. Laboratory studies showed anemia, elevated lactate dehydrogenase, low haptoglobin, and reticulocytosis, raising concern for TMA. Peripheral smear showed few schistocytes, while ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif member 13) activity was reduced but not severely deficient. Autoimmune and complement studies were unrevealing. Renal function progressively worsened, requiring initiation of hemodialysis. Renal biopsy demonstrated acute and chronic TMA with chronic vascular changes. Additional otolaryngologic evaluation confirmed invasive, moderately differentiated nonkeratinizing SCC of the uvula with metastatic cervical disease. Given the biopsy findings, lack of severe ADAMTS13 deficiency, unrevealing autoimmune workup, and overall clinical course, malignancy-associated TMA was favored over primary thrombotic thrombocytopenic purpura and other secondary causes. Renal TMA in patients with newly diagnosed malignancy may present with a broad and overlapping differential diagnosis. In this case, renal biopsy clarified this mechanism, as the limited peripheral smear findings and multiple overlapping causes of secondary TMA had posed significant diagnostic challenges.

The co-occurring epidemics of diabetes and obesity have increased the prevalence of Cardio-Kidney-Metabolic (CKM) syndrome. Comparative studies on long-term trends of its three core components [ischemic heart disease (IHD), diabetic kidney disease (DKD), non-alcoholic fatty liver disease (NAFLD)] across major countries are still limited.

We analyzed age-standardized disability-adjusted life year (DALY) rates of IHD, DKD, and NAFLD attributable to high fasting plasma glucose (HFPG) from 1990 to 2021 among seven representative middle-and high-income countries using Global Burden of Disease 2021 data. We assessed temporal trends, conducted hierarchical clustering, and projected burdens to 2050.

We found substantial cross-country heterogeneity. From 1990 to 2021, IHD burden decreased significantly in the United States and Japan, while trends in China and India showed high uncertainty (coefficients of variation >100%) and should be interpreted with caution. DKD burden increased in Saudi Arabia and the United States but decreased in China. NAFLD burden increased in Saudi Arabia, the United States, India, and South Africa, while declining in China and Japan. Cluster analysis identified three patterns: "High IHD Burden" (India), "High Metabolic Burden" (Saudi Arabia), and "Low-Moderate Burden" (other countries). HFPG was associated with the largest share of DKD burden (Population Attributable Fraction [PAF] >80%) and a substantially smaller share of NAFLD burden (PAF <11%).Projections to 2050 show a sharp rise in DKD in the United States and India, together with increasing NAFLD burden, indicating a shift toward metabolic organ damage.

The burden of CKM syndrome is substantial and dynamic, with marked cross-country differences. These findings support the need for integrated, multi-organ risk management strategies for metabolic disorders.

The clinical benefits of percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) are frequently compromised by the occurrence of microvascular obstruction (MVO). The C-reactive protein-triglyceride glucose index (CTI) is a novel biomarker integrating systemic inflammation and insulin resistance. We aimed to evaluate the association between CTI and MVO, as well as its prognostic value for long-term outcomes in AMI patients.

This study included patients with AMI who underwent successful primary PCI and subsequent cardiac magnetic resonance (CMR). MVO and cardiac function were assessed by CMR. The primary endpoint was the occurrence of MVO, and the secondary endpoint was the incidence of major adverse cardiovascular events (MACE).

A total of 967 patients were ultimately included, comprising 255 with diabetes mellitus and 712 without diabetes; 476 patients developed CMR-defined MVO. Higher baseline CTI levels were significantly and independently associated with an increased risk of MVO (OR = 1.33, 95% CI: 1.13-1.56, P = 0.001). A linear dose-response relationship was observed between CTI and MVO risk (P for overall < 0.05, P for nonlinear > 0.05). During a median follow-up of 43 months, higher CTI levels were associated with an increased risk of long-term MACE in the overall population and the non-diabetic subgroup, whereas this association was attenuated in patients with diabetes mellitus.

CTI is independently associated with MVO after PCI in AMI patients and shows modest prognostic value for long-term MACE, particularly in patients without diabetes. As a clinically accessible tool, CTI may facilitate early risk stratification and individualized microvascular protection strategies following PCI.

Matching insulin injection timing with meals to optimize postprandial glucose excursions is a daily challenge for individuals with diabetes on a multiple daily injection (MDI) regimen. We aimed to analyze the impact of using a connected insulin pen cap (CIPC) on insulin injection timing and glycemic control.

Pragmatic, real-life, multicenter, prospective, open-label, observational study, including one week of run-in and a 6-week follow-up, split into a two-week masked mode phase and a four-week active phase. Continuous glucose monitoring (CGM) and automatically tracked insulin injection data in individuals with insulin-treated diabetes (ITD) who started using the CIPC Insulclock. The baseline and five hours of paired CGM and rapid-acting insulin data collected from Insulclock v2.0^® users were analyzed using the ROC detection methodology to identify meal events and the timing of insulin doses.

Of 82 recruited patients, 52 completed the study (54.4 y, 56.6% women, 60.4% with type 1 diabetes [T1D]) across three hospitals and one primary care center in Spain. The CGM glucometrics comparison between the consecutive masked and active phases showed: Glucose Management Indicator (GMI) 8.1 + 1.7 vs 7.8 + 1.4% (-0.3%, p 0.034); Time in Range 70-180 (TIR): 56.9 + 24.5 vs 61.9 + 21.6% (+5.0%, p 0.0054); Time below range <70 (TBR70): 2.5 + 3.3 vs 1.76 + 2.6% (-0.74%, p 0.0015); Time above range >180 (TAR180): 40.9 + 25.3 vs 36.6 + 22.4% (-5.3%, p 0.016). The on-time insulin injections increased: 45.5 + 15.52 to 54.4 + 16.6% (p 0.0017). The timing of insulin injection relative to the post-meal glycemic excursions shifted from +5.6 min (IQR -19.8 to +34.0) in the masked phase (n = 231 events) to -5.9 min (IQR -27.6 to +33.9) in the active phase (n = 467 events) (p = 0.023). An earlier injection was associated with a reduction in TAR180 (p = 0.042). Questionnaires measuring patients' reported outcomes (PROs) indicated a reduction in perceived treatment burden with the use of the Insulclock v2.0^® CIPC.

The use of Insulclock v2.0^® connected insulin pen cap is associated with improved insulin injection timing and glucometrics.

Higher prepregnancy body mass index (BMI) is a well-established risk factor for adverse neonatal outcomes in IVF-conceived pregnancies; therefore, weight management is important for infertile patients, yet it remains challenging. Determining a clinically applicable BMI threshold for neonatal outcome risk assessment in fresh embryo transfer (fresh ET) cycles is meaningful; however, it remains undetermined. Therefore, this study aimed to identify an exploratory BMI threshold associated with increased risk of adverse neonatal outcomes after fresh ET, providing a preliminary reference for clinical risk communication.

This retrospective cohort study included 2,195 women who underwent autologous fresh ET between June 2019 and December 2023. Multivariable regression analysis examined the association between prepregnancy BMI and neonatal outcomes. Smooth curve fitting and threshold effect analysis identified the exploratory BMI threshold. Adjusted analysis following propensity score matching (PSM) was conducted as a sensitivity analysis to validate the robustness of the results.

The multivariate regression analyses revealed that birthweight (adjusted β: 22.63, 95% CI: 14.53 to 30.73; P<0.001) and Z-score (adjusted β: 0.06, 95% CI: 0.04 to 0.08; P<0.001) were positively associated with increasing maternal BMI. Compared with the reference group (BMI 18.5-24.9 kg/m²), the incidence of macrosomia was increased by 2.25-fold in the BMI 25-29.9 kg/m² group (adjusted OR: 2.25, 95% CI: 1.29 to 3.93; P = 0.004) and by 4.56-fold in the BMI ≥30 kg/m² group (adjusted OR: 4.56, 95% CI: 2.26 to 9.22; P<0.001). Smooth curve fitting and threshold effect analysis revealed a significant increase in the odds of macrosomia when BMI exceeded 26.22 kg/m² (adjusted OR: 4.05, 95% CI: 2.47 to 7.29; P = 0.0009). PSM analysis confirmed that patients with a BMI >26.22 kg/m² (adjusted OR: 3.01, 95% CI: 2.02 to 4.47; P<0.001) had significantly higher odds of macrosomia compared to those with BMI ≤26.22 kg/m².

Our findings suggest that a prepregnancy BMI exceeding approximately 26 kg/m² may be a potential predictor for an increased risk of macrosomia in singleton pregnancies conceived via fresh ET. This exploratory threshold may serve as a preliminary reference for risk communication and weight management counseling in women undergoing IVF treatment, though external validation is needed.

Diabetic foot disease remains one of the leading preventable causes of hospitalization, limb loss, and premature mortality. It is important to understand temporal changes in disease severity and outcomes in order to establish gaps in prevention and acute management. The present study reported on the hospital burden, amputation patterns, and mortality trends of diabetic foot patients over a decade.

This is a retrospective analysis of 500 patients admitted for diabetic foot complications from 2015 to 2024. The records were reviewed for demographic profile, ulcer grade, severity of infection, co-morbidities, length of stay, surgical interventions, and mortality. The amputation was classified into minor or major, while mortality was analyzed at two stages: during hospitalization and within 30 days. Annual trends were studied to assess the changes in clinical presentation and outcomes.

Diabetic foot complication admissions gradually increased year by year, with later years recording more severe grades of ulcers and high infection burden. Major amputations formed a consistent proportion of the surgical cases, though a slight decline was recorded after 2021. Overall mortality remained similar throughout the study period but was higher among those presenting with sepsis, advanced peripheral arterial disease, or chronic renal impairment. The hospital burden remained high, reflected in prolonged lengths of stay and multiple readmissions.

The 10-year pattern demonstrates persistent clinical severity at presentation, continued reliance on major amputations, and stable but meaningful mortality in diabetic foot patients. The findings stress the need for stronger preventive care, earlier referral, and community-level screening strategies to reduce advanced disease and improve survival.