Hyperglycemia at presentation is common after acute ischemic stroke and is associated with worse functional outcomes. We examined whether admission hyperglycemia independently predicted unfavorable discharge outcomes, quantified adherence to the SHINE trial-aligned management standards, and tested the stress hyperglycemia ratio (SHR) as an alternative exposure variable.

This single-center retrospective cohort study included 218 consecutive adults with acute ischemic stroke admitted to the Tawam Stroke Center, Al Ain, United Arab Emirates, between July 1 and December 31, 2023. The primary exposure was an admission capillary glucose level >7.8 mmol/L. Two co-primary outcomes were defined a priori: unfavorable discharge modified Rankin Scale (mRS) scores of 3-6 and in-hospital death. Glycemic management adherence was analyzed as a parallel process measure across 13 q6-h time points. Multivariable logistic regression was adjusted for the pre-specified nine-covariate set (age, sex, NIHSS severity, and six clinical comorbidities). Bonferroni correction was applied across the two co-primary outcomes (α = 0.025).

Admission hyperglycemia (51.7%) was associated with unfavorable mRS (adjusted OR 3.43, 95% CI 1.33-8.87, p = 0.011; surviving Bonferroni correction). Mantel-Haenszel pooled OR across NIHSS strata: 3.47 (p<0.001). Inappropriate management occurred in 85.8% of hyperglycemic versus 11.1% of euglycemic patients (adjusted OR 80.59, p < 0.001). Routine HbA1c testing identified occult diabetes in 18.4% of patients without prior diagnosis. No severe hypoglycemia occurred.

Admission hyperglycemia tripled the adjusted odds of unfavorable discharge outcome and identified patients receiving non-adherent management. Structured admission orders, q6h monitoring and routine HbA1c testing are immediate, low-cost quality improvement targets for Gulf stroke services.

Diabetic retinopathy (DR) and diabetic kidney disease share common microvascular mechanisms, whereas carotid plaque reflects systemic atherosclerotic burden in type 2 diabetes (T2D). We examined the association between urinary albumin-to-creatinine ratio (ACR) and prevalent diabetic retinopathy (DR) in patients with type 2 diabetes and conducted exploratory analyses to assess whether this association differed according to carotid plaque status.

This cross-sectional study included 502 patients with T2D. DR was assessed using fundus photography, and carotid plaque was evaluated by ultrasonography. Because of its skewed distribution, ACR was natural log-transformed as lnACR. Multivariable logistic regression was used to examine the association between lnACR and DR. Subgroup and interaction analyses were performed according to carotid plaque status.

Among 502 participants, 95 (18.9%) had DR. In the extended logistic regression model adjusted for selected clinical covariates, lnACR was associated with prevalent DR (adjusted OR = 1.291, 95% CI: 1.045-1.595, P = 0.018). In a modified Poisson sensitivity analysis using the same covariates, the association was directionally similar but attenuated and did not reach statistical significance (adjusted PR = 1.160, 95% CI: 0.975-1.380, P = 0.094). The point estimate for the lnACR-DR association was numerically larger among participants with carotid plaque than among those without plaque, but the multiplicative interaction was not statistically significant (P for interaction = 0.220).

Higher lnACR was associated with prevalent DR in adjusted logistic regression, whereas the corresponding modified Poisson sensitivity analysis showed an attenuated, non-significant association. Carotid plaque-related findings were exploratory, and no statistically significant interaction was observed. Because of the cross-sectional complete-case design, these findings should not be interpreted as evidence of incident DR risk, prediction, or support for changes in ophthalmic screening practice.

Diabetes-related lower-limb amputation (DLLA) is a severe complication of diabetes associated with considerable disability and mortality. However, the associations of activities of daily living (ADL) and their longitudinal trajectories with DLLA risk remain unclear.

Data from the Health and Retirement Study (HRS; n = 3007) and the English Longitudinal Study of Ageing (ELSA; n = 833) were analyzed. ADL trajectories were identified using Group-Based Trajectory Modeling. Associations of ADL levels and trajectories with diabetes-related lower-limb amputation (DLLA) were evaluated using Cox regression models, with competing-risk, nonlinear, subgroup, and mediation analyses performed as sensitivity and exploratory analyses.

During a median follow-up of approximately two survey waves (approximately four years), 986 DLLA events occurred in the HRS cohort and 254 events occurred in the ELSA cohort. Multivariable Cox regression analyses demonstrated that ADL scores were significantly associated with DLLA risk after adjustment for potential confounders (HRS: adjusted HR = 1.10, 95% CI: 1.07-1.14; ELSA: adjusted HR = 1.20, 95% CI: 1.12-1.28). Compared with the Stable-low trajectory group, the risks of DLLA were significantly higher in both the Stable-rise and Stable-high groups. The risk increased by approximately 51%-84% in the Stable-rise group and by 36%-1.31-fold in the Stable-high group. Kaplan-Meier survival analysis showed significant differences in DLLA incidence among the ADL trajectory groups (log-rank P < 0.001). The competing risk analyses yielded results consistent with those of the Cox models. RCS analysis indicated a significant nonlinear association between ADL and DLLA risk, with a threshold effect observed around ADL ≈ 2. Furthermore, mediation analysis suggested that depression partially mediated the association between ADL and DLLA risk.

ADL levels and their longitudinal trajectories were significantly associated with the risk of DLLA among individuals with diabetes. Individuals with persistently poor functional status or progressively declining function exhibited the highest risk. Dynamic changes in functional status may serve as useful indicators for identifying individuals at elevated risk of DLLA. Routine assessment of ADL may contribute to risk stratification and clinical monitoring in individuals with diabetes.

Type 2 diabetes mellitus (T2DM) predisposes patients to osteosarcopenia, a debilitating condition characterized by concurrent bone loss and muscle wasting. This study aimed to develop and internally validate a nomogram for predicting osteosarcopenia risk in T2DM patients aged ≥ 40 years.

The test cohort included 5,412 hospitalized T2DM patients (January 2010-July 2024), and the temporal validation cohort included 1,671 patients (August 2024-December 2025) from the First Affiliated Hospital of Fujian Medical University. Logistic regression and machine learning algorithms (Boruta, random forest, LASSO) were combined for feature selection. The nomogram was constructed via multivariable logistic regression. We carried out receiver operating characteristic (ROC) curve analysis, calibration, decision curve analysis (DCA), and bootstrap validation for assessing the nomogram. Restricted cubic splines were employed for exploring potential nonlinear associations.

Eight independent predictors, which encompassed gender, age, BMI, WHtR, fracture history, diabetic foot ulcer (DFU), smoking status, and diabetic kidney disease (DKD), were identified. These predictors were incorporated into the nomogram. The nomogram achieved AUCs of 0.864 and 0.904 in the test cohort and validation cohort, respectively. Accordingly, favorable calibration and positive net benefit on DCA was demonstrated. Higher BMI served as a protective factor (OR = 0.56, 95% CI: 0.53-0.59). Besides, higher WHtR acted as a risk factor (OR = 1.47, 95% CI: 1.28-1.69). Restricted cubic spline analysis revealed a significant negative nonlinear relationship between BMI and osteosarcopenia risk, and a significant positive nonlinear relationship between WHtR and osteosarcopenia risk.

This nomogram, based on eight readily available clinical variables, exhibits excellent discriminative performance and clinical utility for predicting osteosarcopenia risk in T2DM patients aged ≥ 40 years. Further multicenter external validation is warranted.

Although the efficacy of labor analgesia in pain relief is well-established, its impact on labor progression and maternal-neonatal outcomes remains inconclusive, particularly in parturients with gestational diabetes mellitus (GDM). This study aimed to examine the effects of labor analgesia on labor progression, delivery mode, and neonatal outcomes in parturients with GDM, thereby providing evidence to optimize clinical intervention strategies.

A total of 201 GDM parturients meeting inclusion criteria at Beilun District People's Hospital of Ningbo City between 1 January 2023 and 31 December 2024, were retrospectively analyzed. Participants were allocated to the observation group (labor analgesia, n = 111) or the control group (routine delivery, n = 90) based on whether they received labor analgesia. Maternal clinical data, delivery mode, labor duration, maximum intrapartum temperature, postpartum hemorrhage, neonatal Apgar scores, and other obstetric outcomes were compared and analyzed retrospectively. Statistical analyses included independent sample t-tests, Mann-Whitney U test, Chi-squared tests, and Chi-squared correction.

Among the 111 parturients receiving labor analgesia, the 2-hour capillary blood glucose variation during labor was significantly higher in the epidural analgesia (EP) group compared with the combined spinal-epidural analgesia (CSEA) group (p < 0.001). The postpartum fasting plasma glucose (FPG) difference was also significantly greater (p < 0.001). The numerical rating scale (NRS) score after EP in the observation group was markedly lower than the pre-analgesia score (p < 0.001). The observation group demonstrated longer first and second stages of labor (p < 0.05), lower 2-hourly glucose fluctuations, higher maximum intrapartum temperature (p < 0.05) and soft tissue lacerations (p < 0.05), and increased rates of oxytocin use and episiotomy (p < 0.05). Furthermore, urinary ketone positivity, FPG difference, and 2-hour postprandial blood glucose (2hPBG) difference were lower in the observation group (p < 0.05), whereas postpartum day 1 C-reactive protein (CRP) levels were higher (p < 0.05). No significant differences were observed in delivery mode, postpartum urinary retention, postpartum hemorrhage, neonatal clavicle fracture, neonatal transfer, or incidence of patent foramen ovale and ductus arteriosus (p > 0.05).

Labor analgesia effectively alleviates labor pain and stabilizes intrapartum blood glucose fluctuations without increasing the risk of cesarean delivery or adverse maternal-neonatal outcomes. However, it may prolong labor duration, elevate intrapartum temperature, and increase oxytocin use, as well as the rates of episiotomy and soft birth canal lacerations. For GDM parturients receiving labor analgesia, close monitoring and management of blood glucose, uterine contractions, and labor progression are essential to minimize potential risks associated with vaginal delivery.

Statins are first-line therapy for atherosclerotic cardiovascular disease (ASCVD), but their differential effects on glucose metabolism, particularly in the elderly, remain a clinical concern. This study aimed to compare the effects of pitavastatin versus atorvastatin on glucose metabolism in elderly patients with ASCVD.

In this retrospective cohort study conducted at Public Health Clinical Center Affiliated to Shandong University between January 2022 and December 2023, 126 elderly ASCVD patients aged ≥60 years were included and allocated to either the pitavastatin group (4 mg/day, n = 58) or the atorvastatin group (20 mg/day, n = 68). Fasting blood samples were collected at baseline and after 12 months of treatment to measure lipid profiles, glucose metabolism parameters, liver function, and renal function.

After treatment, the pitavastatin group demonstrated significantly higher levels of high-density lipoprotein cholesterol (HDL-C) (1.41 ± 0.30 mmol/L vs. 1.26 ± 0.28 mmol/L, p = 0.005). Regarding glucose metabolism, the pitavastatin group showed lower fasting plasma glucose (5.85 ± 0.70 mmol/L vs. 6.19 ± 0.85 mmol/L, p = 0.018) and glycated hemoglobin (6.10 ± 0.42% vs. 6.33 ± 0.51%, p = 0.009). No cases of new-onset diabetes were detected in the pitavastatin group, as compared to the 10.29% rate observed in the atorvastatin group. Multivariate logistic regression analysis confirmed pitavastatin as a protective factor against new-onset diabetes (odds ratio = 0.212, p = 0.018).

Compared with atorvastatin, pitavastatin may be associated with better glycemic outcomes and a lower risk of new-onset diabetes in elderly ASCVD patients, supporting its consideration in clinical practice where glycemic control is a concern.

Diabetic atrial cardiomyopathy, a component of diabetic cardiomyopathy, is increasingly recognized. However, atrial-focused mechanistic and clinical frameworks remain less developed than ventricular paradigms.

This review synthesizes the pathogenesis of diabetic atrial cardiomyopathy from conventional, multiomics, and translational perspectives. We highlight how diabetes-related metabolic stress, inflammation, gut microbiota dysregulation, electrophysiological remodeling, genetic susceptibility, and epigenetic regulation converge on atrial fibrosis, conduction heterogeneity, contractile dysfunction, and thrombogenicity. These processes increase susceptibility to atrial fibrillation, heart failure, and embolic events. We integrate diagnostic strategies, including electrocardiographic indices, biomarkers, and multimodality imaging, with emphasis on left atrial size, strain, and fibrosis assessment. We also appraise emerging artificial intelligence approaches using electrocardiograms, imaging, and wearable signals while emphasizing that most models are not yet validated in DAtCM-specific cohorts. Finally, we outline an integrated management framework that combines cardiometabolic optimization, lifestyle and rehabilitation strategies, guideline-directed anticoagulation when indicated, and cautious development of upstream disease-modifying interventions.

Integrating mechanistic, multiomics, and artificial intelligence-enabled approaches may improve early identification and risk stratification of diabetic atrial cardiomyopathy. Dedicated atrial phenotyping cohorts and prospective trials are needed before these concepts can be translated into routine care.

The Dawn Phenomenon (DP) denotes the occurrence of spontaneous early-morning hyperglycemia in the absence of overnight hypoglycemia, or that necessitating an elevation in insulin to sustain normal morning blood glucose levels. Studies exhibit considerable variability, with some indicating that DP is a spontaneous occurrence reported in a substantial percentage of individuals. Patients with DP demonstrate increased average blood glucose variability over a 24-h period compared to those without DP, presenting considerable problems for clinical diabetes pharmacotherapy and nutritional regulation. Moreover, given the ambiguity surrounding the precise pathophysiology and targeted therapies for DP, therapeutic care predominantly emphasizes symptom alleviation. Conventional perspectives ascribe DP to physiological surges in the secretion of counterregulatory hormones, including cortisol, catecholamines, and growth hormone, in the early morning hours. These hormones enhance hepatic glucose production while concurrently diminishing peripheral tissue sensitivity to insulin. This article examines the contemporary pathophysiological underpinnings of DP to offer insights for clinical diagnosis and treatment in diabetes. This article focuses mainly on the dawn phenomenon in type 2 diabetes (T2DM), while evidence related to type 1 diabetes (T1DM) is addressed independently.

Women with a history of gestational diabetes (GDM) have an increased risk of developing type 2 diabetes later in life. We evaluated the long-term feasibility and effectiveness of a regionally implemented GDM recall register to stimulate postpartum screening and assess (pre)diabetes prevalence up to 10 years postpartum.

We evaluated the "Sweet Pregnancy" GDM recall register, implemented in the northern part of Belgium, from 2009 to 2025. Women with a history of GDM received annual reminders for screening with a fasting plasma glucose in primary care. Response rates, self-reported screening uptake, and cumulative incidence of (pre)diabetes were analyzed.

27,173 women were registered with a mean follow-up of 4.4 years. The yearly response rates (among both responders and non-responders combined) varied from 48.4% (11,048) after the first year to 34.3% (4,116) after the fifth year, and 27.6% (1,190) after 10 years. Among responders, during the follow-up period of 3 and 5 years, 80.4% and 81.9% received at least one screening test, respectively. Non-responders were more often under 30 years of age (45.4% vs. 42.0%, p < 0.001) and obese (32.6% vs. 24.8%, p < 0.001) compared to responders. After 10 years, the cumulative incidence of diabetes was 11.0% and of impaired fasting glucose 34.7%.

This large-scale register implemented in normal routine, up to 10 years of follow-up, indicates a feasible and effective reminder system to stimulate postpartum diabetes screening in women with prior GDM. The high cumulative incidence of (pre)diabetes underscores the importance of long-term follow-up and targeted interventions to prevent progression to type 2 diabetes in this high-risk population.

To evaluate inter-eye asymmetry in macular microvascular parameters across different stages of diabetic retinopathy (DR) using OCT angiography, and to explore the associations with clinical factors.

This cross sectional study included 442 eyes of 221 patients with diabetes mellitus type 2. Central subfield thickness (CST), area and perimeter of foveal avascular zone (FAZA and FAZP), perfusion density (PD), vessel density (VD), fractal dimension (FD) in superficial and deep capillary plexuses (SCP and DCP) were evaluated. Asymmetry indexes (AI) of these parameters were calculated and compared among DR severity groups.

Mean age was 69.09 ± 12.33 years, with 124 males (56.1%). Across DR stages (No DR, n = 168; mild NPDR, n = 46; moderate NPDR, n = 172; severe NPDR, n = 22; PDR, n = 34), interocular comparisons showed that the mean PD, VD and FD were similar between right and left eyes within each stage (all p > 0.05). In eyes with PDR, FAZA and FAZP in SCP and FAZA in DCP were significantly larger in left eyes compared to right eyes, (p < 0.001, p = 0.011, p = 0.002). In multivariate analysis, increased severity of DR was associated with higher FAZA AI in both SCP and DCP (p < 0.05); male sex (p = 0.008) and presence of DME (p = 0.006) were associated with higher FAZA AI in the SCP.

Inter-eye asymmetry in retinal microvascular parameters was associated with male sex, increasing severity of DR and presence of DME.