Diabetic kidney disease (DKD), a chronic microvascular complication is leading cause of End Stage Kidney disease (ESKD). Reduction of ≥30% urinary albumin is recommended to slow ESKD progression. Remote Ischemic conditioning (RIC) induces brief episodes of ischemia and reperfusion and has protective effect on various organs. The current study aims to explore the effects of RIC on albuminuria reduction in adults with type-2 Diabetes Mellitus.

In this double blind, sham controlled, Randomized Clinical Trial, we assigned 40 normotensive Diabetic adults with moderate and severely increased albuminuria to RIC group (n = 20) or Sham group (n = 20) weekly for 8 weeks. Primary outcome was reduction in albuminuria at the end of 8 weeks. Secondary outcomes were changes in serum creatinine, e-Glomerular Filtration Rate (eGFR), and HbA1c levels.

The reduction in albuminuria at the end of 8 weeks was 37.9% [Median (IQR): -7.5, 43.9] in the RIC group while it increased by 1.10% (-5.6, 15.2) in the Sham group (P = 0.015). Significant reduction was noted in serum creatinine in RIC group from 1 to 0.83 mg/dl as compared to increase in Sham group from 0.97 to 1.1 mg/dl (P = 0.0004). The mean eGFR in the RIC group improved from 85 to 99 (ml/min/1.73m2) P = 0.0001). No significant change was detected in HbA1C levels. Mild pain was the only adverse effect noted in 10% in the RIC group and none in the Sham group.

Among adults with DKD, treatment with RIC significantly reduced albuminuria and serum creatinine while improving the eGFR (CTRI/2024/09/074453).

Complex survey designs are widely used in medical cohort studies. Developing risk score models that adequately account for the sampling design is essential to minimize selection bias and obtain representative population estimates. This work addresses three complementary objectives. First, we propose a general predictive framework for regression and classification tasks that utilizes neural networks to incorporate survey weights into the model estimation process. Second, we introduce a procedure for quantifying prediction uncertainty based on conformal inference, adapted to the characteristics of complex survey data. Third, we demonstrate the application of the proposed methodology in a case study assessing the risk of diabetes mellitus in the US population, using the NHANES 2011-2014 cohort. The empirical results show that models of varying complexity, each using different sets of predictors, achieve different trade-offs between predictive performance and economic cost while maintaining generalizability at the population level. Although the case study focuses on diabetes, the proposed framework is directly applicable to the development of clinical prediction models for other diseases and complex survey datasets. All software and data used in this study are publicly available on GitHub.

Obesity-related metabolic diseases are characterized by profound disturbances in glucose and lipid metabolism across multiple organs, yet the mediators that coordinate these tissue-specific alterations remain incompletely understood. Insulin-like growth factor-binding protein 2 (IGFBP2), a circulating and locally expressed regulatory protein, has emerged as a context-dependent modulator of metabolic homeostasis with potential relevance to obesity, insulin resistance, type 2 diabetes mellitus (T2DM), and metabolic dysfunction-associated steatotic liver disease (MASLD). In this review, we integrate evidence from in vitro studies, animal models, and human investigations to examine the tissue-specific roles of IGFBP2 in the liver, adipose tissue, pancreas, skeletal muscle, and cardiovascular system. We further discuss IGFBP2 within an autocrine, paracrine, and endocrine framework, with emphasis on its effects on glucose handling, lipid metabolism, insulin sensitivity, and metabolic adaptation in obesity-related disease states. In addition, we summarize current clinical evidence supporting circulating IGFBP2 as a candidate biomarker of metabolic dysfunction and discuss how nutritional factors and metabolic interventions may influence its expression and circulating levels. Collectively, available evidence suggests that IGFBP2 is a context-dependent regulator and potential translational indicator of metabolic dysregulation; however, important gaps remain regarding its tissue-specific sources and modes of action, receptor interactions, context-specific signaling mechanisms, and the strength of prospective human evidence.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to improve clinical outcomes in patients with heart failure; however, their efficacy and safety in patients with myocardial infarction, particularly when used in addition to conventional therapy, remain controversial. Therefore, this study aims to evaluate the effects of adding SGLT2i to conventional therapy on clinical outcomes in patients with myocardial infarction through a systematic review and meta-analysis.

We conducted a systematic review and meta-analysis to compare the effects of conventional therapy with or without SGLT2i on clinical outcomes in patients with myocardial infarction. PubMed, Web of Science, the Cochrane Library, and Embase were systematically searched.The primary outcome was the incidence of hospitalization for heart failure. Secondary outcomes included all-cause mortality, major adverse cardiovascular events (MACE), left ventricular ejection fraction (LVEF), N-terminal pro-B type natriuretic peptide (NT-proBNP), and low-density lipoprotein cholesterol (LDL-C). Safety outcomes comprised renal dysfunction, hepatic dysfunction, urinary tract infection, and glycemia-related adverse events. All analyses were conducted using a random-effects model. Prespecified subgroup analyses for the primary outcome were performed according to the presence or absence of type 2 diabetes mellitus, timing of SGLT2i initiation, and specific SGLT2i agent.

This meta-analysis included 13 randomized controlled trials involving 22,238 patients with myocardial infarction. Compared with conventional therapy alone, treatment with SGLT-2i significantly reduced the incidence of hospitalization for heart failure (RR = 0.76, 95% CI 0.68-0.84, p < 0.00001). For key secondary outcomes, the use of SGLT2i was not associated with all-cause mortality (RR = 0.87, 95% CI 0.75-1.01, p = 0.06), but was associated with a significant reduction in the risk of major adverse cardiovascular events (MACE) (RR = 0.84, 95% CI 0.73-0.98, p = 0.03). However, no significant difference was observed between the two groups in cardiovascular mortality (RR = 0.87, 95% CI 0.61-1.24, p = 0.44). In addition, SGLT2i combined with conventional therapy significantly improved left ventricular ejection fraction (MD = 3.45, 95% CI 0.67-6.24, p = 0.02) and significantly reduced NT-proBNP levels (MD = -311.99, 95% CI -666.00-15.23, p = 0.04). In terms of safety outcomes, the use of SGLT2i was associated with a reduced risk of renal dysfunction (RR = 0.77, 95% CI 0.66-0.89, p = 0.0006) and glycemia-related adverse events (RR = 0.56, 95% CI 0.40-0.80, p = 0. 001). No significant increase was observed in the risk of urinary tract infection (RR = 1.73, 95% CI 0.76-3.97, p = 0.12; P = 0.19) or hepatic dysfunction (RR = 2.46, 95% CI 0.86-6.98, p = 0.09; P = 0.49). Prespecified subgroup analyses showed that the treatment benefit for the primary outcome was generally consistent irrespective of the presence or absence of type 2 diabetes mellitus or the specific SGLT2i agent used.

In this meta-analysis, the addition of SGLT2i to standard therapy following myocardial infarction was associated with a reduction in hospitalization for heart failure, as well as a lower incidence of renal dysfunction and glycemia-related adverse events. Furthermore, favorable effects of SGLT2i were observed in patients with MI irrespective of the presence or absence of type 2 diabetes mellitus or the specific SGLT2i agent used.

PROSPERO CRD420251129087.

This study aimed to systematically compare differences in body composition between adult patients with type 1 diabetes mellitus (T1DM) and healthy controls using the bioelectrical impedance analysis (BIA) method, to provide an objective basis for clinical nutritional assessment and intervention in T1DM patients.

A total of 57 T1DM patients hospitalized at the First People's Hospital of Yunnan Province between December 2023 and April 2024 were selected as the study group, and 55 healthy adults matched for age, sex, and BMI were recruited as the control group. Body composition indicators, including body fat, fat-free mass, skeletal muscle, visceral fat area, and phase angle (PA), were measured for all subjects using a body composition analyzer, and the skeletal muscle mass index (SMI) was calculated. BIA was used to determine body composition parameters, and statistical analyses were conducted to compare the differences between the two groups.

In males, the T1DM group exhibited significantly lower body fat, body fat percentage, bone mineral content, visceral fat area, and SMI compared to the healthy control group (all p < 0.05). In females, the T1DM group showed significantly higher levels of intracellular water, protein, minerals, skeletal muscle, fat-free mass, right leg lean mass, basal metabolic rate, and SMI, while demonstrating significantly lower body fat, body fat percentage, visceral fat area, and waist-to-hip ratio compared to the control group (all p < 0.05).

Despite having normal or even low BMI, T1DM patients present a unique body composition profile characterized by "low fat mass, low visceral fat, but relatively high skeletal muscle mass." This suggests that the disease state may influence energy metabolism and body composition.

Pathologic similarities between retinopathy of prematurity (ROP) and diabetic retinopathy, leading causes of blindness, suggest that in utero exposure to maternal hyperglycemia may influence an infant's risk of ROP progression to vision-threatening stages. Prior studies exploring this association yielded conflicting results and did not explore maternal diabetes mellitus (DM) subtypes. We aim to clarify these associations while adjusting for significant comorbidities.

Retrospective cohort study.

Preterm infants born at <31 weeks gestational age (GA) or <1500 g birth weight (BW) receiving care at Vanderbilt University Medical Center's Neonatal Intensive Care Unit between 2004 and 2021 with documented ROP staging and maternal diabetes status.

Review of data from the Vanderbilt Neonatal Clinical Repository supplemented by chart review. Data analyzed by descriptive statistics of prevalence, BW, and GA for the cohorts as well as through multivariate logistic regression analyses with ROP stage and maternal diabetes as dependent and independent variables while adjusting for GA, BW, sex, race, year of birth, birth center location, necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia. Infants with ROP stage 3-5 were considered cases, and those with ROP stage 0 were used as controls.

The association between exposure to maternal diabetes and the presence of stage 3-5 versus stage 0 ROP.

Two thousand one hundred twenty-one (68%) infants had stage 0 ROP, and 311 (10%) had stage 3-5 ROP. Maternal DM prevalence was 9% and resulted in higher BW and GA in premature infants. Lower BW and GA were associated with more severe ROP. Stage 3-5 ROP was significantly associated with maternal DM (odds ratio [OR] 3.04, 95% confidence interval [CI]: 1.67-5.45, P = 0.000218), including type 1 DM (T1DM) (OR 6.36, 95% CI 1.29-28.29, P = 0.0174) and type 2 DM (T2DM) (OR 5.82, 95% CI 2.06-15.71, P = 0.00066).

Our results suggest that maternal diabetes, including T1DM and T2DM, increase an infant's risk of developing vision-threatening ROP. The BW and GA profiles of infants with maternal diabetes may provide false reassurance regarding their risk of progression. Considering maternal DM exposure in screening decisions (inclusion and intervals) may help to preserve vision in at-risk infants.

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Older patients with type 2 diabetes mellitus (T2DM) frequently encounter challenges, including a diminished capacity for self-management, a high prevalence of negative emotions, and cognitive decline and physiological changes attributable to long-term disease burden, leading to compromised glycemic control and impaired quality of life. Traditional diabetes nursing interventions often lack systematic strategies to address the psychological and cognitive needs specific to this patient population. The Information-Motivation-Behavioral Skills (IMB) model is a theoretical framework designed to promote health behavioral changes; however, research investigating its specific application in regulating psychological state and managing cognitive function in older patients with T2DM remains limited.

To investigate the effectiveness of a nursing intervention based on the IMB model in older patients with T2DM.

Data from 86 older patients with T2DM were divided into 2 groups: intervention (structured IMB model-based nursing + routine care [n = 43]); and control (conventional T2DM care [n = 43]). Psychological state (Self-Rating Anxiety and Depression Scales [SAS, SDS]), cognitive function (Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA]), glycemic control (fasting blood glucose [FBG], 2 h postprandial blood glucose [2hPBG], and glycated hemoglobin A1c [HbA1c]), and satisfaction with nursing were compared between the 2 groups before and after a three-month intervention.

SAS and SDS scores significantly decreased in both groups after intervention, with a more pronounced reduction in the intervention group (P < 0.05). MMSE and MoCA scores improved in both groups, with significantly higher scores in the intervention group (P < 0.05). Glycemic control (FBG, 2hPBG, and HbA1c) improved substantially in the intervention group (P < 0.05). Satisfaction with nursing among the intervention group (95.35%) was significantly greater than that in the control group (79.07%) (P < 0.05).

The IMB model-based nursing intervention alleviates anxiety and depression, improves cognitive function, enhances glycemic control, and increases satisfaction with nursing in older patients with T2DM, thus meriting broader clinical implementation.

Mucormycosis is an opportunistic infection caused by fungi of the order Mucorales, primarily affecting immunocompromised individuals or those with disruption of skin or mucosal integrity. The most common clinical forms include pulmonary, rhino-orbito-cerebral, and cutaneous presentations. We report the case of a patient in his seventh decade of life with a history of diabetes mellitus who presented with a two-month history of paroxysmal cough with mucopurulent sputum, fever, and weight loss. Bronchoscopy and biopsy confirmed the diagnosis of endobronchial mucormycosis, an uncommon clinical presentation, with histopathological findings of sparsely septate, hyaline hyphae. The patient was started on amphotericin B therapy; however, his clinical course was unfavorable, developing multiorgan failure that led to death within 72 hours. Molecular sequencing of the specimen identified Rhizopus homothallicus as the causative agent.

The prevalence of young and middle-aged patients with Type 2 diabetes mellitus (T2DM) and overweight/obesity is increasing in China, yet determinants of weight loss success in this population remain unclear.

To evaluate weight loss outcomes and identify factors associated with weight loss among young and middle-aged patients with T2DM and overweight/obesity.

In this prospective cohort study, 282 patients with T2DM and overweight/obesity were recruited between March and September 2024. Baseline demographic, anthropometric, and psychosocial data were collected before discharge. Body weight was reassessed 3 months after discharge, and percentage weight loss was calculated. Participants were categorized into success (≥ 5% weight loss) and failure (< 5% weight loss) groups. Factors associated with weight loss were identified using univariate analysis, random forest importance ranking, LASSO regression, and multivariable logistic regression.

Using ≥ 5% weight loss as the clinical target, the overall success rate was 43.7%, with gender-specific rates of 39.5% in males and 58.0% in females. Random forest and LASSO analyses identified six key predictors: diabetes duration, extraversion, agreeableness, conscientiousness, diabetes self-efficacy, and social support. Multivariable logistic regression showed that diabetes duration (OR = 6.511, 95% CI: 1.92-22.05), extraversion (OR = 0.847, 95% CI: 0.73-0.98), agreeableness (OR = 1.228, 95% CI: 1.05-1.43), conscientiousness (OR = 1.254, 95% CI: 1.09-1.44), and diabetes self-efficacy (OR = 1.062, 95% CI: 0.993-1.14) were significant predictors of weight loss success.

Weight loss outcomes among young and middle-aged patients with T2DM and overweight/obesity were suboptimal and differed by gender. Diabetes duration, personality traits, and diabetes self-efficacy were independent predictors of weight loss success.

Diabetic peripheral neuropathy (DPN) is a common, underdiagnosed and irreversible complication of diabetes mellitus. However, limited evidence exists on the drivers of DPN in Asian populations, particularly the role of social and lifestyle factors. This study aimed to identify sociodemographic, lifestyle and clinical predictors of incident DPN in a multiethnic Asian cohort in Singapore.

Data from two ongoing Singaporean cohorts were analysed. Participants included individuals with type 2 diabetes mellitus and no DPN at baseline. DPN was assessed at follow-up using self-report, neurothesiometer testing or monofilament scores. Bivariate and multivariate Cox regression analyses were conducted to examine the association between incident DPN and various sociodemographic, lifestyle and clinical factors.

During a median follow-up of 3.69 years, 169 out of 2110 participants developed DPN. Multivariable analysis revealed age (HR 1.06, 95% CI 1.04 to 1.08, p<0.001), sedentary time (HR 1.54, 95% CI 1.06 to 2.26, p=0.018), housing (HR 0.67 for larger flats, 95% CI 0.48 to 0.94, p=0.020), HbA1c (HR 1.23, 95% CI 1.14 to 1.32, p<0.001), diabetes duration (HR 1.03, 95% CI 1.02 to 1.05, p<0.001), body mass index (HR 1.04, 95% CI 1.01 to 1.07, p=0.010), systolic (HR 0.99, 95% CI 0.98 to 1.00, p=0.004) and diastolic blood pressure (HR 1.02, 95% CI 1.01 to 1.03, p=0.002) and cardiovascular disease (HR 2.00, 95% CI 1.37 to 2.93, p =0.009) to be independently associated with incident DPN.

This study confirms established risk factors for DPN and highlights housing type and sedentary behaviour as novel, potentially modifiable predictors. These findings underscore the importance of targeting high-risk groups and addressing modifiable risk factors to reduce the burden of DPN in Asian populations.