To evaluate the feasibility of a 12-week, randomized, double-blind, placebo-controlled intervention with capsules containing green coffee extract enriched with magnesium di-malate in women with type 2 diabetes mellitus, including overall adherence to capsule use and tolerability, as well as to explore preliminary between-group differences in glycemic and cardiovascular biomarkers.

This randomized, double-blind, placebo-controlled pilot trial included 48 eligible women with type 2 diabetes mellitus, equally assigned to the placebo group (n=24) or the experimental group (n=24). Participants received capsules daily for 12 weeks and were followed up through nursing consultations. Overall retention was 83.3% (40/48), and overall adherence to capsule use was estimated at over 82%. Glycemic biomarkers included fasting glucose, estimated mean glucose, HbA1c, insulin, HOMA-IR, and HOMA-β. Cardiovascular biomarkers included urea, creatinine, uric acid, apolipoprotein B, triglycerides, and the triglycerides-glucose index. Data were analyzed based on avail-able data from participants who completed follow-up and the final evaluation.

The protocol was feasible under the study conditions, although retention differed between groups. Glycemic biomarkers varied during follow-up in both groups, without conclusive evidence of a consistent between-group effect. In the experimental group, triglycerides and the triglycerides-glucose index showed numerical reductions, while uric acid fluctuated in both groups. These findings should be interpreted as exploratory.

This pilot trial provided preliminary information on the feasibility of implementing this intervention in women with type 2 diabetes mellitus. The biomarker findings were exploratory and imprecise and do not allow for definitive conclusions on efficacy.

IntroductionABO groups impact macroangiopathy risk in T2D. It is unknown whether such modulation extends to microvascular complications.MethodSingle-centre cross-sectional study including 1,006 T2D patients.ResultsPrevalence of overall microangiopathy was 51%. No significant differences (ANOVA) were observed between ABO groups in terms of age, sex, diabetes duration, BMI, hypertension, chronic kidney disease or diabetic foot. Insulin sensitivity and the hyperbolic HOMA product [BxS] were lower among non-O groups (-20% and -14%, respectively; p 0.001 and 0.013), while HbA1c and lifetime hyperglycaemia exposure were higher (+5% and +25%, respectively; p 0.006 and 0.002). Overall microangiopathy was more prevalent among non-O patients (+23%; p 0.001), as was neuropathy (+44%; p 0.005). Differences across ABO groups were significant for overall microangiopathy (p 0.009) and neuropathy (p 0.027) (ANOVA). In multivariate analysis, group A (vs O) was associated with overall microangiopathy (OR=1.62; 95%CI: 1.18-2.22; p 0.003) after adjustment for diabetes duration, HbA1c, smoking, remnant-C and hypertension.ConclusionT2D patients of blood group A have increased frequency of overall microangiopathy, regardless of other risk factors. Group O subjects exhibit better glucose homeostasis, with better insulin sensitivity and β-cell function. The ABO system therefore impacts both glucose homeostasis and microvascular susceptibility in T2D.

PurposeTo investigate the longitudinal association between domestic water hardness and incident diabetic retinopathy (DR) in individuals with type 2 diabetes (T2D) and identify circulating proteomic mediators.MethodsThis study analysed data from 13,194 participants with prevalent T2D. Domestic water hardness was determined according to residential postcodes. Weighted Cox proportional hazards models and mediation analyses were employed to evaluate associations between water hardness, proteins, and DR risk.ResultsDuring a median follow-up of 13.28 years, 1,505 cases of incident DR were documented. Compared with soft water (<60 mg/L), very hard water (>180 mg/L) was associated with a 49% higher risk of DR (HR, 1.49; 95% CI, 1.12-2.00). The plasma protein GID8 (Glucose-induced degradation protein 8) was identified as a mediator, explaining 6.2% (95% CI, 1.2%-25.5%) of the association.ConclusionThese findings provide some preliminary proteomic insights that domestic hard water may be a novel, modifiable environmental risk factor for DR, potentially mediated through GID8-related pathways. Future research should include mechanistic studies to confirm the biological pathways linking domestic water hardness to diabetic retinopathy.

Medication non-adherence among chronic disease patients remains a major contributor to poor health outcomes and medication wastage, particularly in multi-ethnic populations such as Malaysia where cultural and religious beliefs strongly influence health behaviours. This study aimed to develop and evaluate machine learning models that integrate demographic, clinical, and complementary and alternative medicine (CAM) belief factors to predict medication non-adherence among patients with type 2 diabetes mellitus, hypertension, and dyslipidaemia. A cross-sectional survey was conducted using a structured questionnaire comprising demographic and clinical data, history of CAM use, the 17-item Complementary and Alternative Medicine Beliefs Inventory (CAMBI), and the Malaysian Medication Adherence Scale (MALMAS). Twelve conventional machine learning algorithms and three stacked ensemble models were utilised using both balanced and unbalanced datasets with all variables as well as feature-selected variables. The best-performing model was a stacked ensemble using logistic regression-selected variables with the unbalanced dataset, achieving the highest AUC of 0.816. Feature selection identified significant variables including CAM beliefs (natural and holistic), race, number of daily doses, number of medications prescribed, religion, educational level, treatment duration, and hypertension status which were later interpreted using SHapley Additive exPlanations (SHAP) analysis. Model performance was further evaluated using the Youden Index and Decision Curve Analysis (DCA) to stratify patients into lower- and higher-risk groups, with a suitable cutoff identified at 0.4. These findings show that incorporating cultural and belief-related factors into machine learning models provides a novel, population-specific approach to predict better non-adherence and guide targeted interventions to reduce medication wastage in chronic disease management.

Patients with diabetes mellitus undergoing coronary artery bypass grafting (CABG) with saphenous vein harvesting are at increased risk of impaired lower extremity perfusion and wound-related complications. Buerger-Allen exercises have been proposed to improve peripheral circulation; however, evidence supporting their effectiveness following CABG remains limited. This study evaluated the effect of Buerger-Allen exercises as an adjunct to phase I cardiac rehabilitation on lower extremity perfusion and wound healing in diabetic patients undergoing CABG.

A randomized controlled trial was conducted involving 60 diabetic patients undergoing CABG with saphenous vein harvesting. Participants were randomly allocated to an intervention group receiving standard phase I cardiac rehabilitation plus Buerger-Allen exercises (n = 30) or a control group receiving standard rehabilitation alone (n = 30). The primary outcome was ankle-brachial index (ABI). Secondary outcomes included wound healing disturbances and peripheral ankle swelling. Postoperative ABI was analyzed using two-way repeated-measures ANOVA, whereas categorical outcomes were analyzed using Fisher's exact test or the Chi-squared test.

A significant effect of time on ABI was observed (p = 0.004), whereas neither the group effect (p = 0.754) nor the group × time interaction (p = 0.711) was statistically significant. An earlier resolution of mild wound-related pain was observed on postoperative day 3 in the intervention group (p = 0.038); however, no between-group differences were present on postoperative day 5. No intervention-related adverse events were reported.

Buerger-Allen exercises were safe and feasible during early postoperative rehabilitation but did not provide additional improvement in lower extremity perfusion beyond standard rehabilitation during the 5-day postoperative period. The isolated improvement in wound-related pain should be interpreted cautiously.

Buerger-Allen exercises did not significantly improve the primary outcome of lower extremity perfusion following CABG. Although they appeared safe and were associated with transient improvement in wound-related pain, further adequately powered studies with longer follow-up are required to determine whether clinically meaningful benefits exist.

This study was prospectively registered in the Clinical Trial Registry India (CTRI/2023/10/058535).

Thirst and xerostomia are common symptoms in patients with chronic heart failure (CHF) and can be very distressing. Studies on the prevalence and associating factors of these symptoms are lacking in patients with CHF in Germany. The aim of the study was to assess the prevalence of thirst and xerostomia, to determine factors associated with thirst and xerostomia intensity, and to identify interventions that patients use to reduce these symptoms.

A cross-sectional study was conducted in seven hospitals. Participants completed a questionnaire on thirst and xerostomia and on interventions they performed themselves. Additionally, they were asked about possible associated factors (e.g., fluid restriction, other symptoms, alcohol intake). Prevalence of thirst and xerostomia was estimated with percentages and a 95% confidence interval. A multiple linear regression analysis was conducted to assess factors associated with the intensity of thirst and xerostomia. Interventions used by patients to alleviate thirst or xerostomia were content-analyzed.

Of 371 patients with CHF (71.7% male, mean age 62.4 ± 14.9 years), 78.7% reported thirst and 64.8% xerostomia in the last three days. Statistically significant factors associated with thirst intensity were thirst distress and body height. Fluid restriction, thirst in the last three days, leg oedema, and drug-treated diabetes mellitus were associated with xerostomia intensity. The most frequently reported intervention to reduce thirst or xerostomia was fluid intake (thirst: 95.1%; xerostomia: 86.2%).

A high proportion of patients with CHF reported thirst and/or xerostomia. Factors were identified that could have an influence on the occurrence of these symptoms.

Sex differences in the outcomes of bifurcation percutaneous coronary intervention (PCI) have received limited study. We compared procedural characteristics and outcomes between women and men in bifurcation PCI. 2,431 patients who underwent bifurcation PCI at 7 centers between 2013 and 2025 from the Prospective Global Registry for the Study of Bifurcation Lesion Interventions (PROGRESS-BIFURCATION) were studied. Of the study population, 25.3% (n=615) were women. Women were older (68.2 ± 11.9 vs 65.6 ± 16.3 years; p<0.001), had higher prevalence of diabetes mellitus (48.8% vs 33.5%; p<0.001), hypertension (84.2% vs 76.9%; p<0.001), and higher rates of moderate or severe proximal main vessel calcification (40.2% vs 32.4%; p<0.001) compared with men. Use of provisional stenting (63.2% vs 64.0%, p=0.694) and two-stent techniques (31.3% vs 30.3%, p=0.653) was similar between groups. Technical success was comparable (93.7% vs 95.4%; p=0.075), but women had lower procedural success (88.5% vs 93.2%; p<0.001) due to higher in-hospital major adverse cardiovascular events (MACE) (6.0% vs 2.7%; p<0.001), including in-hospital mortality (2.8% vs 1.0%; p=0.001), stroke (1.3% vs 0.2%; p=0.003), and procedural bleeding (1.0% vs 0.2%; p=0.010). On multivariable analysis, female sex was independently associated with higher in-hospital MACE (odds ratio 2.99; 95% confidence intervals [CI] 1.69-5.29; p<0.001). During a median follow-up of 2.6 years, female sex was independently associated with long-term MACE (adjusted hazard ratio 1.32; 95% CI 1.04-1.67; p=0.011). In conclusion, compared with men, bifurcation PCI in women is associated with similar technical success but higher in-hospital and follow-up MACE.

Transient ischemic attack (TIA) often precedes ischemic stroke, and the risk of recurrence is highest in the first days to weeks after the initial TIA. Although sociodemographic and socioeconomic factors are associated with stroke incidence, care, and long term outcomes, their relationship to very early progression from TIA to ischemic stroke remains less well defined.

We performed a retrospective cohort study using the National Institutes of Health All of Us Research Program. Adults with TIA were identified using predefined SNOMED, ICD-9-CM, and ICD-10-CM concept codes and were followed for 30 days for subsequent ischemic stroke. Covariates included race, sex at birth, age, income, insurance status, smoking status, hypertension, diabetes mellitus, atrial fibrillation, and carotid stenosis. Multivariable logistic regression was used to evaluate adjusted associations with 30 day ischemic stroke. Model discrimination was assessed using the C-statistic, and calibration was assessed using the Hosmer-Lemeshow goodness of fit test. Interaction terms between race and sex, income, and insurance status were evaluated using likelihood ratio testing.

Among 19,241 participants with TIA, 3,900 (20.3%) experienced ischemic stroke within 30 days. African American race was associated with higher odds of 30 day stroke compared with White race (adjusted odds ratio [aOR] 1.281, 95% confidence interval [CI] 1.157 to 1.419; p < 0.001). Female sex showed a trend toward lower odds that did not reach conventional significance (aOR 0.933, 95% CI 0.863 to 1.010; p = 0.086). Hypertension, diabetes mellitus, atrial fibrillation, and carotid stenosis were independently associated with increased 30 day stroke risk. Income categories showed inconsistent associations without a consistent directional trend, and insurance status was not independently associated with stroke after adjustment. Interaction terms between race and sex, income, and insurance did not significantly improve model fit (likelihood ratio test p = 0.690).

In this national cohort, early ischemic stroke after TIA remained associated with both established vascular risk factors and African American race after adjustment for income, insurance status, and major clinical covariates. These findings suggest that short term post TIA stroke risk may reflect both clinical risk burden and additional patient level or care process factors not captured by routine socioeconomic measures.

Type 2 diabetes mellitus is characterized by insulin resistance, impaired β-cell function, and persistent hyperglycemia. Light exposure may further influence glucose metabolism by modulating vitamin D synthesis, circadian rhythms, melatonin secretion, and sleep-related behaviors.

Relevant publications indexed in the Web of Science Core Collection from 2001 to 2025 were retrieved. A total of 2,491 studies were finally included, and bibliometric and visualization analyses were performed using Bibliometrix, VOSviewer, and CiteSpace.

The number of publications in this field showed a sustained increase, with a marked acceleration after 2019 and a peak in 2024. The United States and China were the main contributing countries. High-frequency keywords included type 2 diabetes, insulin resistance, obesity, inflammation, glycemic control, circadian rhythm, sleep, and gut microbiota. Research hotspots have shifted from early topics related to vitamin D, obesity, and glucose metabolism toward light exposure, circadian rhythm disruption, sleep behavior, and environmental chronomedicine.

Research on light exposure and type 2 diabetes has expanded from the "sunlight-vitamin D-glucose metabolism" framework to circadian and behavioral medicine. Future studies should integrate objective light exposure assessment, sleep/activity monitoring, and continuous glucose monitoring data to further verify the underlying mechanisms.

Type 5 Diabetes Mellitus (T5DM) is an emerging diabetes phenotype linked to chronic undernutrition. It predominantly affects young, lean individuals in low- and middle-income countries. After its formal recognition by the International Diabetes Federation in 2025, T5DM resurfaced as a clinically relevant insulin-deficient phenotype. It is now viewed as distinct from classical autoimmune and insulin-resistant forms of diabetes. This review synthesises recent evidence on the epidemiology, pathophysiology, clinical characteristics, and management of T5DM. Recent studies show that T5DM is influenced by early-life nutritional deprivation. This fits within the Developmental Origins of Health and Disease (DOHaD) framework. Undernutrition during key developmental periods harms pancreatic morphogenesis. It creates a permanent reduction of functional beta-cell mass through epigenetic programming. Clinically, T5DM often appears before age 30. Patients have low body mass index, sarcopenia, marked insulinopenia, absence of diabetes-associated autoantibodies, and resistance to ketosis, despite significant hyperglycemia. Diagnostic challenges remain, as patients are frequently misclassified as type 1 or type 2 diabetes. Relying only on body mass index is insufficient. Accurate diagnosis requires a multidimensional assessment including nutritional history, metabolic features, and exclusion of monogenic diabetes. T5DM is a distinct insulin-deficient phenotype caused by chronic undernutrition. Effective management requires more than glycaemic control. Nutritional rehabilitation is key, with a focus on adequate energy intake, high-biological-value protein supplementation, and correction of key micronutrient deficiencies. Given preserved insulin sensitivity, low-dose insulin should be used cautiously to avoid iatrogenic hypoglycemia. Better recognition and tailored management strategies are needed for optimal clinical outcomes.