The C-reactive protein-albumin-lymphocyte (CALLY) index is a composite biomarker integrating inflammation, nutrition, and immune function, but its causal relationships with a broad spectrum of human diseases and potential utility for public health risk prediction remain unclear. We conducted a population-based genetic epidemiological study combining genome-wide association study (GWAS), phenome-wide association study (PheWAS), and two-sample Mendelian randomization (MR), using data from the UK Biobank (265,409 participants for GWAS; 113,747 participants for PheWAS) and FinnGen to construct genetic instruments for the CALLY index, perform PheWAS across 713 phenotypes, evaluate causal associations via two-sample MR, and conduct sensitivity analyses including linkage disequilibrium score regression and pleiotropy testing. GWAS identified 154 genomic loci significantly associated with the CALLY index; PheWAS detected 24 significant phenotype associations, with higher genetically predicted CALLY index linked to lower risks of Alzheimer's disease, Alzheimer's dementia, unspecified dementia, and lipid metabolism disorders. MR confirmed causal protective effects for these neurodegenerative outcomes while indicating a causal association with increased sleep disorder risk, and pleiotropic analyses highlighted shared biological pathways in lipid metabolism and inflammation. These findings demonstrate that the CALLY index is causally associated with neurodegenerative, metabolic, and sleep disorders, supporting its role as a promising integrated biomarker for disease risk stratification and public health applications.

Appropriate medication management can prevent adverse outcomes, yet medication nonadherence remains common, including among patients with diabetes.

To examine racial and ethnic disparities in medication adherence among Medicare Advantage (MA) enrollees with diabetes and assess factors contributing to these disparities.

Using the Medicare Master Beneficiary Summary File and MA encounter data, this cohort study included MA enrollees with Part D coverage in 2019 and a documented diabetes diagnosis from January 1, 2017, to December 31, 2018, who filled at least 1 prescription for metformin, insulin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, or a glucagon-like peptide-1 receptor agonist (GLP-1 RA) in 2019. Analysis was conducted between December 2024 and November 2025.

Unadjusted and adjusted disparities in adherence (proportion of days covered ≥80%) during 2019 were examined for insulin, metformin, and SGLT2 inhibitors and/or GLP-1 RAs, distinguishing within-plan disparities from differences between plans serving proportionately more vs fewer Black or Hispanic enrollees. Oaxaca-Blinder decomposition analysis estimated the contribution of covariates to adherence disparities.

Among 587 716 total beneficiaries (mean [SD] age, 72.11 [8.85] years), analyses of disparities between Black and White enrollees included 80 586 Black (63.3% female) and 233 505 White (50.9% male) beneficiaries; analyses of disparities between Hispanic and White enrollees included 83 116 Hispanic (53.9% female) and 190 509 White (51.1% male) beneficiaries. In unadjusted analyses, adherence was lower among Black beneficiaries than among White beneficiaries: -9.0 percentage points [pp] for SGLT2 inhibitors and/or GLP-1 RAs, -8.0 pp for insulin, and -10.5 pp for metformin (all P < .001). Adherence was also lower among Hispanic beneficiaries than among White beneficiaries: -8.1 pp for SGLT2 inhibitors and/or GLP-1 RAs, -2.8 pp for insulin, and -3.6 pp for metformin (all P < .001). By medication type, within-plan disparities accounted for 74.6% to 85.3% of adherence disparities between Black and White enrollees and 39.1% to 66.1% of disparities between Hispanic and White enrollees. Medicaid or Low-Income Subsidy enrollment was associated with reductions in disparities between Black and White enrollees (22.0% for insulin and 32.3% for SGLT2 inhibitors and/or GLP-1 RAs) and Hispanic and White enrollees (63.9% for insulin and 41.3% for SGLT2 inhibitors and/or GLP-1 RAs).

This retrospective cohort study of MA enrollees with diabetes found racial and ethnic disparities in diabetes medication adherence. Disparities in adherence to insulin or SGLT2 inhibitors and/or GLP-1 RAs were partially mitigated by Medicaid and prescription drug subsidies but less so by plan-level factors. The findings suggest that additional insurance- and community-level strategies are needed to improve medication adherence among disadvantaged patients and communities.

Kidneys from deceased donors with diabetes mellitus are refused because diabetes is considered a marker of lower organ quality. We evaluated 5-year outcomes according to donor-recipient diabetes status and, secondarily, the prognostic value of pre-implantation histopathological findings among accepted diabetic donor kidneys.

This retrospective single-center cohort study included adult recipients of deceased-donor kidney transplants performed between 2013 and 2017. Five-year kidney function and death-censored graft survival were compared according to donor diabetes status before and after 1:2 propensity score matching. A secondary exploratory analysis evaluated Banff chronicity parameters in pre-implantation pathology reports.

Among 3058 recipients, 244 received kidneys from diabetic donors. These donors were older, more frequently hypertensive, and had higher KDPI than non-diabetic donors. In unadjusted analyses, recipients of diabetic donor kidneys had lower eGFR and death-censored graft survival. After matching, eGFR from years 1 to 5, eGFR slope, and death-censored graft survival no longer differed between groups. Recipient diabetes did not significantly modify the association of donor diabetes with graft survival or longitudinal eGFR, although the D+/R+ subgroup was small (n = 39). Among 164 available pre-implantation biopsy reports, diabetes-related glomerular lesions were uncommon, chronic lesions were predominantly vascular and mild to moderate, and no Banff histological parameter independently predicted eGFR <30 mL/min/1.73 m² or death-censored graft loss at 5 years.

After balancing baseline donor and recipient characteristics, donor diabetes was not associated with significantly lower 5-year kidney function or death-censored graft survival. In the secondary clinicopathological analysis, no individual Banff chronicity parameter independently predicted 5-year outcomes.

Type 2 diabetes mellitus (T2DM) is a multifactorial metabolic disease in which inflammatory mechanisms are involved in disease development and progression. Polymorphisms in cytokine-related genes may influence susceptibility to T2DM, yet evidence in Vietnamese individuals remains scarce. This study was designed to investigate whether IL16 rs11556218 and IL1B rs16944 are associated with T2DM in Kinh Vietnamese adults.

An analytical cross-sectional unmatched case-control study was conducted in 392 unrelated Kinh Vietnamese individuals, including 196 patients with T2DM and 196 non-diabetic controls, recruited at Cho Ray Hospital, Ho Chi Minh City, between February and August 2025. Peripheral blood samples were collected for genomic DNA extraction. Genotyping of IL16 rs11556218 and IL1B rs16944 was performed using TaqMan SNP Genotyping Assays. Hardy-Weinberg equilibrium was assessed in the control group. Associations between the investigated polymorphisms and T2DM were analyzed under codominant, dominant, recessive, and log-additive models, with adjustment for body mass index (BMI), waist-to-hip ratio (WHR), and family history of diabetes.

Both polymorphisms satisfied the Hardy-Weinberg equilibrium in the control group. For IL16 rs11556218, significant differences in allele and genotype frequencies were observed between patients and controls, and the G allele showed a nominal association with lower odds of T2DM. After adjustment for BMI, WHR, and family history of diabetes, the TG genotype showed a nominal association with lower odds of T2DM in the codominant model (adjusted OR = 0.56, 95% CI: 0.32-0.98; nominal P = 0.026). Nominal associations were also observed in the dominant model (adjusted OR = 0.52, 95% CI: 0.30-0.89; nominal P = 0.016) and the log-additive model (adjusted OR = 0.52, 95% CI: 0.32-0.85; nominal P = 0.0081). For IL1B rs16944, genotype distribution likewise differed between the two groups. Under the recessive model, the CC genotype showed a nominal association with higher odds of T2DM after adjustment (adjusted OR = 2.13, 95% CI: 1.20-3.79; nominal P = 0.0089). None of these associations met the Bonferroni-corrected significance threshold of P < 0.00625. Compared with controls, participants with T2DM had higher BMI and WHR, higher triglyceride levels, lower HDL cholesterol, higher fasting plasma glucose and blood pressure, and more commonly reported a family history of diabetes.

IL16 rs11556218 and IL1B rs16944 showed nominal associations with T2DM in this sample of Kinh Vietnamese adults, although none remained statistically significant after Bonferroni correction. These exploratory findings require confirmation in larger independent studies before any firm conclusions regarding their biological or clinical relevance can be drawn.

Lumbar sympathetic ganglion radiofrequency ablation (LSGRF) is an effective pain relief technique for patients with diabetic peripheral neuropathic pain (DPNP). Fluoroscopy, when combined with ultrasound, can guide the needle tip to locate the lumbar sympathetic ganglion (LSG) accurately, but the vertebrae pose an obstruction.

The purpose of this study is to compare the technical efficacy and clinical outcomes between curved-needle and straight-needle techniques for LSGRF in DPNP patients.

A prospective, randomized design.

The study was carried out in the anesthesiology department of Foshan Fosun Chancheng Hospital, Foshan, China.

This study included 60 DPNP patients aged 18 to 80 years, with ASA grade II to III and BMI 18 to 30 kg/m2, who underwent combinations of LSGRF and anhydrous ethanol under ultrasound and fluoroscopy guidance. The patients were divided randomly into the curved-needle group (Group C, n = 30) and the straight-needle group (Group S, n = 30). The primary endpoint was the duration of the procedure. Secondary outcomes included ablation success rate, fluoroscopic imaging time, number of needle redirections, frequency of needle-bone contacts, serial pain scores on the visual analog scale (VAS), and surgical complications.

Group C demonstrated statistically significant advantages in procedural efficiency, including shorter operation time (10.6 ± 3.1 min vs. 15.2 ± 2.3 min, P < 0.001), fewer needle redirections (0.5 vs. 4.5, P < 0.001), and reduced bone contacts (1.0 vs. 4.0, P < 0.001), over Group S. While the ablation success rate was numerically higher in Group C (96.7% vs 90.0%), this difference did not reach statistical significance (P = 0.611). Both groups showed a significant reduction in VAS scores from their preoperative counterparts at all postoperative assessment time points (P < 0.05), but there was no significant difference in VAS scores between the groups. The complication rate was lower in Group C (3.33% vs. 13.33%, P = 0.357), but that result had no statistical significance.

The analgesic effect of LSGRF and the temperature of the affected limb were evaluated based only on short-term outcomes.

Compared to the traditional straight needle, the curved needle can reduce the operation time and the number of needle redirections in LSGRF for treating DPNP. Satisfaction of both patients and anesthesiologists also increased when using the curved needle. However, no statistically significant differences were observed between the 2 types of needles in terms of success rate or post-procedural analgesic efficacy.

Although post-dexamethasone suppression test (DST) cortisol levels ≤ 1.8 µg/dL are generally considered compatible with nonfunctioning adrenal tumors, accumulating evidence suggests that cardiometabolic risk may vary even below the threshold for mild autonomous cortisol secretion (MACS). This study aimed to evaluate cardiometabolic risk across different post-DST cortisol levels in patients with adrenal incidentaloma using conventional metabolic parameters and atherogenic indices.

In this retrospective cross-sectional study, 156 patients with adrenal incidentaloma were classified into three groups according to post-DST cortisol levels: ≤0.9 µg/dL (Group 1, n = 48), 0.91-1.79 µg/dL (Group 2, n = 60), and ≥ 1.8 µg/dL (Group 3, n = 48). Demographic characteristics, blood pressure, glucose metabolism parameters, lipid profiles, and cardiometabolic risk indices, including the triglyceride-glucose (TyG) index, plasma atherogenic index (PAI), and Castelli Risk Indices I and II, were compared among groups. Correlations between post-DST cortisol levels and cardiometabolic parameters were evaluated using Spearman correlation analysis.

Blood pressure and the prevalence of hypertension increased significantly across post-DST cortisol categories. Notably, Group 2 already differed significantly from Group 1 in systolic and diastolic blood pressure and hypertension prevalence. Diabetes mellitus was also more prevalent in Group 2 than in Group 1. Fasting glucose, HbA1c, total cholesterol, LDL cholesterol, and non-HDL cholesterol differed significantly among the three groups, with Group 2 showing significantly higher HbA1c and LDL cholesterol than Group 1. The TyG index and Castelli Risk Indices I and II also differed significantly across cortisol categories, although pairwise differences for these indices were primarily observed between Groups 1 and 3. Overall, Group 2 exhibited an intermediate cardiometabolic pattern between Groups 1 and 3. Post-DST cortisol levels were positively correlated with blood pressure, glucose metabolism parameters, atherogenic lipid parameters, and several atherogenic indices.

Post-DST cortisol levels were associated with a graded pattern of cardiometabolic risk among patients with adrenal incidentaloma. Patients with post-DST cortisol levels of 0.91-1.79 µg/dL exhibited an intermediate cardiometabolic phenotype, with significant abnormalities in several cardiometabolic parameters compared with patients with more complete cortisol suppression. These findings suggest that patients below the current MACS threshold may not represent a metabolically homogeneous or uniformly benign population and support further prospective investigation of cardiometabolic risk across the continuum of post-DST cortisol levels.

Concurrent training (CT), combining aerobic and resistance exercise, is recommended for managing type 2 diabetes mellitus (T2DM). However, whether the sequence of CT-aerobic training followed by resistance training (CART) or the reverse order (CRAT)-influences cardiometabolic outcomes remains unclear. This study compared the effects of CT sequences on cardiometabolic risk factors in T2DM using network meta-analysis (NMA).

An NMA of randomized controlled trials (RCTs) published up to January 2026 was conducted using five databases. Two reviewers independently screened and extracted data. Data were analysed using Stata 16.0.

Twenty-seven RCTs (n = 965) were included. Both CART and CRAT significantly improved body fat percentage, HbA1c, fasting blood glucose, total cholesterol, triglycerides, and low-density lipoprotein compared with control (all p < 0.05). Based on unadjusted SUCRA probabilities, CRAT ranked highest for body composition, glycaemic control, insulin resistance, and most lipid outcomes, whereas CART ranked highest for systolic and diastolic blood pressure. Sensitivity analyses indicated that intervention duration influenced rankings for body composition, whereas participant sex influenced rankings for blood pressure. Meta‑regression further suggested that participant age might modify the relative efficacy of these sequences for BMI, HbA1c, and blood pressure, warranting cautious interpretation of unadjusted rankings.

Both CT sequences improve cardiometabolic risk factors in T2DM. Although SUCRA rankings varied across outcomes, these findings are exploratory and do not establish superiority of either sequence. Meta-regression suggested that participant characteristics and training factors may partly account for ranking differences. Given the non-significant direct comparisons and low certainty of evidence according to CINeMA, current evidence does not support a definitive recommendation for one training sequence over the other. Future head-to-head trials are warranted.

PROSPERO CRD420261293127. Registered 25 January 2026.

Celiac disease (CD) and type 2 diabetes mellitus (T2DM) are increasingly recognized as overlapping metabolic conditions. However, the impact of concomitant CD on diabetes-related complications and metabolic outcomes in patients with T2DM remains poorly characterized. We aimed to compare clinical outcomes between patients with T2DM and CD versus patients without CD.

We performed a retrospective multicenter electronic health record (EHR)-based cohort study using the TriNetX research network. Adults with T2DM and concomitant CD were identified using ICD-10-CM codes for T2DM and CD, along with either markedly elevated tissue transglutaminase IgA levels or upper endoscopy procedures. Propensity score matching (1:1) was performed for demographics, cardiovascular risk factors, lipid disorders, medications, and laboratory markers, yielding 8,760 patients per cohort. Outcomes included albuminuria, depression, anxiety, severe hyperglycemia, ophthalmic complications, hospitalization, neuropathy, nephropathy, and a composite cardiovascular outcome.

After matching, patients with T2DM and CD had significantly higher hazards of albuminuria (HR 1.30, 95% CI 1.15-1.46), depression (HR 1.14, 95% CI 1.07-1.21), anxiety (HR 1.12, 95% CI 1.06-1.18), severe hyperglycemia (HR 1.39, 95% CI 1.27-1.53), ophthalmic complications (HR 1.77, 95% CI 1.55-2.02), neuropathy (HR 1.73, 95% CI 1.59-1.88), nephropathy (HR 1.13, 95% CI 1.04-1.22), and a composite cardiovascular outcome (HR 1.09, 95% CI 1.01-1.17) compared with matched controls. Hospitalization risk did not differ between cohorts (HR 0.97, 95% CI 0.92-1.01). Mean follow-up after matching were 1,574 days and 1,438 days.

Among patients with T2DM, concomitant CD was associated with significantly higher risks of macro and microvascular diabetic complications, and psychiatric comorbidities.

In our study, we investigated the predictive value of the region of interest (ROI)-modified Mayo Adhesive Probability (MAP) score which objectively assesses perirenal fat density for postoperative fever following retrograde intrarenal surgery (RIRS), as well as its comparative performance against the conventional MAP score. This retrospective study included 318 patients who underwent RIRS with a sterile urine culture between January 2021 and May 2025. Demographic, stone, and procedure-related data were recorded. Both scores were calculated from non-contrast computed tomography (CT) images prior to surgery; independent risk factors for postoperative fever were identified using logistic regression models and compared via receiver operating characteristic (ROC) analysis. Postoperative fever developed in 41 patients (12.9%). In the model including the conventional MAP score, diabetes mellitus (DM) (odds ratio [OR] = 3.475, p = 0.002), recurrent urinary tract infection (UTI) (OR = 3.567, p = 0.039) and MAP ≥ 3 (OR = 2.707, p = 0.006) were identified as independent risk factors. In the model including the ROI-MAP score, DM (OR = 2.953, p = 0.008) and ROI-MAP ≥ 3 (OR = 7.057, p < 0.001) were identified as independent predictors. The ROI-MAP score demonstrated statistically significantly higher predictive accuracy compared to the conventional MAP score (area under the curve [AUC]: 0.789 vs. 0.709; p = 0.011). The ROI-modified MAP score, which reduces interobserver variability through Hounsfield unit (HU)-based measurement of perirenal fat density, may serve as a potentially useful adjunct for identifying patients at risk of fever following RIRS during the preoperative period.

To determine the risk of recurrent urinary tract infection (UTI) after early reinitiation of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in adults with type 2 diabetes and to identify patient-level factors associated with recurrence.

We conducted a retrospective cohort study. Adults with type 2 diabetes who discontinued an SGLT2i after an index UTI and were subsequently restarted were classified by reinitiation timing (early vs delayed). Recurrent UTI was defined as a new, clinically coded episode following reinitiation. Multivariable models assessed associations between recurrence and demographics, comorbidities, glycemic control, renal function, and psychiatric history.

Among 316 patients who restarted SGLT2i within 21 days during or after the first UTI episode, recurrent UTI occurred in 43.99% after 14 days post-reinitiation. In the combined cohort (n = 395), early reinitiation (<21 days) showed a trend toward increased recurrence risk compared to delayed reinitiation (≥21 days) in unadjusted Cox regression (HR 1.348; 95% CI 0.948-1.915; p = 0.096) and logistic regression (OR 1.305; 95% CI 0.797-2.139; p = 0.290), though neither reached statistical significance. After adjusting for baseline covariates, the trend persisted (adjusted Cox HR 2.011; 95% CI 0.973-4.158; p = 0.0592). In univariable Cox regression analysis of the combined cohort, female sex (HR 0.649 for males; 95% CI 0.448-0.942), higher HbA1c (HR 1.09 per %; 95% CI 1.004-1.184), and reduced eGFR (HR 0.992 per ml/min/1.73 m²; 95% CI 0.987-0.998) were identified as factors significantly associated with recurrence.

In this retrospective cohort of patients whose UTI was clinically coded and treated with antibiotics, recurrence was less frequent among men with preserved renal function and lower HbA1c, suggesting early SGLT2i reinitiation is a reasonable option in this subgroup. No conclusion could be drawn for higher-risk patients. The comparison of early versus delayed reinitiation remained inconclusive: the point estimate favored delayed reinitiation but did not reach significance (adjusted HR 2.011; 95% CI 0.973-4.158). In univariable analysis, female sex, older age, poor glycemic control, and impaired renal function were associated with recurrence. As ascertainment required a coded encounter and an antibiotic prescription, these findings apply only to clinically significant episodes. Randomized trials are needed to define optimal timing.