Type 2 diabetes mellitus (T2DM) requires sustained self-management and lifestyle modification to achieve optimal glycemic control. Hybrid care models that combine digital health technologies with in-person clinical support may enhance patient engagement while improving the accessibility and scalability of diabetes care. However, evidence regarding their effectiveness and feasibility in Southeast Asian populations remains limited.

This study aimed to evaluate the preliminary effectiveness and feasibility of a national hybrid digital intervention for individuals with T2DM in Brunei Darussalam. The primary objective was to evaluate the proportion of participants achieving a reduction in glycated hemoglobin (HbA1c) of ≥0.6% after 16 weeks. Secondary objectives included evaluating changes in metabolic parameters, anthropometric outcomes, and health-related quality of life (QoL).

This single-arm, nonrandomized pilot trial enrolled adults with T2DM into a 16-week hybrid digital intervention integrating remote health coaching, structured digital education, self-monitoring activities, and asynchronous communication via WhatsApp. Participants attended scheduled video consultations (VCs) and submitted self-monitoring records throughout the intervention period. Clinical outcomes included changes in HbA1c, fasting blood glucose, lipid profile parameters, BMI, waist circumference, and QoL measured using the EQ-5D-5L instrument. Feasibility outcomes included intervention completion, VC attendance, participant engagement, and intervention acceptability.

A total of 122 participants were enrolled, and 108 (88.5%) completed the intervention. Among 104 participants with complete HbA1c data, there was a mean reduction of 1.2% (95% CI -1.45 to -0.96; P<.001). Overall, 65.4% (68/104) of participants achieved the predefined HbA1c reduction threshold of ≥0.6%, while 84.6% (88/104) demonstrated an overall reduction in HbA1c. Significant improvements were also observed in fasting blood glucose (-1.7 mmol/L, 95% CI -2.3 to -1.2; P<.001), BMI (-0.4 kg/m², 95% CI -0.6 to -0.2; P<.001), waist circumference (-1.9 cm, 95% CI -2.9 to -0.9; P<.001), total cholesterol (-0.3 mmol/L, 95% CI -0.6 to -0.2; P<.001), triglycerides (-0.5 mmol/L, 95% CI -0.7 to -0.2; P<.001), and EuroQol Visual Analog Scale (EQ-VAS) scores (+6.7 points, 95% CI 3.9 to 9.6; P<.001). The intervention demonstrated favorable feasibility outcomes, including an 88.5% (108/122) completion rate, attendance at ≥5 VCs by 75.9% (82/108) of participants, and high participant satisfaction, with 86.9% (86/99) of respondents reporting satisfaction or extreme satisfaction with the intervention.

The pilot trial demonstrated the acceptability, preliminary effectiveness, and feasibility of a national hybrid digital intervention for individuals with T2DM in Brunei Darussalam. High completion rates, sustained participant engagement, and positive participant feedback support the practicality of implementation within a national digital health ecosystem. The intervention was also associated with improvements in glycemic control, metabolic outcomes, anthropometric measures, and health-related QoL. Larger controlled studies are warranted to evaluate long-term effectiveness, scalability, and implementation outcomes.

Within the last three decades, common metabolic diseases have become a worldwide health burden, including type 2 diabetes mellitus (T2DM), hypertension, obesity, hypercholesterolemia, and metabolic dysfunction-associated steatotic liver disease (MASLD). However, trends and burdens of these metabolic diseases across age and sex in Mainland China from 1990 to 2021 remain unclear.

Estimated disability-adjusted life years (DALYs) and deaths from GBD 2021 were utilized to analyze common metabolic diseases (T2DM, hypertension, obesity, hypercholesterolemia, and MASLD). Trend analyses were conducted using age-standardized DALYs (mortality) per 100,000 population and the total percentage change (TPC) between 1990 and 2021. Estimates were presented with uncertainty intervals (UI).

In 2021, among the five common metabolic diseases, hypertension had the highest burden (55.69 million [95% UI: 43.30-70.33] DALYs), followed by obesity (20.87 million [95% UI: 8.50-33.64] DALYs), hypercholesterolemia (18.41 million [95% UI: 10.27-27.11]), T2DM (11.47 million [95% UI: 8.83-14.70] DALYs) and MASLD (0.41 million [95% UI: 0.32-0.53] DALYs). Over the past three decades, the burden of these metabolic diseases has increased, albeit at varying magnitudes (ranging from a 0.64-fold to a 2.84-fold increase). Obesity and T2DM were the top two diseases with the highest TPC (2.84 and 1.90 respectively). The burden of DALYs and deaths, as well as their TPC in males with almost all the five common metabolic diseases was higher than that in females. In addition, the 55-74 years age group had the greatest burden of metabolic conditions.

The burden of common metabolic diseases remained high and continued to increase in Mainland China over the past 30 years. Therefore, urgent interventions are needed to address the concerning surge in DALYs and mortality as well as the persistent age-sex disparities attributed to metabolic diseases.

Diabetic foot ulcers (DFUs) are a severe, costly complication of diabetes and a major public health challenge. Early multidisciplinary intervention is critical. This study investigated how pre-hospital practices affect clinical characteristics, metabolic profiles, and outcomes in DFU patients.

A retrospective cohort study included DFU patients treated at a tertiary center (2021-2024). Patients were stratified into the timely medical care group (TMCG, ≤ 7 days) and the delayed medical care group (DMCG, 7-30 days) based on initial consultation timing. Comparative analysis evaluated metabolic parameters and lesion severity. Kaplan-Meier analysis was performed to assess healing outcomes, and multivariable Cox regression was used to identify predictors of DFU healing.

A total of 116 patients were enrolled in this study. A high proportion of patients in both the TMCG (n = 49) and DMCG (n = 67) had used Chinese herbal medicine or topical Western medications prior to admission. Compared to patients in the TMCG, those in the DMCG were associated with more severe Wagner grades (≥ 3: 38.8% vs. 18.4%, p = 0.02), hypoalbuminemia (< 35 g/L: 62.7% vs. 40.8%, p = 0.02), and higher rates of surgical intervention (14.9% vs. 4.1%, p = 0.02). Kaplan-Meier analysis revealed that the DMCG had a significantly higher risk of non-healing than the TMCG (p = 0.002). Multivariate Cox regression analysis identified delayed medical care (7-30 days) (HR = 1.62, 95% CI: 1.02-2.56, p = 0.04), and a higher Wagner grade (HR = 1.62, 95% CI: 1.19-2.22, p = 0.003) as independent predictors of impaired DFU healing.

Inappropriate pre-hospital practices commonly delay definitive care and worsen outcomes. Early medical intervention (≤ 1 week) is positively associated with therapeutic outcomes and reduces the risk of complications.

The aim of the study was to explore the effects of type 2 diabetes mellitus (T2DM) on the severity and prognosis in community-acquired pneumonia (CAP) patients.

A retrospective analysis was carried out on 2471 CAP patients. All subjects were divided into the non-diabetic group and the T2DM group. The information of pneumonia and mortality records were collected.

This study enrolled 2471 CAP patients. Of these patients, 559 (22.6%) had T2DM. The frequencies of septic shock (6.4% vs 3.5%, χ ² = 9.759, P = 0.002) and respiratory failure (22.7% vs 16.5%, χ ² = 11.482, P = 0.001) were higher in patients with T2DM than patients without T2DM. The mortality was higher in patients with T2DM than patients without T2DM (T2DM 8.4% vs non-diabetes 4.3%, χ ² = 14.353, P < 0.001). In multiple logistic regression analysis, T2DM was an independent risk factor of death in CAP inpatients (OR = 1.713, 95%CI:1.157~2.536, P = 0.007). Stratified by CURB-65 risk grade, T2DM was an independent risk factor for in-hospital mortality in patients with low risk group (OR = 2.150, 95%CI: 1.092-4.233, P = 0.027) and intermediate risk group (OR = 1.966, 95%CI: 1.066-3.626, P = 0.030), yet no significant difference was seen in the high-risk group (OR = 1.133, 95%CI: 0.563-2.280, P = 0.727).

CAP patients with T2DM were more severe than CAP patients without T2DM. The mortality was higher in CAP patients with T2DM compared with non-diabetic patients, especially for patients with low to intermediate risk.

Especially, the coxsackievirus B group of enteroviruses has been linked to the development of islet autoimmunity and type 1 diabetes in genetically susceptible individuals. Our aim was to study the possible associations of 10 different microbial infections with islet autoimmunity in a large international prospective study.

In a nested case-control study within the TRIGR study, follow-up serum samples from 240 islet autoantibody-positive case children and 436 age- and country-matched control children were analysed for IgG class antibodies against 10 different respiratory and gastrointestinal microbes using an enzyme immunoassay, and for neutralising antibodies against all six coxsackievirus B types. The samples were obtained at several time points prior to and at the time of seroconversion for multiple islet autoantibodies. All children had a first-degree relative with type 1 diabetes, and they carried risk-associated HLA-DQ alleles.

Coxsackievirus B5 was associated with an increased risk of islet autoimmunity (OR 2.22, 95% CI 1.29-3.80, p = 0.004, corrected p = 0.024), which remained after adjustment for HLA, sex, and maternal type 1 diabetes. This association was particularly seen for infections occurring more than 12 months (OR 2.02, 95% CI 1.06-3.84, p = 0.032) and 0-6 months (OR 2.66, 95% CI 1.11-6.35, p = 0.028) before the first detection of multiple islet autoantibodies. After correction for multiple comparisons, none of the other viruses showed an association with islet autoimmunity.

This study supports previous evidence of the risk association of coxsackievirus B infections. These results support the role of certain virus infections as possible modulating factors in the pathogenesis of type 1 diabetes.

Hidradenitis suppurativa (HS) is linked to cardiometabolic disease (CMD), and guidelines recommend annual primary care visits. This study examined predictors of primary care utilization among patients with HS.

In this cross-sectional study, 307 patients with HS were analyzed. χ² tests, one-way analysis of variance, and multivariable logistic regression assessed associations among barriers to care, primary care provider (PCP) adherence, HS severity, and CMD presence.

Mean age was 39.4 years; 26.4% had Hurley stage III disease. Overall PCP adherence was 85.0% but lower in patients under 30 years (71.0%). CMD prevalence included hypertension (33.9%), type 2 diabetes (17.6%), and hypercholesterolemia (32.9%). Patients without CMD were 74.0% less likely to adhere to annual PCP visits (adjusted odds ratio [AOR], 0.26; P = .001), and being uninsured reduced adherence by 82.0% (AOR, 0.18; P = .01). HS severity did not predict adherence, but Hurley stage III disease was associated with more PCP visits and independently predicted type 2 diabetes (AOR, 2.26; P = .02).

Primary care engagement is influenced more by CMD and insurance than HS severity. Coordinated dermatology-primary care strategies may enhance preventive care, especially for younger patients without CMD.

Evidence suggests that a substantial part of influenza-related morbidity and mortality is due to cardiovascular events. Limited population-level evidence exists regarding whether seasonal influenza vaccination is associated with a lower risk of ischemic stroke (IS) in older adults with diabetes. We conducted a retrospective cohort study using data from the Regional Health Information Platform. Among 143,841 diabetic adults aged ≥ 60 y alive and free of prior IS as of January 1, 2022, 131,045 met inclusion criteria and were followed until IS occurrence, death, or July 31, 2022. The primary outcome was first-ever IS. Vaccination exposure was receipt of the 2021/22 seasonal inactivated influenza vaccine. Subdistribution hazard ratios (sHR) and 95% confidence intervals (CI) were estimated using Fine-Gray competing risk models, with death as a competing risk. Pneumococcal vaccination served as a negative control. Of 131,045 participants, 54,617 (41.7%) received influenza vaccination. During 75,593 person-years of follow-up over approximately 7 months, 1,427 IS cases occurred (incidence rate: 18.9 per 1,000 person-years). After multivariable adjustment, influenza vaccination was associated with a 15% reduced IS risk within 7 months of follow-up (adjusted sHR = 0.85; 95% CI: 0.76-0.95). This inverse association was consistent across influenza activity phases and was most pronounced during high antigenic similarity epidemic periods (sHR = 0.74; 95% CI: 0.61-0.89) and among patients with coronary heart disease (sHR = 0.46; 95% CI: 0.25-0.86; interaction P = .034). The negative control analysis showed no association between pneumococcal vaccination and IS risk. Seasonal influenza vaccination was associated with a significantly reduced risk of incident IS within 7 months among older adults with diabetes, supporting its potential inclusion as a low-cost stroke prevention strategy in this high-risk population. Randomized controlled trials are warranted to confirm causality.

The use of antenatal corticosteroids appears to be increasing despite limited and conflicting evidence about its efficacy among women with diabetes in pregnancy.

To separately assess the effects of maternal diabetes and the effects of antenatal corticosteroid administration prior to late preterm birth on adverse maternal and neonatal outcomes.

Cohort study of women who gave birth ≥ 35 weeks gestation between September 2016 and March 2021 in two local health districts in New South Wales, Australia. Women were grouped into one of the following: (1) diabetes and received corticosteroids, (2) diabetes and no corticosteroids, (3) no diabetes and received corticosteroids. Modified Poisson regression was used to estimate adjusted relative risks (aRR).

A total of 5 067 women were included (Group 1 = 205, Group 2 = 4 028, Group 3 = 834). Women who received corticosteroids were characterised by higher proportions of hypertension, hospital-based medical antenatal care, multiple births and caesarean section. There were no differences in maternal and neonatal outcomes for women who had diabetes and received corticosteroids compared to those who had diabetes and did not receive corticosteroids. Women with diabetes who received corticosteroids had a higher risk of infants with neonatal hypoglycaemia (aRR 1.61, 95% CI 1.28-2.02) and admission to nursery or intensive care unit (aRR 1.18, 95% CI 1.02-1.38), compared to women without diabetes who received corticosteroids.

There is limited evidence of benefit for the use of antenatal corticosteroids in late preterm gestations, regardless of diabetes status. Further studies are required to identify potential longer-term benefits or harms.

BackgroundAdvanced glycation end products (AGEs) can be measured non-invasively through skin autofluorescence (SAF). Studies on SAF in gestational diabetes mellitus (GDM) remain limited. This study aims to evaluate SAF in Tunisian pregnant women with GDM and its association with the requirement for insulin therapy.MethodsA cross sectional study was conducted of 242 pregnant women who visited at the Monastir-Tunisia Center for Maternity. Screening for GDM was performed using the OGTT. 200 pregnant women were included in the study with and without GDM. We measured SAF using the AGE reader Mu device and the age-adjusted SAF-z score was calculated.ResultsHigher SAF levels and SAF-z scores were observed in pregnant women with GDM compared to healthy controls (2.1 ± 0.5 AU vs 1.9 ± 0.4 AU p < 0.001, 1.02 ± 0.9 vs 0.64 ± 0.7 p = 0.002, respectively). The ROC analysis revealed that an SAF >2.3 AU was the optimal cut-off point for predicting insulin therapy requirement with a sensitivity of 90.9% and a specificity of 69.7% (p < 0.001).ConclusionSAF was increased in GDM, and can be a biomarker associated suboptimal glycemic control in pregnant women with GDM. Our findings highlight the relevance of SAF measurement and suggest SAF monitoring during pregnancy.

Copeptin, a surrogate marker for vasopressin secretion, is associated with cardiovascular disease, insulin resistance and dysglycaemia. The cardioprotective effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) may involve vasopressin modulation through fluid redistribution, but whether this effect persists long-term in high-cardiovascular-risk patients with newly detected dysglycaemia remains unknown.

In this post-hoc analysis of the SOCOGAMI double-blind, placebo-controlled trial, 42 patients (mean age 67.5 years, 19% females) with impaired glucose tolerance or newly detected type 2 diabetes following an ACS and no heart failure were randomized to empagliflozin 25 mg/day (n = 20) or placebo (n = 22) for 7 months. Copeptin was measured during oral glucose tolerance tests (OGTT) at baseline, after 7 months on-treatment, and 3 months after treatment withdrawal. Treatment effects were assessed by repeated-measures ANOVA with treatment × time interaction and linear mixed-effects models.

Haematocrit, but not copeptin, showed a significant between-group difference at 7 months (p = 0.03 and p = 0.63, respectively). Both markers returned toward baseline after treatment withdrawal, but the overall treatment × time interaction was not significant for either (p = 0.72 and p = 0.64 respectively). Results were unchanged after accounting for a baseline imbalance in diuretic use (35% vs. 14%). Copeptin was not associated with the glucose-lowering effect of empagliflozin and no differential copeptin response during the OGTT across groups or visits was observed. In exploratory analyses, copeptin correlated with arterial pulse wave velocity at baseline (rs = 0.40, unadjusted p = 0.03).

In this post-hoc analysis, empagliflozin treatment was not associated with statistically significant sustained vasopressin secretion in post-ACS patients with newly detected dysglycaemia and preserved cardiac function. Due to the limited power and the absence of early on-treatment sampling these findings cannot exclude AVP modulation and warrant confirmation in adequately powered studies.

EudraCT number 2015-004571-73.