Type 2 diabetes (T2D) and its vascular complications, including diabetic retinopathy (DR), are escalating in prevalence globally, with disproportionately high prevalence in Middle Eastern populations, where genetic predispositions and lifestyle factors intersect. Early detection and precise risk stratification remain critical challenges in this region. We hypothesised that an integrated plasma multi-omics profile; comprising microRNA, mRNA, and protein biomarkers, could accurately distinguish individuals with T2D and its complications in a Middle Eastern cohort.

A candidate panel of mRNA and protein biomarkers identified from in vitro hyperglycaemia models, along with a vascular microRNA signature previously defined in an Australian cohort, was evaluated. These multiomic biomarkers were profiled in 962 individuals (492 controls, 434 T2D and 36 T2D with DR) from the Qatar Biobank (QBB). Random Forest machine learning workflow was used for risk stratification, with model performance assessed by accuracy and area under the receiver operating characteristic curve. SHAP analysis and penalised regression were used to identify key discriminative biomarkers.

The Random Forest classifier achieved robust performance, with an AUC of 0.83, F1 score of 0.78, and overall accuracy of 0.76 in distinguishing T2D cases from controls. A regulatory axis involving miR-29c (protective) and PROM1 (risk-promoting) was identified as a central driver for T2D and DR progression. Protein biomarkers, including ANGPT2 (fold change = 1.64, p-value = 3.8e-03) and PlGF (fold change = 0.66, p-value = 3.7e-02), were significantly associated with vascular complications.

Integrating multi-omics data with machine learning enables accurate risk stratification for T2D and DR in Middle Eastern populations. The miR-29c-PROM1 axis and associated proteins represent promising biomarkers for early detection and targeted intervention. Leveraging QBB resources, this study lays the groundwork for precision health initiatives aimed at mitigating diabetes-related complications in a high-risk Middle Eastern cohort.

This prospective study investigated plaque morphologies based on the underlying culprit lesion pathology in relation to the Atherogenic Index of Plasma (AIP) in patients with acute ST-elevated myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention and optical coherence tomography (OCT) for assessment of culprit lesions. The aim of the study was to elucidate the effects of the AIP index and plaque type on the incidence of major adverse cardiovascular events (MACEs).

A total of 274 patients with STEMI aged ≥ 18 years who underwent pre-intervention OCT imaging of culprit lesions between March 2017 and March 2019 were enrolled. AIP index was calculated using the formula: log 10 (triglycerides [TG]/ high-density lipoprotein cholesterol [HDL-C]). We stratified the cohort into four groups according to the presence of Thin-Cap Fibroatheroma (TCFA), as assessed by OCT, and the cutoff value of AIP: Group I consisted of patients with AIP < cutoff & without TCFA; Group II had AIP < cutoff & with TCFA; Group III included those with AIP > cutoff & without TCFA; and Group IV comprised patients with AIP > cutoff & with TCFA.

Patients in Group IV exhibited a higher prevalence of Diabetes Mellitus (p = 0.012), elevated triglyceride-glucose index (TyG) levels (p < 0.001), increased LDL-C levels (p = 0.002), higher triglycerides levels (p < 0.001), and elevated total cholesterol (p = 0.001), indicating accelerated atherosclerosis. Furthermore, individuals within higher tertiles of AIP demonstrated a greater frequency of healing plaques (p = 0.021). Among patients with diabetes mellitus (DM), the AIP index exhibited a correlation with the healing of plaques (p < 0.05). Multivariable Cox regression analysis revealed that the incidence of MACEs among patients in Group IV (AIP > cutoff & with TCFA) increased by compared to those in Group I. Kaplan-Meier analyses confirmed risk stratification for MACEs based on interactions between AIP-TCFA interaction (log-rank p = 0.027), AIP-plaque interaction (log-rank p = 0.033), AIP-mixed plaque interaction (log-rank p = 0.041), AIP-lipid plaque interaction (log-rank p < 0.001), AIP- macrophage interaction (log-rank p = 0.032).

Microstructural features observed via OCT for culprit lesions, combined with the AIP index-an important marker for cardiovascular disease-may be utilized clinically to support risk stratification and predict adverse events among STEMI patients.

Community level screening, referral and care intervention for the rising burden of cardiovascular diseases (CVD) and its risk factors in sub-Saharan Africa has been advocated. However, very low completed referral rates among those identified at risk has been reported. The goal of the current study was to use a citizen science-based approach to identify and refer those at high CVD risk to local health clinics, assess the referral rates in each community, and explore reasons for non-attendance by urban or rural location.

Twelve trained health extension workers (HEWs) screened 772 community members aged ≥ 35 year from 10 randomly selected health clinic catchment areas in an urban and a rural community in Adama district and Addis Ababa, Ethiopia with a mobile app-based on the Framingham 10-year CVD risk algorithm. HEWs also provided simple educational tools to support communicating CVD risk and counselling, and referral of at-risk persons for further care. Participants were followed up for four weeks after referral.

The proportions of participants with high (> 20%), moderate (10-20%), and pooled moderate and high risk (> 10%) were 6.0%, 12.6%, and 18.5% respectively. The most common risk factors identified included hypertension, diabetes mellitus (DM), and tobacco use. Of the 143 at risk participants identified, 124 were interviewed at 4-weeks follow-up (86.7%), and 80/124 (64.5%) voluntarily attended a local clinic for further assessment and management; rural at-risk participants (n = 42) had higher rates of follow-up (72.4%) compared with urban (57.6%) dwellers (p = 0.08). Those without prior hypertension or diabetes had lower rates of follow-up (57.1%) compared to those with at least one of these risk factors (74.1%, p = 0.05). The most common reasons for not attending clinic were inconvenience (63.4%), feeling fine (24.4%), and financial challenge (12.2%).

We observed high rates of voluntary clinic attendance among community members screened with moderate to high CVD risk scores in both rural and urban communities of Ethiopia. These findings imply that this novel approach may be useful for scaling up CVD risk screening in regions of Ethiopia.

Erectile dysfunction (ED) is the inability to achieve or sustain an erection adequate for satisfactory sexual activity. The prevalence of ED varies widely among diabetic patients worldwide, mainly due to disparities in healthcare access and diabetes management between low-income and high-income countries. ED significantly impacts the quality of life for affected men, potentially leading to frustration, despair, and sometimes separation from an intimate partner. This study aimed to assess the prevalence, severity patterns, and factors associated with erectile dysfunction among diabetic men attending clinics in three selected sites in Western Uganda.

The clinic-based cross-sectional study was conducted involving 236 diabetic men from three clinics: Fort Portal Regional Referral Hospital, Hoima Regional Referral Hospital, and Kampala International University (KIU) Teaching Hospital in Western Uganda from June to September 2024. The number of patients was proportionally assigned depending on the number of diabetic men receiving care at the selected facilities. For each clinic, the patients were enrolled consecutively. The IIEF-5 questionnaire was used. Descriptive statistics and bivariate and multivariable logistic regression were done with SPSS version 20.0.

The prevalence of erectile dysfunction was 79.2%, whereby 21.95%, 36.4%, 22.4% and 19.3% had mild, mild to moderate, moderate, and severe erectile dysfunction, respectively, at 95% CI. Multivariable logistic regression identified increasing age, HbA1c (aOR = 2.44, 95%CI:1.067–5.569, p = 0.035), fasting blood sugar (aOR = 2.50, 95%CI:1.106–5.657, p = 0.028), and BMI (aOR = 15.1833, 95%CI: 1.168–19.739) to be significantly associated with ED. No behavioural characteristic was associated with ED.

The prevalence of erectile dysfunction was very high. Increasing age, obesity, and inadequate control of blood sugar were significantly associated with ED. Future studies should focus on qualitative data and causal and therapeutic interventions. We also recommend routine screening and timely addressing of blood sugars.

The online version contains supplementary material available at 10.1186/s12902-025-02048-2.

Pathological changes in the arterial vasculature play a pivotal role in the development of macrovascular and microvascular complications of diabetes mellitus (DM). Compared with traditional measurements of carotid artery intima-media thickness, separate measurements of the thickness of the intima and the media using high-resolution ultrasonography could reveal vascular anatomical changes more precisely. Homocysteine (HCY) is closely related to vascular complications in DM patients. This study aimed to explore the thickness of the intima and media separately in the carotid, radial, and dorsalis pedis arteries in DM patients, to examine their diagnostic value for DM with complications and their relationship with HCY.

This was a cross-sectional study. A total of 123 DM patients and 102 healthy controls were enrolled. Arterial ultrasonography was performed using a 24-MHz probe to measure the thickness of the intima and media in the carotid, radial, and pedal arteries. Serum levels of fasting glucose, low-density lipoprotein cholesterol, HCY, and clinical information were also collected. Multivariate linear regression was performed to investigate the association between ultrasonographic parameters and risk factors, and binary logistic regression was used to explore the diagnostic value of combination model for DM with complications.

Carotid, radial, and pedal artery intima thickness were substantially thicker in DM patients than controls. Compared with DM patients without macrovascular complications, those with macrovascular complications exhibited a thicker media in all three arteries, a thicker carotid intima, and a thicker carotid artery intima-media thickness. The relative difference was greatest for carotid artery media thickness (28.4%). HCY positively correlated with all MTs and CIT in DM patients. CIT was associated with traditional risk factors including age, systolic blood pressure and HCY. Combination model of age, SBP and CIT provides a satisfactory diagnostic value for DM patients with macrovascular complications (area under the curve, 0.827).

Measurement of arterial intima and media thickness using high-resolution ultrasonography might be a promising tool to reveal arterial pathological changes in DM patients.

This study explores user experiences of CompARTE Diabetes, a nurse-moderated online peer support community, to identify factors influencing its adoption using the Non-adoption, Abandoning, Scale-up, Spread, and Sustainability (NASSS) framework. A qualitative descriptive design was employed through semi-structured interviews with 15 adult users (33.3% women; aged 19-65, M = 42.3) conducted between November and December 2024. Participants were purposively selected and met inclusion criteria. Data were thematically analysed using a deductive approach aligned with the NASSS, supported by inductive coding. Adoption was facilitated by a user-friendly interface, mobile app functionality, and attractive design. Nurse moderation was pivotal in fostering trust, curbing misinformation, and promoting meaningful discussion. Participants highlighted the value of innovative content, gamification, and hybrid (online/offline) interactions. Peer support reduced isolation, improved emotional well-being, and enhanced self-care. Barriers included technical difficulties, limited time, stigma, and challenges in integrating diabetes management into daily life. In conclusion, moderated virtual communities such as CompARTE Diabetes offer emotional, educational, and practical support for people with diabetes. Their success depends on overcoming digital divides, maintaining professional moderation, and fostering user engagement to enhance chronic illness self-management. Future studies should explore the long-term effects on clinical outcomes and assess strategies to enhance inclusivity across diverse populations.

Adropin is a peptide involved in the regulation of glycolipid metabolism, contributing to improved glucose homeostasis and the mitigation of dyslipidemia. The objective of this study is to ascertain whether there is a discrepancy in the expression of microRNA-21 (miRNA-21) and adropin levels in Type 2 diabetes mellitus (T2DM) patients who also exhibit macro- and micro-vascular complications (nephropathy, neuropathy, retinopathy) were also observed to uncomplicated diabetes patients and healthy individuals; to explore the relationship between serum adropin and miR-21, endothelial dysfunction, and carotid intima-media thickness (CIMT). The present study comprised 89 patients with T2DM (microvascular n = 24, macrovascular n = 20, uncomplicated type 2 n = 45) and 19 non-diabetic coronary artery disease (CAD). The control group was composed of 20 healthy individuals. Expression of miRNA-21 in all diabetic patients was significantly higher than control group, while adropin levels were found to be significantly lower. No significant difference was observed between the diabetic patient groups with microvascular complications and those without complications regarding miRNA-21 and adropin levels. The miR-21 expression and adropin levels of the non-complicated diabetic group and only the coronary disease group were significantly higher and lower than the control group. CIMT was significantly higher in patients with macrovascular complications and non-diabetic CAD than in the other groups. A positive correlation was found between miR-21 and CIMT, whereas a moderate negative correlation was detected between miR-21 and adropin levels. The present study indicated that adropin and miR-21 can be equally good markers both in separating diabetic patients with macrovascular complications from the healthy group. In the meantime, the endothelial cell is an important target, and endothelial dysfunction is important in diabetic vasculature. Increased miR-21 expression and decreased adropin levels can be explained by the damage that hyperglycemia causes to the endothelium in diabetic patients.

Therapeutic inertia (TI), the failure to intensify or de-intensify treatment when appropriate, is a contributor to poor guideline adherence in diabetes treatment, including the suboptimal use of sodium-glucose cotransporter 2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs).

We developed a multifaceted improvement initiative targeting TI at four academic primary care practices, aiming to increase rates of SGLT-2i and GLP-1RA use for patients with type 2 diabetes (T2DM). Prescribing trends for GLP-1RAs, SGLT-2is, sulfonylureas and insulin were compiled quarterly over a 12-month baseline period and 12-month intervention period and analysed using interrupted time series analyses. Providers completed a brief questionnaire assessing project feasibility and acceptability.

GLP-1RA prescribing showed an upward trend during both the baseline and intervention periods (+0.70% vs +0.87% per quarter; p=0.14 for difference) and increased significantly in the first intervention quarter (+1.73%; p=0.003). SGLT-2i prescribing was static during the baseline period, showed an upward trend during the intervention (0.0% vs +0.43% per quarter; p=0.05 for difference) and increased significantly in the first intervention quarter (+1.0%; p=0.03). In those prescribed a GLP-1RA or an SGLT-2i, sulfonylurea prescribing dropped significantly after intervention (-2.0% per quarter; p=0.02). Insulin prescribing rates did not change throughout the study period. There was no significant change in haemoglobin A1c among patients newly prescribed a GLP-1RA and/or an SGLT-2i during the intervention period (7.3% ±1.5% baseline vs 7.2% ±1.4% intervention period, p=0.23). Most providers indicated that they had prescribed (90%) and were more likely to prescribe (81%) GLP-1RAs and/or SGLT-2is in the future because of their participation.

A quality improvement initiative targeting drivers of TI was associated with increased rates of guideline-based medication prescribing for primary care patients with diabetes and may be applied to other conditions in which TI limits care optimisation or guideline adherence.

Significant variations exist in computable phenotype definitions to identify patients with type 2 diabetes (T2D) using electronic health records (EHRs). These variations cause challenges in identifying T2D populations for clinical research. To address these challenges, this study compares the variations in common phenotypes in identifying patients with T2D using EHRs.

A retrospective data analysis was performed using clinical data extracted from EHRs of 207 813 adult patients captured 2017-2019. Multiple T2D phenotypes were used: (1) Surveillance, Prevention and Management of Diabetes Mellitus, (2) Centers for Medicare and Medicaid Services Chronic Conditions Data Warehouse (CCW), (3) eMERGE Northwestern Group, (4) Durham Diabetes Coalition (DDC) and (5) a definition developed by a panel of experts at Johns Hopkins.

Each phenotype definition identified a different T2D population with a unique composition of demographics and clinical features. Although the identified patients overlapped across phenotypes, only 22.7% (47 326) of the population was commonly identified across all definitions. Of the phenotypes, DDC identified the greatest number of patients with T2D (139 832, 67.3%), while CCW had the highest mean age (65.3 years), the highest percentage of black patients (35%) and the highest mean Charlson comorbidity score of 2.96. DDC identified patients with T2D with the lowest means of inpatient (0.64) and emergency room (1.06) visits.

Our study highlights the complexity of computable T2D phenotypes in translating commonly agreed T2D clinical definitions when applied against retrospective EHR data. Our findings provide an understanding of using appropriate phenotypes to identify, enrol and analyse T2D populations of interest using EHR data.

To examine trends in preconception and pregnancy cardiometabolic risk factors and conditions, pregnancy and birth complications, obstetric interventions, and the impact of COVID-19, and to forecast future disease burden.

A multi-centre retrospective cohort study.

A large hospital network with three maternity hospitals serving ethnically diverse populations in Melbourne, Australia.

Pregnant women who gave birth between 2016 and 2022.

Trends in cardiometabolic conditions, birth complications and obstetric interventions.

Over 7 years, 63 232 women were included, of whom 40% were nulliparous, and 60.9% were born overseas from 167 countries. From 2016-2022, maternal age (30.2-31.3 years), obesity (21.0%-26.2%), gestational diabetes mellitus (GDM) (15.9%-28.1%) and caesarean delivery (28.5%-37.6%) increased, while average gestational weight gain, premature births and special care admissions declined from 12.6-11.6 kg, 6.3%-4.9% and 24.2%-14.1%, respectively; and was statistically significant (p<0.05). Hypertensive disorders of pregnancy remained stable, fluctuating slightly (6.5% in 2016, 7.6% in 2020, 6.9% in 2022). During the COVID-19 lockdown period, the odds of GDM and induced birth increased by 8.0%, whereas the odds of caesarean section decreased by 5.0%. GDM is forecast to reach 43.0% by 2028.

Prepregnancy and pregnancy cardiometabolic risk factors and conditions, pregnancy and birth complications, and obstetric interventions increased markedly over 7 years. Despite this, offspring complications, including special care admissions, stillbirths and prematurity, decreased, while pregnancy complications peaked during COVID-19. GDM is forecasted to increase to 43.0% by 2028, posing an unsustainable health and economic burden that necessitates urgent public health initiatives.