Background/Objectives: Diabetic retinopathy (DR) is a leading cause of preventable visual impairment, and systematic screening is essential to detect sight-threatening stages before symptoms occur. However, long-term real-world evidence on visual outcomes from structured screening programmes remains limited. This study evaluates, in a retrospective analysis of routinely collected clinical data, the real-life visual outcomes of screening for and treating sight-threatening DR, based on 32 years of data collected in a purpose-built centre implementing the 1990 European Working Party recommendations for screening. Methods: Screening was performed by retinal photography between 1991 and 2022 in 18,161 patients (63,289 screening episodes). Diabetes specialists graded photographs, referring patients to ophthalmologists when needed. The 10-year trajectories of visual acuity (VA) were assessed in patients with different stages of retinopathy and macular involvement at first screening. Results: At first screening, two-thirds of patients had no DR, 15% had mild DR, and the remainder had referable DR or a non-assessable fundus. There was no difference by sex. Patients with more severe DR at first screening had lower VA, but this did not worsen over 10 years. Median VA in 514 patients treated with panretinal photocoagulation for pre-proliferative or proliferative DR changed from 0.10 logMAR (7-8/10) to 0.15 (6-8/10), 1874 ± 1252 days after treatment. In 823 patients photocoagulated for diabetic macular edema, median VA remained 0.10 logMAR (7-8/10) before treatment and 1998 ± 1288 days after treatment. Conclusions: Screening for sight-threatening DR using European Working Party recommendations was feasible in everyday practice and was associated with long-term preservation of visual acuity and a low incidence of severe visual loss.

Background: Food insecurity (FI), which is defined as limited or uncertain access to sufficient, nutritious food, disproportionately affects low-income populations and has been linked to poor control of chronic diseases including type 2 diabetes mellitus (T2DM) with North Louisiana having one of the highest rates of FI in the United States. The interaction between FI and neighborhood-level socioeconomic disadvantage has not been well characterized in relation to microvascular diabetic complications. Objective: This study aimed to evaluate the relationship between FI, socioeconomic disadvantage, and microvascular complications in patients with T2DM. Methods: A retrospective cohort study of 163 adult patients with T2DM who received care at Ochsner LSU Health clinics in Shreveport and Monroe, Louisiana, between January 2018 and January 2023 were reviewed. FI status, Area Deprivation Index (ADI), a validated measure on neighborhood socioeconomic disadvantage, and microvascular complication outcomes including nephropathy, neuropathy, and retinopathy were obtained from electronic medical records. FI was assessed using the validated two-item Hunger Vital Sign screening tool. Results: The study found that FI alone was not a statistically significant predictor of nephropathy based on microalbumin-to-creatinine ratio (MACR). However, the combination of FI and high ADI (≥7) was significantly associated with neuropathy (p = 0.024) and retinopathy (p < 0.001), particularly among patients with T2DM for more than five years. Additionally, the interaction between FI and high ADI was also found to influence MACR values significantly (p = 0.026), indicating that socioeconomic stressors may exacerbate kidney dysfunction. Conclusions: Food insecurity, coupled with socioeconomic adversity, was associated with an increased risk of microvascular complications in T2DM. These results highlight the importance of integrating FI screening and addressing social determinants of health in high-risk populations. Early identification and targeted interventions could help mitigate disease progression and reduce health disparities.

Diabetes mellitus (DM) and chronic obstructive pulmonary disease (COPD) are among the leading chronic diseases that significantly impact global morbidity and mortality. Growing evidence indicates a bidirectional interplay between metabolic and pulmonary dysfunction. This study aims to identify the demographic and regional trends of DM and COPD-related mortality in the United States from 2000 to 2023.

DM- and COPD-related deaths in the United States from 2000 to 2023 were obtained from the CDC WONDER database using ICD-10 code E10-14 for DM and J40-44 as the underlying cause of death. Results are presented as age-adjusted mortality rates (AAMR) per 100,000 population, with Joinpoint regression used for trend analysis and to calculate annual percentage change (APC).

A total of 796,757 DM- and COPD-related deaths were recorded. From 2000 to 2008, the AAMR for DM and COPD increased from 11.19 to 14.32, remaining relatively stable until 2018. This was followed by a significant rise to 19.03 in 2021 (APC: 10.57), before declining to 16.28 in 2023 (APC: -9.08). Men demonstrated a higher AAMR (19.28) than women (12.02); however, both experienced decline post-2021, with rates falling to 20.54 in men (APC: -9.08) and 13.02 in women (APC: -8.33). AAMR increased among all racial groups except Asians and Hispanics. From 2000 to 2021, American Indians had the highest AAMR (30.48). After 2021, AAMR declined across all groups. Rural areas reported higher AAMR (19.02), compared to urban areas (12.85). AAMR in rural areas increased markedly from 2018 to 2020 (13.67). State-level comparisons revealed substantial variation in AAMR. Oklahoma had the highest rate at 28.79, followed by West Virginia (28.53), Kentucky (26.74), Vermont (23.95), and Mississippi (20.83). In contrast, Hawaii (6.69), Utah (7.33), and Massachusetts (7.99) reported the lowest rates, all below 10. Regionally, the Midwest had the highest average AAMR (16.30).

COPD-related diabetes mortality rose from 2000 to 2020, highest among men, Non-Hispanic American Indians, and rural populations, and then declined post-2021. Findings indicate increased vulnerability during acute events, highlighting the need for targeted interventions.

Although many people discontinue glucagon-like peptide-1 receptor agonists (GLP-1 RAs), the reasons for discontinuation are unclear.

To identify self-reported reasons for GLP-1 RA discontinuation among US adults.

Cross-sectional survey of US adults fielded in June 2025 using Ipsos Omnibus and incorporating survey weights calibrated to census benchmarks. We included individuals who initiated a GLP-1 RA between January 2022 and June 2025 and subsequently discontinued therapy. Outcomes included duration of use, self-reported reason(s) for discontinuation, medication source, out-of-pocket payment, and insurance coverage. Descriptive statistics and chi-square tests for statistical significance were used.

Of 7,035 individuals screened, 440 respondents met eligibility criteria and completed the survey. Of these 440 participants, 51.1% were female, 42.3% were aged between 18 and 34 years, and 23.8% reported having type 2 diabetes. More than half of these discontinuers (54.6%) reported discontinuing a GLP-1 RA within 6 months of initiation, and 79.7% reported discontinuation within 12 months of use. Approximately 1 in 7 (14.4%) reported sourcing GLP-1 RAs from a friend or family member, and more than half reported using a copayment coupon (35.4%) or free sample (22.0%). Many respondents (31.3%) reported first filling a prescription without insurance. Approximately 1 in 5 reported sourcing their medicine from a compounding pharmacy (9.8%) or Internet-based (9.1%) source. The most frequently cited reasons for discontinuation were cost (36.1%), side effects (33.3%), no insurance coverage (28.2%), and achieving a weight-loss goal (26.1%). Compared with those without diabetes, respondents with diabetes were significantly more likely to discontinue because of side effects (50.1% vs 28.1%, P = 0.0008). Respondents who reported sourcing their GLP-1 RA from a compounding pharmacy or Internet-based source were significantly more likely to discontinue because they perceived the medication to be ineffective compared with those who obtained their medication from a retail or mail-order pharmacy (17.5% vs 6.6%, P = 0.009). Neither diabetes status nor GLP-1 RA source was significantly associated with early discontinuation (<6 months).

In this national survey, most US adults who stopped GLP-1 RAs did so within 6 months because of cost, adverse effects, lack of coverage, or having achieved a weight loss goal. Differences in coverage, costs, and sourcing are modifiable targets that may decrease high rates of GLP-1 RA discontinuation.

Whether Takayasu arteritis (TAK) and giant cell arteritis (GCA), the most common forms of large-vessel vasculitis (LVV), are distinct clinical entities or different manifestations of the same disease is an ongoing debate. This study analyzes and compares the clinical manifestations, imaging characteristics, and diagnostic and therapeutic features of TAK and GCA in a longitudinal cohort of patients recruited from three Italian centers.

The study population consisted of 59 patients with TAK and 37 with GCA, including 7 with cranial-GCA (C-GCA) and 30 with large vessel-GCA (LV-GCA), all diagnosed between January 2014 and November 2025. Most (72%) were followed up for at least 60 months.

In TAK patients, the time to diagnosis following the onset of symptoms was longer (p = 0.025), the prevalence of females higher (p = 0.001), and the presence at diagnosis of constitutional symptoms (p < 0.001), cardiovascular signs (p < 0.001), renal (p = 0.006) and dermatologic involvement (p = 0.040) more frequent than in GCA patients. In GCA patients, the sex distribution was equal. However, in addition to the cranial and constitutional symptoms associated with the cranial and large vessel forms of the disease, respectively, the prevalence of polymyalgia rheumatica (p < 0.001), hypertension (p < 0.001), diabetes mellitus (p = 0.003), and chronic liver disease (p = 0.02) was higher in GCA than in TAK patients. Vascular involvement was observed in both groups, with participation of the axillary artery more frequent in GCA patients (p = 0.02). Additionally, involvement of the aortic arch (p = 0.009), mesenteric (p = 0.004), and renal (p < 0.001) arteries was more frequent in TAK patients. Glucocorticoids were administered at a higher dose (p < 0.001) and combined more frequently with immunosuppressants in TAK patients. Among relapsing/refractory GCA patients, 50% received tocilizumab as second-line treatment. The two groups did not significantly differ concerning long-term remission, but relapse was more frequent in TAK patients.

Despite their phenotypic similarities, TAK and GCA differ in their epidemiological and genetic features and, to a lesser extent, in their clinical manifestations, arterial involvement, and response to therapy. Our data therefore indicate that TAK and GCA are clinically distinct, requiring disease-specific approaches in their diagnosis and management.

Immune checkpoint inhibitors (ICIs) have transformed the management of multiple malignancies but can lead to immune-related adverse events (irAEs) affecting endocrine organs. Diabetes mellitus secondary to ICIs is uncommon but potentially life-threatening. We report a case of new-onset insulin-dependent diabetes developing during pembrolizumab therapy in a patient treated for triple-negative breast cancer. The patient presented with severe hyperglycaemia and ketosis after several cycles of immunotherapy. Autoimmune diabetes antibodies were negative, and C-peptide levels indicated relative insulin deficiency. Glycaemic control remained challenging after discharge, with alternating hyperglycaemia and hypoglycaemia despite insulin therapy. This case highlights the variability in the presentation of checkpoint inhibitor-associated diabetes and the challenges in ongoing glycaemic management.

In South and Southeast Asia, chronic diseases (CD) are a major public health concern and have a considerable impact on people's quality of life (QoL). CD and their ailments place a dual burden of sickness and socioeconomic difficulties on afflicted people and healthcare systems.

This review aims to provide a comprehensive synthesis of evidence on the relationship between chronic diseases and HRQoL in the region, focusing on study populations, disease types, methodologies, sample sizes, and assessment tools used.

A systematic search was conducted to identify studies published between 2014 and 2024 that assessed HRQoL among patients with CD in South and Southeast Asia. Eligible studies included cross-sectional, observational, prospective cohort, and economic evaluation designs involving conditions such as chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), diabetes mellitus, sarcopenia, cardiovascular diseases, breast cancer, and hepatitis C. Data extracted included study design, sample size, participant characteristics, and validated HRQoL measurement instruments.

Twenty-five studies conducted across multiple South and Southeast Asian countries were included. Sample sizes ranged from 99 to 816 participants. A variety of validated instruments were used to assess HRQoL, including the St. George's Respiratory Questionnaire (SGRQ), Kidney Disease Quality of Life (KDQOL), WHOQOL-BREF, and Short Form-36 (SF-36). Overall, CD were consistently associated with reduced HRQoL, with variations influenced by disease severity, comorbidities, and socioeconomic status. Specific challenges included reduced functional capacity among patients with sarcopenia and significant decisional conflict among patients with CKD. In addition, economic evaluations, particularly for hepatitis C treatments using direct-acting antivirals, highlighted important cost-effectiveness considerations.

CD negatively affect HRQoL, which is influenced by disease severity, sociocultural factors, and barriers to healthcare access. Community-based disease management, telemedicine, culturally tailored health education, and financial protection policies may improve outcomes. Future studies should assess the effectiveness and scalability of these interventions across diverse regional settings.

Diabetes-related quality of life (DR-QoL) is shaped by interactions between cardiometabolic dysfunction and psychological stress, yet these mechanisms are rarely examined within a unified framework.

To evaluate the independent, interactive, and mediating effects of cardiometabolic factors and stress on DR-QoL obstacles.

A cross-sectional study was conducted among 1815 adults with type 2 diabetes from 15 Indonesian provinces (2023-2024). Stress and DR-QoL obstacles were assessed using validated instruments. Independent and synergistic effects were examined using logistic regression, and mediation was tested via path analysis.

Overweight, obesity, stage 2 systolic hypertension, and abnormal fasting blood glucose (FBG) significantly predicted high stress (AOR = 1.982-20.889; p < 0.001), with synergistic interactions markedly amplifying the risk (AOR up to 53.972). DR-QoL obstacles were strongly associated with cardiometabolic abnormalities (AOR = 1.352-18.420) and high stress (AOR = 18.930), with the highest risk observed in participants with multiple concurrent abnormalities (AOR = 52.097). Mediation analysis identified FBG and stress as key mediators, with stress showing the strongest direct effect on DR-QoL obstacles (β = 0.397).

These findings highlight FBG and stress as central mechanistic targets for interventions aimed at reducing DR-QoL obstacles.

Assess how changes in food insecurity in the first 2 years of life are associated with overweight and obesity among children 6-11 years old born to mothers with gestational diabetes mellitus (GDM).

This secondary analysis utilised data from the Study of Women, Infant Feeding and Type 2 Diabetes Mellitus after GDM pregnancy, a prospective cohort of 1033 mother-child dyads. Food insecurity was assessed 6-9 weeks, 1 year and 2 years postpartum. Children were categorized as having persistent food security (food secure all visits), persistent food insecurity (food insecure all visits), or transient food insecurity (experienced both food security and insecurity). Overweight, obesity and severe obesity were classified using height and weight at 6-11 years old. Linear and logistic regressions estimated the relationship between food insecurity groups and BMI percentile, overweight, obesity and severe obesity.

Among 748 youth, 72% had persistent food security, 18% had transient food insecurity and 10% had persistent food insecurity. Compared to those with persistent food security, those with persistent food insecurity had higher odds of overweight (aOR = 2.81, [1.36, 5.80]), obesity (aOR = 2.17, [1.05, 4.47]) and severe obesity (aOR = 2.62, [1.02, 6.74]) (p < 0.05).

Screening and addressing food insecurity during early childhood may help identify children at risk for overweight, obesity and severe obesity among children exposed to GDM.

ClinicalTrials.gov identifier: NCT019967030.

Tooth extraction in medically compromised adults presents significant clinical challenges due to an increased risk of bleeding, infection, delayed healing, and systemic complications. The review indicated that Diabetes mellitus affects 8-12% of dental patients and is associated with a 10-15% risk of intraoperative hypoglycemia, while anticoagulated patients experience postoperative bleeding in 8-12% of cases compared with 2-3% in controls. Hypertension affects up to 30% of adults, leading to perioperative blood pressure elevations in 20-25%, and asthma or chronic obstructive pulmonary disease COPD occurs in 7-10% of patients with a 3-6% risk of bronchospasm. Immunosuppressed and transplant patients show postoperative infection rates as high as 20%. Five structured tables summarize medical classifications, safe clinical thresholds, emergency management, referral criteria, and a stepwise safety ladder for pre-, intra-, and postoperative care. The review emphasizes the importance of strict risk stratification and adherence to validated clinical cut-offs, including HbA1c <9%, INR ≤3.5, and blood pressure <180/110 mmHg. Implementation of standardized safety ladders and evidence-based thresholds can enhance patient safety, improve decision-making, and promote global consistency in managing medically compromised dental patients.