Type 2 diabetes mellitus (T2DM) and degenerative or mechanical spinal disorders frequently co-occur and amplify one another's clinical and socioeconomic burden. T2DM has been associated with greater pain severity, prolonged disability, and higher reported risks of surgery and opioid use, although the underlying mechanisms remain hypothesized rather than established. In South Korea's dual healthcare system, patients may access both Western medicine (WM) and Korean medicine (KM), yet national-level evidence on spine-T2DM multimorbidity care patterns is limited. This study examined 10-year healthcare utilization, expenditures, and medication use among patients with coexisting T2DM and degenerative or mechanical spinal disorders.

We conducted a retrospective study using the Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) from 2010 to 2019. Patients with both T2DM (E11) and at least one degenerative spinal diagnosis (M47, M48, M51, M54, S33) were included. KM users were defined as those with ≥ 1 KM claim per year. Outcomes included annual claim counts, expenditures, service categories, medication use, and facility type. Annual percent change (APC) was estimated using log-linear regression, and baseline characteristics were compared using standardized mean differences (SMDs).

A total of 188,716 patients generated 9,590,400 claims over 10 years; 62.9% were KM users. KM users were more often female and slightly older; back pain (M54) showed the largest imbalance (SMD = 0.26). Total claims increased from 715,279 (2010) to 1,157,475 (2019). KM users had substantially more annual claims; yet per-patient expenditures were similar, reflecting reliance on lower-cost outpatient KM services, notably acupuncture. Medication use peaked in 2012 and declined thereafter following national drug pricing reforms. Non-users received fewer but higher-cost prescriptions, particularly for pain and inflammatory medications.

Adults with coexisting T2DM and degenerative spinal disorders demonstrate increasing and complex healthcare needs driven primarily by chronic pain rather than glycemic management alone. KM users engage in high-frequency, multimodal outpatient care at lower unit cost, whereas non-users rely more heavily on tertiary WM services and higher-cost pharmaceuticals. Korea's dual healthcare system appears to support differentiated care pathways in this multimorbidity population. Findings underscore the need for integrated, longitudinal chronic care models that combine conservative pain management with diabetes care to reduce disability and long-term healthcare burden.

Adults with diabetes mellitus are at an increased risk of poor oral health; however, how individual- and community-level factors jointly contribute to oral health disparities in this population remains unknown. This study aimed to examine multilevel determinants of self-rated oral health among adults with diabetes in South Korea. A cross-sectional analysis was conducted using data from 21,996 adults aged ≥19 years with physician-diagnosed diabetes who participated in the 2021 Korea Community Health Survey. Self-rated oral health was dichotomized as good or poor. Individual- and community-level variables representing health behaviors, clinical care, social and economic factors, and physical environment were selected, guided by the County Health Rankings model. Multilevel logistic regression models accounted for clustering within administrative districts. At the individual level, poorer self-rated oral health was significantly associated with sociodemographic disadvantages (older age, male sex, not married, lower education, and economic inactivity), poorer general health status, adverse health behaviors (lifetime smoking and inadequate toothbrushing), and unmet dental care needs (all p < 0.05). At the community level, greater accessibility to public transportation was associated with better self-rated oral health (OR = 0.997, 95% CI: 0.993-1.000), whereas a higher prevalence of moderate-intensity physical activity was associated with poorer oral health (OR = 1.006, 95% CI: 1.000-1.011). Self-rated oral health among adults with diabetes is influenced by individual-level socioeconomic and behavioral factors alongside selected community-level contextual conditions. Multilevel strategies integrating oral health into chronic disease management are required, while addressing structural barriers to dental care.

Large-for-gestational-age (LGA) and macrosomic births pose significant maternal and neonatal health risks, particularly in low- and middle-income countries (LMICs), where access to care are often limited. Despite well-established associations between LGA, macrosomia, and various risk factors, the relative contributions of these factors remain underexplored in LMICs. This study aims to identify risks factors for LGA and macrosomia in LMICs, with an emphasis on modifiable ones, and quantify their population attributable fractions (PAFs).

A systematic review will be conducted across the following databases: MEDLINE, Scopus and ProQuest Central and regional databases (Africa Index Medicus, Index Medicus for South Asia and Latin America and Caribbean literature of health sciences). Eligible studies will include observational studies, reviews and interventional research conducted between 2000 and 2025 that report on prevalence or association of risk factors for large-for-gestational-age (LGA) and/or macrosomia births in low- and middle-income countries (LMICs). Data extraction will encompass study characteristics, prevalence/incidence estimates, risk factor distributions and measures of association. Quality assessment will be performed by two independent reviewers using the Newcastle-Ottawa Scale for observational cohort, case-control and cross-sectional studies. While Cochrane Risk of Bias Tool will be used for randomised controlled trials and a Measurement Tool to Assess Quality of Systematic Reviews 2 (AMSTAR-2) for systematic reviews and meta-analyses. Meta-analyses using a random-effects model, which accounts for population heterogeneity, will synthesise risk estimates for factors examined in three or more studies from LMICs, up-to-date meta-analysis including all relevant studies identified through our search. Population attributable fractions for individual and combined risk factors will be calculated.

This systematic review will use only previously published information. Ethical approval is therefore not required. The results will be submitted for publication in a peer-reviewed journal and the findings will be presented at international conferences to engage relevant stakeholders including policymakers and public health organisations in LMICs with the aim of informing the development of targeted interventions to reduce the burden of LGA and macrosomia births in the region.

In the management of gestational diabetes mellitus (GDM), the usual medical treatment requires frequent visits for glucose monitoring and insulin dose adjustment, and this imposes significant physical, psychological, and economic burdens on pregnant women. As mobile health platforms become increasingly integrated into diabetes care, telemedicine may help alleviate these burdens; however, evidence evaluating its effectiveness as a replacement for routine in-person GDM care remains limited.

This study aims to evaluate the impact of telemedicine on the quality of life and costs for patients with GDM requiring insulin therapy.

This single-center, 2-arm, randomized, open-label, parallel-group study included patients with GDM who started insulin injection therapy. Participants were randomized to either the telemedicine or standard face-to-face care groups for 10 (SD 2) weeks. The telemedicine intervention used a smartphone-linked platform that enabled the automatic transfer of glucose data from connected glucose meters and facilitated real-time video consultations. Primary end points included costs and patient satisfaction. Costs were assessed using claims data, transportation calculations, and wage-based productivity losses, while patient satisfaction was evaluated through changes in the Problem Areas in Diabetes Survey and Diabetes Therapy-Related Quality of Life questionnaire scores. Secondary outcomes included glycemic control and perinatal outcomes.

In total, 38 participants were included, with 18 assigned to the telemedicine group and 20 to the standard care group. Total costs (32,712, 95% CI 15,412-50,013 vs 59,202, 95% CI 42,603-75,800 Japanese yen; $284, 95% CI 134-435 vs $515, 95% CI 370-659, purchasing power parity [PPP]-adjusted; P=.01), direct non-health care costs (922, 95% CI -240 to 2084 vs 2561, 95% CI 1447-3676 yen; $8, 95% CI -2 to 18 vs $22, 95% CI 13 to 32 PPP-adjusted; P=.02), and indirect costs (8981, 95% CI -7119 to 25,082 vs 32,832, 95% CI 17,384-48,279 yen; $78, 95% CI -62 to 218 vs $285, 95% CI 151-420 PPP-adjusted; P=.01) reduced significantly in the telemedicine group compared with the standard care group. The improvements in the Problem Areas in Diabetes Survey (-7.6, 95% CI -13.7 to -1.4; P=.02) and Diabetes Therapy-Related Quality of Life domain 1 (10.5, 95% CI 0.9-20.1; P=.03) scores from the baseline were significantly greater in the telemedicine group than that in the standard care group. Nonetheless, glycemic control and frequency of perinatal complications were comparable between the 2 groups. Consultation time was similar across groups, suggesting no added workload for clinicians.

In this randomized trial, mobile health-enabled telemedicine safely replaced routine in-person visits for patients with GDM requiring insulin therapy. Telemedicine significantly reduced psychological and economic burdens without compromising glycemic or perinatal outcomes, demonstrating its value as a patient-centered and cost-efficient model of care. These findings support the broader implementation of mobile-based telemedicine approaches in GDM management.

Quality care for pediatric type 1 diabetes (T1D) requires frequent, multidisciplinary visits. Technological and clinical innovation have led to changes in T1D management, resulting in increasing data exchange required during these visits. Capturing comprehensive personal health and diabetes-related information discretely and integrating it into the clinical workflow is critical for optimal T1D care but is time-consuming. Time spent on data transfer often results in less time for holistic care and can lead to unmet needs for patients, families, and health care providers, as well as increased time pressures in clinic. To address this, the Children's Hospital of Eastern Ontario developed a caregiver proxy-reported questionnaire distributed via the MyChart patient portal, allowing families to input care information ahead of visits with the aim of dedicating more clinic time to personalized care. The launch of this tool, which integrates caregiver-entered information into the physician's documentation workflow, brings the opportunity to systematically evaluate its impact on care quality and efficiency, with potential implications for broader adoption.

Our objective is to evaluate the impact of a caregiver proxy-reported, electronic health record-integrated preclinic questionnaire (MyChart questionnaire) on the quality of care in a pediatric diabetes clinic, through measurement of its impact on caregiver-perceived quality of care compared to the standard of care using 2 validated measures of care quality. We also aim to explore the impact of the intervention on glycemic control and visit efficiency.

We conducted a single-center, parallel-group randomized controlled trial designed for 222 children with T1D. Participants were randomly allocated in a 1:1 ratio to either the intervention (MyChart questionnaire) or standard care. Our primary outcome is caregiver-perceived quality of care, as measured by the Patient's Evaluation of the Quality of Diabetes Care at 8 months, administered with caregivers serving as proxy respondents for patients. Secondary outcomes are the Patient's Evaluation of the Quality of Diabetes Care at 4 months and Perceived Quality of Medical Care at 4 and 8 months. Tertiary outcomes include glycemic control and physician-reported visit efficiency at 4 and 8 months. Analysis of covariance models will be used to assess changes between baseline and postintervention outcomes across treatment groups.

Recruitment for this study began in April 2023 and was completed in February 2024, with a total of 139 participants enrolled. Data collection has concluded, and the first results are expected in the spring of 2026.

This study is the first randomized trial to assess the impact of a caregiver proxy-reported, electronic health record-integrated, preclinic questionnaire distributed via a patient portal on caregiver-perceived quality of care in a pediatric care setting. The results will guide changes in health service infrastructure and delivery to enhance comprehensive data capture and improve care quality within and beyond pediatric T1D.

Multiple cardiometabolic indices have been proposed for prognostic assessment, yet their comparative performance in palliative care remains unclear. The triglyceride-glucose body mass index (TyG-BMI) integrates metabolic dysfunction with adiposity, but whether it outperforms traditional lipid-based, inflammatory, and nutritional indices requires systematic evaluation.

To comprehensively compare TyG-BMI against eleven established cardiometabolic indices for predicting sepsis, mechanical ventilation requirement, and 30-day mortality in palliative care patients, with specific focus on performance in diabetic subpopulations.

This retrospective cohort included 318 palliative care patients. Twelve indices were calculated: TyG-BMI (primary); lipid-based (AIP, CRI-I, CRI-II, Non-HDL, TG/HDL); inflammatory (NLR, PLR, SII, MHR); and nutritional (PNI, CAR). ROC analysis compared discriminative ability for sepsis, mechanical ventilation, and 30-day mortality. Subgroup analyses stratified by diabetes mellitus status were performed with interaction testing.

Of 318 patients (mean age 67.4 ± 14.8 years, 55% male), 121 (38.1%) had diabetes, 58 (18.2%) developed sepsis, 42 (13.2%) required mechanical ventilation, and 30 (9.4%) died within 30 days. TyG-BMI achieved the highest AUCs: 0.84 (95% CI 0.78-0.90) for sepsis, 0.82 (0.75-0.89) for ventilation, and 0.87 (0.82-0.92) for 30-day mortality-significantly superior to all comparator indices (p < 0.001). In multivariate analysis, TyG-BMI independently predicted mortality (OR 2.38 per SD, 95% CI 1.78-3.18, p < 0.001). In diabetic patients, TyG-BMI's discriminative ability was markedly enhanced (mortality AUC 0.92, 95% CI 0.87-0.97; OR 2.65, 95% CI 1.88-3.74, p < 0.001), while other indices showed minimal performance improvement (interaction p < 0.001).

TyG-BMI demonstrates superior prognostic performance compared to traditional cardiometabolic indices for predicting sepsis and 30-day mortality in palliative care, with exceptional discriminative ability in diabetic patients.

To investigate the changes in fetal cardiac function in pregnant women with well-controlled gestational diabetes mellitus (GDM) using a novel ultrasound technology named HOLO-PW. Secondly, we aim to evaluate the predictive ability of cardiac function parameters for adverse perinatal outcomes and establish an individualized nomogram.

This study included 122 pregnant women with well-controlled GDM and 256 pregnant women with normal blood glucose. Fetal cardiac function parameters were extracted based on the HOLO-PW technology. The differences between the 2 groups were analyzed. Subgroup analysis was performed in the GDM group according to the pregnancy outcome and fetal growth status. The effectiveness of cardiac function parameters in predicting adverse pregnancy outcomes in GDM was evaluated by receiver operating characteristic (ROC) curves. Independent predictors were identified through logistic regression with LASSO variable selection, and a nomogram was developed. The model's performance was evaluated with ROC analysis, calibration curves, and decision curve analysis (DCA).

Compared with the control cohort, the myocardial performance index (MPI), K index (KI), isovolumic contraction time (ICT), and isovolumic relaxation time (IRT) of left and right ventricles were increased in the fetuses of GDM cohort (p < .05). Compared with the appropriate for gestational age (AGA), the fetuses with abnormal growth in the GDM cohort presented significant differences in the cardiac function parameters (p < .05). The incidence of adverse pregnancy outcomes in the GDM cohort was higher than that in the control cohort. The cardiac function parameters of fetuses with adverse and normal perinatal outcomes significantly differed in the GDM cohort (p < .05). We also evaluated the predictive capacity of each heart function parameter for adverse pregnancy outcomes in GDM. The LMPI showed the strongest ability to predict adverse pregnancy outcomes with an AUC of 0.951 (95% CI: 0.909-0.993). A nomogram constructed with the 3 key predictors selected by LASSO regression (LMPI, LKI, and RIRT) demonstrated excellent discrimination, with an AUC of 0.960 (95% CI: 0.924-0.996). The model was well calibrated, and DCA indicated clinical utility.

Even under well-controlled glycemic conditions, fetal cardiac function is altered in GDM pregnancies. In this cohort, a model based on fetal cardiac function parameters showed good predictive performance for composite adverse perinatal outcomes. However, external validation is required before clinical implementation.

This study seeks to investigate the relationship between pericardial fat volume and the risk of developing type 2 diabetes mellitus (T2DM) and major adverse cardiovascular events (MACE).

The analysis included a cohort of 39, 125 participants from the UK Biobank. The associations between the mean estimate pericardial fat area (MEPFA), as measured by cardiac magnetic resonance imaging, and the incidence of T2DM and MACE were evaluated using multivariable Cox proportional hazards regression models and Kaplan-Meier survival curves.

There were 343 occurrences of new-onset T2DM and 1, 894 occurrences of new-onset MACE over a median follow-up period of 55 months. Compared with patients with MEPFA ≤ 13.80 cm², there was a significantly higher risk of new-onset T2DM (adjusted-HR: 2.09, 95% CI 1.38 to 3.18, P < 0.001) and MACE (adjusted-HR: 1.19, 95% CI 1.02 to 1.39, P = 0.027) in the highest MEPFA quartiles. The survival analysis further substantiated this discrepancy, with a log-rank test yielding P < 0.001. Participants exhibiting higher levels of MEPFA demonstrated poorer left ventricular morphology, systolic function, and global strain.

The findings indicated that elevated MEPFA levels were significantly and independently associated with the onset of T2DM and MACE. Preliminary results suggested that increased levels of pericardial fat might enhance the predictive capability for cardio-metabolic risk.

Type 2 diabetes mellitus (T2DM) is a recognized risk factor for mild cognitive impairment (MCI), yet the combined effects of T2DM and MCI on cerebral metabolism and neural activity remain poorly characterized. Fifty-four participants were categorized into four groups based on the presence of T2DM and MCI. Simultaneous positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) was used to assess cerebral glucose metabolism and the fractional amplitude of low-frequency fluctuations (fALFF). The main and interactive effects of T2DM and MCI were evaluated using the two-way analysis of variance. Partial correlation analyses were conducted to examine the relationships between clinical variables and cognitive scores and neuroimaging measures. Changes in glucose metabolism in the T2DM-MCI group were primarily attributable to T2DM, with significant alterations observed across frontal, occipital, and temporal lobes, as well as subcortical areas. Both main and interactive effects of T2DM and MCI were identified for fALFF. A synergistic interaction between T2DM and MCI was found specifically in the right amygdala, where their combined presence was associated with amplified intrinsic neural activity. Moreover, in the right angular gyrus (ANG), T2DM emerged as the predominant factor underlying concurrent reductions in glucose metabolism and fALFF. Clinically, fALFF in the left superior frontal gyrus-medial orbital showed a significant negative correlation with Montreal Cognitive Assessment scores in both MCI and T2DM-MCI groups, while fALFF in the right amygdala was positively correlated with Mini-Mental State Examination scores in the T2DM-MCI group. This PET/fMRI study establishes T2DM as a key driver of coupled metabolic and functional deficits in the right ANG and reveals a synergistic interaction with MCI that amplifies neural activity in the amygdala. These findings position the ANG and amygdala as potential early biomarkers for T2DM-related cognitive decline, offering new insights into mechanisms and potential therapies.