To explore reasons for medication non-adherence among rural patients with diabetes and/or hypertension and to understand how health-system, personal and socio-cultural factors shape adherence behaviour.

Qualitative study using individual in-depth interviews SETTING: A Rural Health and Training Centre in Thiruvallur district, Tamil Nadu, India.

15 adults aged ≥30 years with diabetes and/or hypertension for at least 1 year were purposively recruited from the non-communicable disease clinic. Interviews were conducted in Tamil, audio-recorded, transcribed verbatim and translated into English. Two researchers independently coded the transcripts. Sample adequacy was guided by information power and concurrent assessment of code saturation.

4 themes and 12 subthemes described health-system constraints, everyday routines and treatment beliefs, family relationships and emotional burden and experiences and strategies that reinforced medication use. Medication interruption occurred through three overlapping routes: structurally constrained interruption related to supply, affordability or access; unintentional interruption when routines were disrupted by work, travel or caregiving; and intentional modification based on perceived harm, symptoms or treatment need. Participants could move between interruption and renewed medication-taking as circumstances, emotional states and perceptions of risk changed. Family relationships could both support and hinder medication-taking, while symptoms and experienced or witnessed complications sometimes prompted re-engagement.

Medication-taking was dynamic rather than a fixed patient characteristic. Structural, unintentional and intentional interruptions require different responses. More flexible medicine supply, structured counselling that checks understanding, attention to household influences and fasting practices and recognition of emotional strain may better support long-term medication use in rural primary care.

Despite WHO recommendations for integrated care since 2011, implementation of tuberculosis (TB) and diabetes mellitus (DM) care integration remains poorly documented in sub-Saharan Africa. We assessed integration and identified implementation barriers across healthcare facilities in Lagos, Nigeria.

Cross-sectional survey of 100 facilities providing TB or diabetes services in Lagos State, January to June 2019, drawn by stratified random sampling from a frame of 237 facilities. Structured questionnaires based on WHO guidelines assessed integration measures, and twelve focus group discussions explored barriers. We used chi-square tests and multivariable logistic regression.

Among 100 facilities (response rate 67%), 8 (8.0%, 95% CI 4.0 to 15.1) had surveillance systems for diabetes screening in TB patients and 4 (4.0%, 95% CI 1.5 to 9.9) for TB screening in diabetes patients; formal screening guidelines were present in 12 (12.0%) and 7 (7.0%). Diagnostic capacity was largely available but unused: chest X-ray was present in 78% of facilities but systematically used in 42%. Staff trained in both conditions was the strongest facilitator (adjusted OR 6.2, 95% CI 2.9 to 13.4) and resource constraints the strongest barrier (adjusted OR for integration 0.20, 95% CI 0.11 to 0.36). Integrating facilities detected 2.4 more diabetes cases and 1.9 more TB cases per month, with higher TB treatment success (89.2% versus 83.4%, p=0.014) and diabetes control (48.7% versus 41.3%, p=0.029). The incremental cost-effectiveness ratio was US$1121 per quality-adjusted life-year in 2025 dollars.

In this 2019 pre-pandemic survey, TB and diabetes integration in Lagos was critically inadequate, with fewer than 15% of facilities implementing formal screening protocols. Substantial diagnostic capacity was present but underused, and joint staff training showed the strongest positive association with integration. These findings provide a structural baseline for post-pandemic reassessment and suggest that training should be accompanied by joint registers, supervision indicators and sustainable financing.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease and a major hepatic manifestation of metabolic syndrome. It is closely linked to obesity and type 2 diabetes mellitus. While many patients display a steatotic liver, some progress to steatohepatitis, fibrosis, and cirrhosis, increasing the risk of hepatocellular carcinoma (HCC). Current management targets metabolic risk factors. Metabolic and bariatric surgery (MBS) has therefore emerged as both an obesity treatment and a therapeutic option for MASLD. This narrative review summarizes evidence on clinical outcomes, efficacy, and mechanisms. Histology-based studies show MASLD resolution and relevant fibrosis regression after MBS, with durable benefits. Comparative studies indicate superiority over lifestyle intervention and conservative treatment, while direct comparisons with modern drugs (e.g. GLP-1 agonists) remain limited. Mechanistic studies suggest that MASLD remission by MBS is driven through a combination of sustained weight loss and surgery-specific effects on hepatic lipid metabolism, mitochondrial function, glucose metabolism, incretin and bile acid signalling, adipose tissue biology, and the gut-liver axis. Emerging evidence suggests fewer liver-related events and lower HCC incidence, with potential benefits in selected high-risk patients. In conclusion, MBS is not merely a weight loss intervention, but a disease-modifying, multi-system metabolic therapy with direct hepatic effects.

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become a major global health challenge, largely driven by the increasing prevalence of obesity and type 2 diabetes mellitus. The disease spectrum ranges from isolated steatosis to metabolic dysfunction-associated steatohepatitis (MASH) with progressive fibrosis. Advanced fibrosis substantially increases the risk of cirrhosis, hepatocellular carcinoma, and cardiovascular complications, thereby contributing significantly to morbidity and mortality.Although lifestyle modification remains the cornerstone of therapy, pharmacological treatment is gaining importance in patients with progressive disease or high-risk profiles. Advances in the understanding of MASLD pathophysiology have enabled the development of targeted therapies addressing hepatic lipid accumulation, insulin resistance, inflammation, and fibrogenesis. Promising clinical data have been reported for resmetirom, semaglutide, tirzepatide, survodutide, lanifibranor, and fibroblast growth factor-21 analogues including efruxifermin, pegozafermin, and efimosfermin.This review summarises current and emerging diagnostic and therapeutic strategies and provides practical guidance for clinical management. In addition, a structured treatment algorithm for non-cirrhotic MASLD (F0-F3), restricted to therapies currently available in Europe and stratified according to diabetes status and fibrosis stage, is proposed as an evidence-based tool for routine clinical practice.

One in 4 young adults has prediabetes, and improving diet is a key step to lowering the risk of diabetes. Existing standard-of-care diet approaches show short-term efficacy but lack long-term effectiveness, including in young adults. Greater fiber intake is associated with a reduced risk of diabetes; however, fiber is not well targeted using existing interventions. Many young adults may be reluctant to consume fiber given the coexistence with digestible carbohydrates and concerns over gastrointestinal effects. Targeting these factors more explicitly may improve uptake and lower diabetes risk, and doing so via a mobile health (mHealth) intervention may be particularly responsive to young adult demands.

This study aims to establish and preliminarily test the feasibility of a highly innovative and scalable mHealth-based intervention to improve fiber intake among young adults with prediabetes.

This single-arm feasibility study includes 2 phases to preliminarily test an mHealth-based fiber intervention (phase 1) and elucidate factors that impact sustained behavior change and fiber intake after intervention end using ecological momentary assessment (EMA; phase 2). The intervention is 3 months in length and features daily EMAs with responsive text-based coping messages to target key predictors of fiber intake. EMAs will also be paired with brief (ie, <1 minute) educational videos on fiber delivered once per day. Participants will also receive weekly home-delivered high-fiber food packages and wear a continuous glucose monitor at 2 time points during the intervention as a form of biofeedback. At the baseline and postintervention time points, fasting blood glucose, hemoglobin A_1c, and insulin resistance (Homeostatic Model Assessment of Insulin Resistance) will be assessed. After the postintervention time point, participants will continue with daily EMAs to assess factors associated with sustained fiber intake. Diet will be assessed using Automated Self-Administered 24-hour dietary recalls at the baseline and postintervention time point and after the phase 2 EMA.

This study was initiated in July 2025. As of March 2026, the mHealth intervention content is being built, with app completion and trial enrollment both slated to begin in April 2026.

The results of this study will provide pivotal evidence on the utility of a fiber-focused intervention delivered via mHealth with biofeedback and home-delivered foods to lower the risk of diabetes in young adults with prediabetes.

The recurrence of acute coronary syndrome (ACS) represents a major public health issue due to its significant contribution to cardiovascular morbidity and mortality. Despite therapeutic advances in interventional cardiology, a substantial proportion of patients remains at risk of recurrent ACS. The objective of our study was to identify predictive factors for ACS recurrence.

We conducted a single-center, observational, retrospective, etiological study between January 2017 and December 2023. A total of 224 patients were included, of whom 107 experienced recurrent ACS, while 117 presented with only one episode. Clinical and paraclinical data were collected from medical records and univariate and multivariate statistical analyses were performed.

The mean age of the study population was 60.01±10.69 years, with a male predominance (79%). Statistical analyses showed that patients with recurrent ACS had a significantly higher number of cardiovascular risk factors (3.89±1.36 vs 2.91±1.17; OR=3.43, 95% CI: 1.79-6.57; P<0.001), particularly smoking (83.2% vs 70.9%, OR=2.03; 95% CI: 1.07-3.87; P=0.015), diabetes (60.7% vs 45.3%, OR=1.87; 95% CI: 1.10-3.18; P=0.021), and hypertension (51.4% vs 36.8%, OR=2.07; 95% CI: 1.22-3.55; P=0.027). Moreover, multivessel disease (57.9% vs 42.7%, OR=1.84; 95% CI: 1.08-3.13; P=0.035), low HDL cholesterol levels (0.31 vs 0.35g/L, OR=2.07; 95% CI: 1.04-4.14; P=0.006), elevated C-reactive protein levels (14.75 vs 8.2mg/L, OR=2.10; 95% CI: 1.11-3.98; P=0.018), implantation of two or more stents (40% vs 13.6%, OR=4.05; 95% CI: 2.04-8.03; P<0.001), suboptimal angioplasty outcomes (9.5% vs 1.9%, OR=2.13; 95% CI: 1.83-2.48; P=0.021), and poor medication adherence (50.5% vs 26.2%, OR=2.96; 95% CI: 1.68-5.17; P=0.001) were more frequent among patients with recurrent ACS. Multivariate analysis revealed that diabetes, elevated CRP levels, and implantation of two or more stents were independently associated with ACS recurrence.

This study identified predictive factors for ACS recurrence. Diabetes, inflammation, and multi-stenting were independently associated with recurrence. These results highlight the importance of strict management of metabolic and inflammatory factors, as well as the optimization of revascularization strategies.

Type 1 diabetes mellitus (T1DM) is a chronic disease characterized by progressive autoimmune-mediated destruction of pancreatic beta cells. With the establishment of the three-stage classification system for T1DM and the advancement of early screening, disease-modifying therapies (DMT), represented by immunotherapy, are driving a shift in clinical management from "insulin replacement" to "etiological intervention". This guidance statement was jointly developed by adult and pediatric endocrinology experts and is intended for clinical endocrinologists engaged in the diagnosis and management of T1DM. The guidance systematically reviews the immune pathogenesis of T1DM, disease staging, and the mechanisms of action and development progress of five categories of immunotherapeutic agents. It further elaborates on the eligible patient populations, pre-treatment assessment, dosing regimens, adverse event management, and follow-up strategies for teplizumab in patients with stage 2 T1DM. This insight aims to provide clinicians with standardized references for the application of DMT and immunotherapy in clinical practice, promote precision medicine, and improve patient outcomes.

Islet xenotransplantation is a strategy for treatment of Type 1 Diabetes, but immune-mediated rejection limits graft survival. This study investigated a strategy with flow cytometry-based immune monitoring to evaluate immunosuppressive therapy and provide indicators of graft rejection.

Porcine neonatal islet cell clusters (NICC) from GTKO-hCD55-hCD59 transgenic pigs were transplanted into streptozotocin-induced diabetic baboons (n = 10). Recipients received anti-CD2 induction with anti-CD154, Belatacept, and full-dose (n = 7) or reduced/no dose Tacrolimus (n = 3). Leukocyte subsets and activation status were monitored using multiplex flow cytometry. Graft function was assessed by blood glucose measurements, porcine C-peptide ELISA, and histological analysis.

Porcine C-peptide was detected in all recipients. Seven animals receiving full-dose Tacrolimus maintained NICC function for up to 675 days, whereas three experienced acute rejection within two months. Flow cytometry generated absolute leukocyte counts equivalent to standard full blood counts (Deming regression slope 0.91-1.03, p<0.001), while requiring less blood (50 µl vs ∼500 µl) and processing time (50±15 vs 150±30 min). Anti-CD2 treatment significantly reduced unoccupied surface CD2 on circulating T cells (mean 73.21%, range 55.26-91.16%, p<0.001). Long-term graft survival was associated with greater first-month T-cell suppression (36.47%, 13.35-50.75%) than acute rejection (176.28%, 171.26-181.31%). Following immunosuppression withdrawal, lymphocyte counts increased by 40%-142% in all recipients. Multiplex immunofluorescence of endpoint grafts from these IS-free animals revealed cell-mediated destruction with increased lymphocyte infiltration and activated cytotoxic CD8⁺ T cells.

Multiplex flow cytometry provides a reliable method for immune monitoring in islet xenotransplantation and may help predict graft rejection.

Restenosis after carotid revascularisation remains a clinical concern, yet predictors of restenosis after carotid endarterectomy (CEA) and carotid artery stenting (CAS) are still incompletely defined. This study aimed to identify clinical and procedural predictors of restenosis after CEA and CAS.

This was a single centre retrospective cohort study. All patients who underwent primary CEA or CAS between January 2011 and December 2024 were included. The primary outcome was severe restenosis, (≥ 70% restenosis and/or re-intervention for restenosis > 30 days). The secondary outcome was any restenosis (≥ 50%). Multivariable Cox proportional hazards models were constructed to identify independent predictors, including separate analyses for CEA and CAS.

Included were 1 011 patients (744 CEA; 267 CAS), with mean follow up of 2.9 years. Severe restenosis occurred in 5.5% of patients, with similar rates after CEA and CAS. Any restenosis occurred in 10.3% (10.7% CEA vs. 9.0% CAS). In the overall cohort, women had a higher hazard of developing severe restenosis (hazard ratio [HR] 1.77, 95% confidence interval [CI] 1.03 - 3.02), whereas greater ipsilateral symptom severity at presentation was associated with a lower hazard of both severe (HR 0.73, 95% CI 0.55 - 0.95) and any restenosis (HR 0.67, 95% CI 0.55 - 0.82). CAS was associated with a lower hazard of any restenosis compared with CEA (HR 0.41, 95% CI 0.24 - 0.68). In procedure specific analyses, diabetes mellitus was significantly associated with any restenosis after CEA, while smoking was associated with restenosis after CAS at both thresholds.

Severe restenosis occurs in approximately 5% of patients following both CEA and CAS. Predictors differed by procedure: diabetes mellitus was associated with restenosis after CEA, whereas smoking after CAS. Higher ipsilateral symptom burden at presentation was consistently associated with a lower risk of restenosis. These findings provide insight into procedure specific risk profiles and may inform future risk stratified follow up studies.

Despite major technological advances, contemporary drug-eluting stents (DES) remain intrinsically limited by the permanent implantation of a metallic prosthesis, exposing patients to chronic vessel caging, impaired vasomotion, neoatherosclerosis, and persistent risks of restenosis and late thrombotic events. These limitations have renewed interest in implant-sparing coronary revascularization based on the "leave-nothing-behind" concept. Drug-coated balloons (DCB) have emerged as the most mature implant-free technology, with robust evidence supporting their use beyond in-stent restenosis and small-vessel disease to increasingly complex clinical scenarios, including chronic total occlusions, diffuse coronary artery disease, bifurcation lesions, diabetes mellitus, and patients at high bleeding risk. Successful DCB angioplasty, however, depends on meticulous lesion preparation, tailored plaque modification, and selective intracoronary imaging to optimize procedural outcomes. In parallel, new-generation bioresorbable scaffolds (BRS) and bioadaptors are revitalizing the concept of temporary vessel scaffolding. By incorporating thinner struts, improved mechanical properties, enhanced biocompatibility, and restoration of vascular physiology following resorption or uncaging, these technologies aim to overcome the thrombotic limitations that hindered first-generation devices. This review provides a comprehensive overview of the biological rationale, current clinical evidence, procedural optimization, and future perspectives of implant-sparing PCI, highlighting the ongoing transition from a device-centered strategy to a personalized, morphology-guided approach in which lesion characteristics, vascular biology, and patient-specific risk drive revascularization decision-making.