Diabetes mellitus is a global health issue, affecting over 6.2% of the population. Effective management of type II diabetes mellitus (DM II) depends largely on patients' knowledge, attitudes, and practices (KAP). This study has examined how demographic and clinical factors influence KAP among DM II patients in Punjab, India, aiming to identify knowledge gaps and behavioral trends.

A cross-sectional study was conducted from February 2023 to July 2024 across three outpatient clinics in Punjab. A total of 500 patients were recruited using non-probability purposive sampling. Data were collected using a pre-validated questionnaire and analyzed through SPSS software. KAP scores were assessed and categorized into poor, fair, or good, with multiple linear regression used to identify significant predictors.

Among the 500 participants (197 females, 303 males), demographic and clinical factors significantly influenced KAP scores (p<0.05). Higher scores were associated with males, married individuals, those with higher educational attainment, health insurance, and regular clinic visits. Education was a key predictor of improved KAP across all domains. Conversely, poor scores were linked to lower education levels, absence of health insurance, and limited physical activity. Gender disparities were observed, with males displaying better knowledge and attitudes, while females exhibited higher practice scores.

This study has highlighted disparities in KAP among DM II patients in Punjab, emphasizing the critical role of education, healthcare access, and physical activity. Targeted interventions, community-based educational programs, and policy-driven improvements in healthcare accessibility are essential to bridge knowledge gaps, reshape attitudes, and foster positive practices. These findings can guide the development of tailored strategies for diabetes management, ultimately improving health outcomes and quality of life for affected individuals.

Diabetic cardiomyopathy in type 2 diabetes mellitus (T2DM) often progresses silently, manifesting as diastolic dysfunction or subtle systolic impairment despite preserved ejection fraction (EF). Detecting these changes early is critical to prevent symptomatic heart failure. This study assessed the prevalence of left ventricular (LV) diastolic dysfunction and impaired global longitudinal strain (GLS) in T2DM patients with preserved EF and identified related risk factors.

We performed a cross-sectional study of 232 adults with T2DM and EF > 50% at a tertiary hospital. Standard transthoracic and speckle-tracking echocardiography were used to evaluate LV diastolic function and GLS. Logistic regression identified predictors of myocardial dysfunction.

LV diastolic dysfunction was found in 53.9% of patients, while 13.4% showed impaired GLS (>-17.9%). Independent predictors of diastolic dysfunction were age ≥ 60 years (OR = 2.51, 95% CI: 1.25-5.07, p = 0.010) and diabetes duration of 5-10 years (OR = 3.06, 95% CI: 1.46-6.40, p = 0.003). Reduced GLS was independently associated with male sex (OR = 2.45, p = 0.040) and the presence of diastolic dysfunction (OR = 3.14, p = 0.010).

Subclinical myocardial dysfunction is common in Vietnamese T2DM patients with preserved EF. Both diastolic dysfunction and reduced GLS may occur independently or together, influenced by age, sex, and diabetes duration. Incorporating GLS into echocardiographic evaluation may enhance early detection and support tailored cardiovascular risk management in this high-risk group.

Introduction: This study will explore the effectiveness of current extracorporeal shockwave therapies in ulcer healing in diabetic foot disease compared to the standard of care. Methods: The systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. The electronic databases WoS, EMBASE, MEDLINE Complete, CINAHL Complete, Academic Search Ultimate, AMED-The Allied and Complementary Medicine Database, Scopus and PubMed searched for the outcome rate of complete ulcer healing. The risk of bias assessment was conducted using the tool recommended by the Cochrane Collaboration (Robvis Tool). Statistical analysis included the individual and combined result of the studies, heterogeneity test, the effect size, sensitivity analysis, and publication bias tests. Results: Eight randomized controlled trials (RCTs) with a total of 672 patients were included in this study. This meta-analysis showed a higher rate of complete ulcer healing in groups receiving extracorporeal shockwave therapies (OR = 2.747 [1.965, 3.841], p < 0.01, I² =0.02) compared to control groups. Conclusions: In conclusion, the results of this meta-analysis show that extracorporeal shockwave therapies, when used as an adjunctive treatment, demonstrate significantly higher ulcer healing rates compared to standard of care. Extracorporeal shockwave therapies should be taken into account as a valuable adjunct to standard care for diabetic foot ulcer treatment.

Visceral adiposity is a pivotal pathogenic driver of type 2 diabetes mellitus (T2DM) and its vascular complications. We performed two-sample Mendelian randomization (MR) analyses to examine the causal relationships between visceral adipose tissue (VAT) accumulation and diabetes complications. Single nucleotide polymorphisms (SNPs) specific to VAT accumulation were identified through large-scale genome-wide association studies (GWAS) at genome-wide significance (P < 5 × 10^-8), using the inverse variance weighted (IVW) approach for primary analyses. The MR-IVW random-effects model revealed significant associations between genetically predicted VAT accumulation and increased risks for T2DM complications: multi-organ (OR = 2.58, 95% CI, 2.21-3.03), neurological (OR = 3.58, 95% CI, 2.34-5.47), retinopathy (OR = 2.90, 95% CI, 2.21-3.81), nephropathy (OR = 3.14, 95% CI, 2.23-4.45), and peripheral vascular (OR = 3.32, 95% CI, 2.31-4.76). Consistency across complementary MR methods supported the causal inference. This study provides genetic evidence that VAT accumulation is causally associated with increased risk of multiple T2DM complications, including neurological, ocular, kidney, and peripheral vascular outcomes. Future research should prioritize mechanistic studies to elucidate VAT-driven inflammatory and lipotoxic pathways in diabetic complications.

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among women with type 2 diabetes (T2DM). The interplay between sex-specific biological factors, social determinants, and environmental exposures amplifies cardiometabolic risk across the female life course.

This manuscript explores how socioeconomic disparities, environmental pollution, chronic stress, food insecurity, and climate change synergistically increase the burden of T2DM and cardiovascular complications in women, and reviews potential preventive interventions including dietary strategies.

A comprehensive narrative review was conducted, synthesizing current evidence on the exposome, social inequities, environmental insults, and evidence-based lifestyle interventions that contribute to or mitigate the development and progression of T2DM and CVD in women.

Lower socioeconomic status, limited education, housing instability, and inadequate access to healthcare and nutritious foods profoundly affect T2DM management and CVD prevention in women. Concurrently, exposure to air pollutants (PM_2.5, NO₂, O₃), climate change-induced food insecurity, and heat-related stress further exacerbate insulin resistance, systemic inflammation, and vascular dysfunction. Life transitions such as gestational diabetes mellitus and menopause further magnify these risks. Current healthcare models insufficiently address these multilayered factors.

Effective cardiovascular prevention in women with T2DM requires a life-course approach that integrates biological transitions with environmental and social determinants to deliver sex-sensitive, stage-specific strategies.

The objective of this study is to establish an evidence-based protocol for managing high-risk neurogenic bladder (NB) in Chinese patients with T2DM, integrating risk stratification to standardize clinical practice in China region.

Through a two-round Delphi consensus process involving 20 national experts and evidence synthesis from 13 clinical guidelines and a systematic review, we developed China's first hierarchical NB risk stratification system. Quantitative analyses incorporated authority weighting (0-1 scale), coordination coefficients, and Kendall's concordance testing across 81 systematically validated clinical indicators.

High expert engagement persisted through both rounds (Round 1: 90% response rate; Round 2: 94.7%). Consensus levels demonstrated progressive improvement, with primary indicators achieving the most substantial enhancement (Kendall's W: 0.289 vs. 0.391, 35.3% improvement). Secondary and tertiary indicators showed 5.5% and 27.4% increases respectively (all p<0.01). The final protocol reached a consensus, including 4 primary indicators, 17 secondary indicators, and 60 tertiary indicators.

This consensus-driven framework provides innovative clinical tools for NB risk stratification in diabetes care. Its three-tiered structure-integrating policy recommendations, clinical algorithms, and bedside assessment protocols-significantly improves patient management and outcomes, serving as a valuable resource to guide clinical practice.

To investigate the effect of short-term intensive insulin (STII) pump therapy on serum endotrophin (ETP) levels in patients with newly diagnosed type 2 diabetes, examine the relationship between serum ETP levels and insulin resistance (IR).

Our study recruited 40 patients with newly diagnosed type 2 diabetes and 40 healthy controls. First, we compared the serum ETP levels between patients with newly diagnosed type 2 diabetes and controls. Second, 40 patients with newly diagnosed type 2 diabetes underwent two weeks of STII pump therapy.

Higher serum ETP levels were observed in patients with newly diagnosed type 2 diabetes compared to controls. After 2 weeks of STII pump therapy, serum ETP levels significantly attenuated in patients with newly diagnosed type 2 diabetes. Both before and after treatment, serum ETP exhibited a significant positive correlation with homeostasis model 2 assessment of IR (HOMA2-IR). Multiple linear regression analysis revealed that changes in ETP levels (δ-ETP) were independently associated with changes in HOMA2-IR (δ-HOMA2-IR).

Serum ETP serves as a risk factor for type 2 diabetes and correlates with insulin resistance index. STII contributed to reducing the heightened inflammatory response in individuals with type 2 diabetes.

Cognitive impairment is a frequent complication of type 2 diabetes (T2DM). Global longitudinal strain (GLS), an echocardiographic marker of subclinical left ventricular (LV) systolic dysfunction, has been associated with adverse cardiovascular outcomes in T2DM. However, its relationship with cognitive performance remains unexplored. The aim was to investigate the association between GLS and cognitive function in patients with T2DM.

We prospectively enrolled 234 T2DM patients without hemodynamically significant carotid stenosis, history of stroke or severe hypoglycemia. Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and GLS measured via speckle-tracking echocardiography. Multivariable linear regression models were used to evaluate associations between GLS and RBANS scores. Sensitivity analyses excluded individuals with coronary heart disease (CHD), atrial fibrillation (AF), or LV ejection fraction (LVEF) <50%.

The mean RBANS total score was 96.7 ± 17.1; 19.7% of participants scored <80, indicating borderline/impaired cognition. Mean GLS was -19.23 ± 2.59%, with 29.1% of patients showing subclinical LV dysfunction (GLS ≥ -18%). Unlike LVEF, impaired GLS (≥ -18%) was associated with lower RBANS total scores. This association remained significant after excluding individuals with CHD, AF, or LVEF<50%, and after adjusting for age, sex, education, lifestyle factors, metabolic and hemodynamic parameters. Educational attainment modified the association, with stronger GLS-cognition links in participants with lower education. The relationship was unaffected by adjustment for markers of inflammation and endothelial dysfunction.

In patients with T2DM, impaired GLS is independently associated with reduced cognitive performance, even in patients with normal LVEF.

Arterial stiffness is an early indicator of atherosclerosis. The blood urea nitrogen to serum albumin ratio(BAR) is associated with poor prognosis in several chronic diseases. However, the relationship between BAR and arterial stiffness in type 2 diabetes mellitus (T2DM) patients has not been extensively studied. This study aimed to examine the relationship between BAR and brachial-ankle pulse wave velocity (baPWV), an indicator of arterial stiffness in patients newly diagnosed with T2DM.

A total of 510 adult patients newly diagnosed with T2DM were enrolled between January 2021 and December 2023. BAR was calculated by blood urea nitrogen/albumin ratio. A baPWV ≥1400 cm/s was defined as arterial stiffness. A linear regression model and logistic regression model were used to assess the relationship between BAR and baPWV after adjusting for potential confounders.

The average age of the patients in this study was 45.66 ± 10.18 years, and 78.8% were male. The mean baPWV was 1469.15 ± 295.82 cm/s, and 50.8% of patients exhibited arterial stiffness. The prevalence of arterial stiffness increased significantly across ascending BAR tertiles (T1: 39.3%, T2: 51.7%, T3: 61.4%; p = 0.002). Linear correlation analysis revealed a positive correlation between BAR and baPWV. According to the fully adjusted logistic regression model, each unit increase in the lnBAR was associated with a 3.452-fold greater risk of arterial stiffness[95% CI(1.586, 7.513), p = 0.002]. Compared to the lowest tertile (T1), participants in the middle (T2) and highest (T3) BAR tertiles had a significantly greater risk of arterial stiffness [T2: OR = 1.915, 95% CI (1.016, 3.609), p = 0.044; T3: OR = 2.064, 95% CI (1.051, 4.054), p = 0.035]. Stratified analyses demonstrated consistent positive correlations between BAR and baPWV across sex and BMI subgroups, as well as in individuals aged < 50 years.

BAR levels were independently and positively correlated with baPWV in Chinese patients with newly diagnosed T2DM.

Diabetic nephropathy (DN) is a prevalent and serious microvascular complication of diabetes that poses a significant public health challenge and negatively impacts quality of life in China. The objective of this study was to evaluate the disease burden of type 2 diabetic nephropathy in China and to predict the trend of this burden over the next 15 years.

This study used the Global Burden of Disease (GBD) system to analyze trends in the disease burden of type 2 DN in China between 1990 and 2021. The study utilized prevalence, incidence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) for DN, along with their 95% uncertainty intervals (UIs). Secondly, joinpoint Regression, age-period-cohort, and decomposition analyses were employed to estimate the contribution of epidemiological changes to the DN burden. We used the inequality slope index (SII) and concentration index to assess absolute and relative cross-country inequalities in 1990 and 2021. Furthermore, Bayesian age-period-cohort (BAPC) models were employed to predict the future burden of DN from 2022 to 2036.

From 1990 to 2021, the burden of DN in China continued to increase, reaching a total of 20,911,520 cases. The age-standardized prevalence rate (ASPR) was 1,053.92 per 100,000 people. The age-standardized incidence rate (ASIR) was 16.29 per 100,000 people, and the age-standardized death rate (ASDR) was 5.64 per 100,000 people. Age-standardized disability-adjusted life years (DALYs) were 122.15 per 100,000 people. In 2021, the overall burden of DN continued to increase, with the effect of age strengthening with increasing age. The incidence rate showed a sustained upward trend. Decomposition analysis revealed that population ageing was the main cause of the increased burden of DN in China. Predictive Analysis suggests that the ASIR will continue to rise from 2022 to 2036, while the ASDR will decrease.

DN in type 2 diabetes mellitus places a significant burden on China's healthcare system, primarily due to an ageing population. The incidence rate is expected to increase over the next 15 years before declining. Given China's large population and severe ageing, implementing a tiered prevention and control strategy, strengthening health education, and promoting early, effective prevention are imperative to alleviating the disease burden in China.