Māori experience a disproportionate burden of Type 2 diabetes mellitus (T2DM), with ongoing inequities in access, continuity, and outcomes of care. While culturally responsive approaches are recognised as important, limited qualitative research centers kaumātua (Māori elders aged 50 years and over) voices in evaluating current diabetes care and informing service redesign.

To explore kaumātua and Māori health providers' perspectives on the cultural responsiveness, strengths, and limitations of current T2DM management in New Zealand, and to examine perceived opportunities for community-embedded and mobile models of care.

A qualitative study informed by Kaupapa Māori principles was conducted using a wānanga-based (collective forum for discussion and knowledge-sharing) approach. Kaumātua living with T2DM were purposively recruited through a Māori community organisation. Collective kōrero (conversation/discussion) were audio-recorded and analysed using reflexive thematic analysis, interpreted through a Kaupapa Māori analytic lens. Reporting followed the Consolidated Criteria for Strengthening Reporting of Health Research Involving Indigenous Peoples (CONSIDER).

Seven kaumātua and Māori health providers participated. Current diabetes care was described as fragmented and insufficiently responsive to cultural and contextual needs. Effective care was grounded in whanaungatanga (relationships and connectedness), manaakitanga (care, respect, and dignity), whānau engagement, culturally safe spaces, and accessibility. Structural barriers, including transport challenges, financial pressures, and fragmented information systems, constrained continuity of care. Participants strongly endorsed a mobile, community-embedded diabetes service as a culturally appropriate approach to improving access, continuity, and equity.

Kaumātua perspectives highlight the need for relational, culturally grounded, and accessible diabetes care. Mobile, community-embedded models offer a promising pathway to address structural barriers while upholding mana, dignity, and whānau-centred care.

Prediabetes is a heterogeneous condition encompassing three glucose-defined phenotypes (isolated impaired fasting glucose [i-IFG], isolated impaired glucose tolerance [i-IGT], and IFG + IGT), with distinct pathophysiological mechanisms. This study assessed the associations of weight status (body mass index [BMI]), general adiposity (fat mass index [FMI]), total lean mass (lean mass index [LMI]), and body fat distribution (waist circumference [WC] and DEXA-derived appendicular, gynoid, abdominal and visceral adiposity) with prediabetes phenotypes.

This cross-sectional study included 3225 adults without diabetes who had complete data on fasting and 2-h plasma glucose, anthropometric measures (BMI and WC), and DEXA-derived measures (FMI, LMI, and percentages of total fat in appendicular, gynoid, abdominal and visceral regions) from the National Health and Nutrition Examination Survey 2011-2016. BMI and WC were classified according to WHO criteria. DEXA-derived measures were classified using sex-specific tertiles. Glycemic status was classified as normoglycemia, i-IFG, i-IGT, or IFG + IGT based on ADA criteria. Logistic regression and restricted cubic spline analyses were performed.

The weighted mean (SD) age was 37.16 (12.15) years, and 49.5% of participants were male. Overall, 59.6%, 29.1%, 4.2%, and 7.0% had normoglycemia, i-IFG, i-IGT, and IFG + IGT, respectively. Compared with individuals with normal BMI, those with overweight or obesity had higher odds of i-IFG (overweight: OR = 1.56 [1.19, 2.03]; obesity: OR = 2.73 [2.09, 3.56]) and IFG + IGT (overweight: OR = 2.81 [1.61, 4.91]; obesity: OR = 6.72 [4.03, 11.22]), whereas both underweight (OR = 3.22 [1.21, 8.58]) and obesity (OR = 2.57 [1.64, 4.04]) were associated with higher odds of i-IGT, indicating a U-shaped relationship between BMI and i-IGT (p_{non-linearity} = 0.006). Higher FMI and LMI were associated with higher odds of all three phenotypes (all p_T3vs.T1 < 0.05). Compared with normal WC, very-high-risk central obesity was associated with higher odds of all three phenotypes (all p < 0.05). Higher proportions of abdominal or visceral fat and lower proportions of appendicular or gynoid fat were associated with higher odds of i-IFG and IFG + IGT (all p_T3vs.T1 < 0.001). For i-IGT, only gynoid fat showed an inverse association (p_T3vs.T1 = 0.002).

Adiposity patterns differed across prediabetes phenotypes. These findings provide insights for tailoring intervention strategies by prediabetes phenotype to optimize diabetes prevention.

Chronic liver disease (CLD) is often accompanied by a variety of skin conditions, which may be related to the severity of the disease and to other systemic involvement. This study aimed to determine the prevalence and evaluate demographic and clinical predictors of cutaneous manifestations in patients with CLD.

The study was a hospital-based analytical cross-sectional study conducted at the Department of Gastroenterology and Hepatology, Lady Reading Hospital (Peshawar, PAK), from February 2025 to February 2026. Non-probability consecutive sampling was used to recruit a total of 238 patients with CLD. A structured pro forma was used to collect detailed demographic, clinical, dermatological, and laboratory data. The severity of CLD was assessed using the Child-Pugh classification, and cutaneous manifestations were diagnosed through standardized clinical dermatological examination. Associations between variables were assessed using the chi-square test, and independent predictors were identified using multivariable logistic regression analysis. Variables were selected based on univariate analysis and clinical relevance.

Cutaneous manifestations were present in 196 (82.35%) patients and absent in 42 (17.65%). The most common findings included pruritus in 154 (64.71%), jaundice in 147 (61.76%), xerosis in 118 (49.58%), and palmar erythema in 96 (40.34%) patients. Severity-wise, manifestations were significantly higher in Child-Pugh class C (91.78%) compared to class B (86.54%) and class A (63.93%) (p <0.001). Independent predictors of cutaneous manifestations included Child-Pugh class C (adjusted odds ratio (AOR) 3.95), hepatitis C virus infection (AOR 2.87), diabetes mellitus (AOR 2.11), male gender (AOR 1.72), and disease duration greater than five years (AOR 2.36).

Cutaneous manifestations are highly prevalent in patients with CLD and are significantly associated with disease severity and important clinical risk factors. These findings should be interpreted as associations rather than causal relationships. Future studies should use longitudinal multicenter designs to better establish temporal relationships and causal pathways between CLD progression and cutaneous manifestations. In clinical practice, routine dermatological examination should be incorporated into the assessment of CLD patients as a simple, low-cost tool to aid early recognition of disease severity and systemic involvement.

Background Acute kidney injury (AKI) in hospitalized adults is often framed as an unavoidable consequence of critical illness. Yet a substantial proportion emerges within a modifiable clinical space: exposure to nephrotoxic medications, iodinated contrast, hemodynamic stress, and delayed renal monitoring. This study evaluated whether high nephrotoxic exposure was associated with in-hospital AKI among adult inpatients after balancing measured baseline risk. Methods This prospective observational cohort study included adult inpatients admitted to general wards and intensive care units at Mamata Medical College and General Hospital, Khammam, India. From 1,500 admissions, 240 patients with high nephrotoxic medication exposure and/or iodinated contrast exposure were identified and matched 1:1 with 240 unexposed controls using propensity-score matching. Matching variables included age, sex, body mass index, diabetes mellitus, congestive heart failure, baseline serum creatinine, estimated glomerular filtration rate, blood urea nitrogen, and intensive care unit status. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria, primarily using serum creatinine changes. A sensitivity analysis excluded very mild Stage 1a AKI. The primary outcome was in-hospital AKI after the index date; secondary outcomes included AKI severity, Stages 2-3 AKI, time to AKI among AKI cases, in-hospital mortality, length of stay, vancomycin concentration patterns, and medication-specific AKI-overlapping exposure burden. Results After matching, baseline characteristics were generally balanced, although blood urea nitrogen remained modestly imbalanced. AKI occurred in 61 exposed patients and 38 controls, corresponding to 25.4% versus 15.8% and an odds ratio of 1.81 (95% CI, 1.15-2.85; p = 0.013). Severe AKI was numerically higher in exposed patients but did not reach statistical significance. After excluding Stage 1a AKI, clinically meaningful AKI remained more frequent in the exposed group, 17.5% versus 10.0% (OR, 1.91; 95% CI, 1.12-3.27; p = 0.024). Vancomycin, iodinated contrast, piperacillin-tazobactam, antivirals, and calcineurin/mammalian target of rapamycin (mTOR) inhibitors contributed prominently to AKI-overlapping exposure days. Maximum vancomycin concentrations were higher among patients who developed AKI, although reverse causality could not be excluded. Conclusion High nephrotoxic medication and/or iodinated contrast exposure was associated with a higher frequency of in-hospital AKI in matched adult inpatients. The association persisted after excluding minor creatinine-only events, supporting a clinically meaningful renal injury signal. These findings strengthen the need for nephrotoxin stewardship, early creatinine surveillance, dose adjustment, hydration optimization, and active multidisciplinary review when renal-risk medications are clinically unavoidable.

Medication compliance is crucial to patient care and clinical objectives. One of the healthcare system's primary challenges is patient non-adherence to medications. This study aims to evaluate medication adherence for diabetes mellitus during pregnancy. In this cross-sectional study, Saudi pregnant women either with diabetes or gestational diabetes mellitus (GDM) participated in self-reported antidiabetic medication adherence using the Moriskey adherence scale, MMAS-4, while attending their antenatal follow-up visits at a large tertiary hospital in Riyadh, Saudi Arabia. We collected data from 180 participants, 107 (59.4%) of them were in their 3rd decade of age (31-40). GDM constituted 46.1% of pregnant women, of whom 55.6% received insulin and 43.9% without comorbidities. The chi-squared test and two-way cross-tabulation showed that the type of diabetic medicine had a statistically significant effect (P = .04). Adherence to diabetes medication was also linked to A1C levels (P = .04). According to MMAS-4, 76 respondents (42.2%) had intermediate diabetes treatment adherence, 40% (n = 72) had high adherence, and 17.8% (n = 32) had low adherence. Saudi pregnant women exhibited inadequate medication adherence levels despite the provision of complimentary medications and extensive healthcare access at the health care facility. In order to identify patients who are not adhering to their drug regimens, antenatal clinics should include a validated medication adherence measure in all patient care plans.

A 19-year-old male with end-stage renal disease caused by vesicoureteral reflux, hypertension, and type 2 diabetes mellitus underwent preemptive kidney transplantation using his mother's left kidney. This was an ABO-incompatible kidney transplant between a recipient with blood type O and a donor with blood type B. Therefore, plasma exchange and rituximab administration were performed preoperatively as desensitization therapy. Immediately after vascular anastomosis, blood flow in the transplanted renal cortex was assessed using ultrasonography, which was deemed adequate. Nonetheless, the urine output did not increase. Ultrasound re-evaluation revealed an elevated vascular resistance index in the transplanted renal cortex, raising hyperacute rejection suspicion. Rejection therapy was initiated before vesicoureteral anastomosis. Because concomitant de novo thrombotic microangiopathy (dnTMA) was also suspected, anticoagulant therapy was initiated. By the end of the surgery, the velocity of the renal cortical blood flow had decreased, prompting immediate plasma exchange. Hemodialysis was performed on postoperative day (POD) 0 but was not required thereafter. Serum creatinine levels remained at around 5-6 mg/dL for some time; nevertheless, they began to decrease on POD15, finally improving to 1.36 mg/dL on POD 65. A renal biopsy performed 1 h after reperfusion revealed fibrin thrombi and inflammatory cell infiltrates in the glomerular capillaries (g1), resulting in the diagnosis of dnTMA due to hyperacute rejection. The cause of hyperacute rejection was possibly HLA-DP donor-specific antibody. This report describes a case in which the prompt treatment for dnTMA due to hyperacute rejection preserved graft function.

Immunonutritional impairment driven by chronic inflammation and metabolic dysregulation plays a significant role in the progression of diabetic kidney disease (DKD). The hemoglobin-albumin-lymphocyte-platelet (HALP) score is a biomarker reflecting immunonutritional status; however, its prognostic value in patients with advanced DKD remains uncertain.

In this retrospective cohort study, 348 patients with stage 3-4 chronic kidney disease (CKD) secondary to type 2 diabetes mellitus (eGFR 15-59 mL/min/1.73 m²) were included after screening 769 individuals (2012-2024). The primary endpoint was renal progression, defined as a ≥ 40% decline in eGFR or initiation of renal replacement therapy. HALP was initially categorized into tertiles to evaluate baseline differences. Subsequently, a ROC-derived cutoff was used to dichotomize patients into low- and high-HALP groups, followed by Kaplan-Meier and Cox regression analyses. Predictive performance was assessed using ROC analysis, and robustness was evaluated through subgroup analyses and 1:1 propensity score (PS) matching.

Renal progression occurred in 181 patients. HALP components and urine protein creatinine ratio (UPCR) differed significantly across tertile groups (p < 0.001 for components; p = 0.025 for UPCR). The ROC-derived cutoff was 34.15 (AUC 0.602; p = 0.001). After PS matching (n = 278), low-HALP group remained independently associated with an increased risk of renal progression (HR 1.627; p = 0.005). Subgroup analyses revealed no significant interaction, supporting the consistency of the findings across clinical strata.

The HALP score may serve as a simple, cost-effective and widely available adjunctive tool for risk stratification in patients with advanced DKD.

This study aimed to investigate the predominant pathogenic microorganisms, antimicrobial resistance patterns, and antibiotic sensitivity profiles of diabetic foot infections in the southern region of a province in central-eastern China, thereby providing evidence-based guidance for the rational use of antibiotics for treating foot infections in patients with diabetes.

A retrospective analysis was performed on the clinical data from patients with diabetic foot infections who were treated at a large tertiary hospital between 1 July 2019 and 31 July 2024. Wound specimens were collected for bacterial culture and antimicrobial susceptibility testing, and both clinical and microbiological data were analyzed.

A variety of pathogenic microorganisms, predominantly Gram-positive (G⁺) and Gram-negative (G^-) bacteria, were isolated. The top five pathogens identified were Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Streptococcus agalactiae (group B), and Proteus mirabilis. As the Wagner grade increased, there was a shift in pathogens from G⁺ to G^- bacteria, along with a rise in polymicrobial infections, primarily coinfections involving G⁺ and G^- bacteria. The G⁺ bacteria exhibited high resistance to penicillin and certain cephalosporins but remained highly sensitive to vancomycin and linezolid. G^- bacteria showed increased resistance to quinolones, carbapenems, and aminoglycosides while maintaining relative sensitivity to tigecycline and polymyxins. Fungal infections were highly sensitive to commonly used antifungal agents. Overall, significant variations in resistance to antimicrobials were observed among different strains, with some exhibiting notable multidrug resistance, underscoring the high risk of empirical monotherapy.

The issue of antimicrobial resistance in foot infections associated with diabetes mellitus is becoming increasingly severe. Clinical treatment should be guided by antimicrobial susceptibility testing to ensure rational antibiotic use, improve therapeutic outcomes, reduce the emergence of resistant bacteria, and lower recurrence rates.

This study aimed to investigate the relationship between serum metabolomic profiles and continuous glucose monitoring (CGM) metrics in adults with type 1 diabetes (T1D), given that glycaemic control differences influence distinct metabolic pathways.

In this cross-sectional study, 325 adults with T1D were evaluated. CGM metrics were derived from 14-day recordings. Participants were stratified by achievement of clinical glycaemic targets [time in range (TIR70-180) > 70%, coefficient of variation (CV) < 36%, and time below range (TBR < 70) < 5%] into "on-target" and "off-target" groups. Serum metabolomic profiles were quantified using proton nuclear magnetic resonance spectroscopy (1 H-NMR).

Among the 325 participants (46% female; mean age 41 ± 14 years; diabetes duration 20 ± 12 years), 57 (18%) achieved all clinical glycaemic targets. These patients had higher concentrations of glutamine, valine, and isoleucine, and lower lactate levels. TIR70-180 correlated negatively with lactate, Glyc B, and Glyc B H/W. Mean glucose was positively associated with IDL-C, IDL-TG, LDL-P, small LDL-P, Glyc A H/W, and lactate, and negatively with glutamine and acetone. Hypoglycaemia metrics were associated with small LDL-P, while glucose variability correlated with alanine [β: - 0.026 (95% CI: - 0.057 to - 0.008); P = 0.013]. In logistic regression analyses adjusted for duration of T1D, glutamine [Exp(B) = 0.993 (95% CI: 0.987-0.999), P = 0.022] and lactate [Exp(B) = 1.004 (95% CI: 1.001-1.007, P = 0.003] were significantly associated with glycaemic control.

Serum metabolomic profiles reflect CGM-derived glycaemic metrics in T1D, highlighting their potential role as biomarkers for a refined assessment of metabolic control.

Objective: Overdoses remain a major public health challenge. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been proposed as a treatment for opioid use disorder (OUD) based on preclinical research. Early observational research suggests that GLP-1RAs are associated with reduced opioid overdoses but warrants replication in different patient populations. Methods: This target trial emulation study used Veterans Health Administration (VA) data to include Veterans with a diagnosis of type 2 diabetes mellitus and OUD who initiated semaglutide and tirzepatide or a comparison diabetes medication (insulin, metformin, a sulfonylurea, a sodium-glucose transport 2 (SGLT2) inhibitor, or a dipeptidyl-peptidase 4 [DPP4] inhibitor) between January 1, 2020, and December 31, 2024. Each set of comparison groups was propensity score matched on relevant variables. Cox proportional hazards regression models were used to compare the time to all-cause overdose events in the 12 months after medication initiation. Results: After propensity score matching, semaglutide and tirzepatide were associated with significantly lower risk of all-cause overdose compared to insulin (hazard ratio [HR]=0.32; 95% CI=0.14-0.71; P=.006; n=630) and SGLT2 inhibitors (HR=0.25; 95% CI=0.09-0.68; P=.006; n=432). Semaglutide and tirzepatide were not associated with significantly lower risks than metformin (HR=0.75; 95% CI=0.38-1.45; n=1,016), sulfonylureas (HR=0.82; 95% CI=0.33-1.96; n=710), or DPP4 inhibitors (HR=1.20; 95% CI=0.52-2.78; n=858). Conclusion: Collectively, semaglutide and tirzepatide were associated with lower risk of all-cause overdose compared to insulin and SGLT2 inhibitors, but not metformin, sulfonylureas, or DPP4 inhibitors. These results suggest the possible role of GLP-1RAs in OUD but underscore the need for randomized controlled trials.