Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia due to impaired insulin secretion, action, or both. As a major global health concern, its prevalence is rapidly increasing, particularly in low- and middle-income countries like Pakistan. This review aims to assess the epidemiological trends of DM in Pakistan, identify key risk factors, and explore diagnostic practices and preventive strategies.

A comprehensive literature review was conducted using peer-reviewed national and international publications from multiple databases. The review focused on the prevalence of DM in Pakistan, associated risk factors, urban-rural disparities, diagnostic criteria (ADA vs. WHO), complications, technological applications in disease management, and levels of awareness and treatment practices.

The prevalence of DM in Pakistan increased significantly from 5.2 million adults in 2000 to approximately 33 million in 2021. Contributing factors include urbanization, sedentary lifestyles, poor dietary habits, and limited healthcare access, especially in rural regions. Urban areas showed higher detection rates, while rural areas exhibited significant barriers to diagnosis and management. Technological solutions, such as telemedicine and mobile health applications, offer promise but face obstacles like limited infrastructure and affordability. Diabetes-related complications particularly cardiovascular and kidney diseases-are widespread. Despite treatment availability, awareness and adherence remain low, with notable disparities between knowledge and practice.

Pakistan is facing an escalating diabetes epidemic influenced by both behavioral and systemic factors. Immediate action is needed to implement targeted public health interventions, improve healthcare accessibility, and promote awareness and lifestyle modification. Leveraging technology and aligning with standardized diagnostic frameworks may significantly enhance early detection and effective management, ultimately reducing the national burden of DM.

Type 2 diabetes is a prevalent chronic disease, associated with health complications, premature morbidity and significant healthcare costs. Optimal lifestyle behaviour control and patient self-management are crucial for improving diabetes control; however, they are difficult to achieve in primary care. There is limited research on the use of information from wearable devices to encourage behaviour change. This study will examine the effectiveness and cost-effectiveness of a multi-component health behaviour intervention in achieving clinically significant reductions in haemoglobin A1c (HbA1c) among general practice patients with type 2 diabetes.

The study uses a cluster-randomised controlled design, with general practices randomly assigned to either the Wearables Integrated Technology (WEAR-IT) intervention (n=15) or usual care (n=15). To achieve a sample size of 375 participants, 12-13 patients per practice will be recruited. Patients diagnosed with type 2 diabetes will be eligible to participate if they are aged 18-75 years; have had poorly controlled diabetes (HbA1c≥7.5%), with the cognitive capacity and ability to access the intervention application via an iOS or Android smart device. The WEAR-IT self-management intervention combines information from wearable devices (physical activity, blood glucose and blood pressure) and the electronic medical record, with goal setting and coaching support. The intervention will be primarily delivered by the general practice nurse, with review and confirmation of goals by the general practitioner. Participants attending the usual care practices will receive standard care. Outcome measures, including HbA1c, lipids, blood pressure, quality of life, dietary and exercise behaviours and cost-effectiveness, will be collected at baseline, 6-month (primary endpoint) and 12-month post-randomisation. The primary analysis will compare the change in HbA1c between the intervention and control groups at 6-month follow-up, with long-term outcomes assessed at 12-month post-randomisation.

The study was approved by Bond University (BH00137). Results will be disseminated through peer-reviewed journal publications, conference presentations and summaries to participating sites and patients.

Australian New Zealand Clinical Trials Registry (ACTRN12624000957594).

Cardiovascular autonomic neuropathy (CAN) is a serious, untreatable complication of diabetes that contributes to excess cardiovascular mortality and morbidity. CAN is associated with increased fibrosis and inflammation, possibly driven by increased sympathetic activity and overactive mineralocorticoid receptors (MRs). These may represent a potential therapeutic target. MR antagonists (MRAs) improve autonomic function in non-diabetic diseases, and finerenone, a non-steroidal MRA, has demonstrated promising results in managing diabetic kidney disease and cardiovascular complications, suggesting its potential as a novel therapy for early-stage CAN. This trial aims to evaluate whether daily administration of finerenone can modify the disease progression of early-stage CAN.

This trial is a two-centre, double-blind, parallel-group, 1:1 randomised, placebo-controlled study evaluating the effect of 78 weeks of intervention with finerenone or placebo on early-stage CAN in 100 individuals with type 2 diabetes in Denmark. The primary endpoint is the between-group difference in the expiration:inspiration ratio of the cardiovascular autonomic reflex tests (CARTs). Secondary endpoints are the between-group differences in the remaining CARTs, heart rate variability measures and fibrosis markers. Treatment effects on other forms of neuropathy and related pathological mechanisms will be explored.

The study complies with the Declaration of Helsinki and the International Counsil for Harmonisation good clinical practice guidelines, with ethics approval obtained from the Danish Medical Research Ethics Committee. All participants will provide written informed consent. Due to the risk of hyperkalaemia associated with finerenone, safety will be closely monitored throughout the study. Findings will be disseminated through peer-reviewed publications, conference presentations and clinical trial registries. A lay summary will be provided to participants on study completion.

ClinicalTrials.gov: NCT06906081; registration date: 25 March 2025. Clinical Trials Information System: EUCT no. 2024-516597-30-00; registration date: 3 September 2024.

Real-world data and patient-reported outcomes in diabetes in Emilia-Romagna is a multi-centric observational cohort study aimed at improving diabetes care in the Emilia-Romagna region, by exploring trends and predictors of clinical and psychological parameters in a large population of people with diabetes, during and after the COVID-19 pandemic.

The study has a mixed retrospective/prospective design. The retrospective component involves computerised data linkage of administrative and clinical data from the local health authorities of Romagna and Reggio Emilia, and the University Hospital of Parma, covering a population of approximately 100 000 prevalent cases with diabetes, followed throughout the years 2019-2024. The selection of data items collected in the reference time frame is based on the International Consortium for Health Outcomes Measurement (ICHOM) standard set for diabetes, including clinical, lifestyle, social and healthcare service measurements. The prospective component includes primary data collection of indicators of psychological well-being through the WHO-5 Well-Being Index, diabetes distress using the Problem Areas In Diabetes-Short Form and depression through the Patient Health Questionnaire-9, measured at 0-6 months in an overall sample of 455 people with type 2 diabetes. Statistical analysis will include descriptive analysis and multivariate logistic regression using a two-step federated approach.

The study has obtained ethics approval from the Ethics Committee of Romagna and the Ethics Committee of Area Vasta Emilia Nord. The results of the study will be published in scientific journals to evaluate quality and outcomes of diabetes care across the region.

NCT06639100.

Depression is a common and serious mental health issue in individuals with diabetes, especially among middle-aged and elderly women, leading to reduced treatment adherence, an overall decline in well-being and a significant reduction in quality of life. Although previous studies have investigated the prevalence and risk factors of depression in this population, the results have been inconsistent and lack consensus. The aim of this review is to determine the prevalence of depression and explore associated risk factors among middle-aged and elderly women with diabetes.

A comprehensive search will be performed in eight electronic databases, including PubMed, Web of Science, Scopus, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform and Chinese Biomedicine Literature Database from their inception to 15 April 2025. Studies published in English and Chinese that report on the prevalence and risk factors of depression among middle-aged and elderly women with diabetes will be included. Two reviewers will independently screen studies for eligibility, extract data and evaluate the risk of bias. Any disagreements will be addressed by a third reviewer. The quality of the included studies will be assessed using Joanna Briggs Institute Critical Appraisal Tools. All statistical analyses will be conducted using Review Manager V.5.4. Heterogeneity will be assessed using the I² statistic and Q test. Subgroup analysis and sensitivity analysis will be performed to identify potential sources of heterogeneity and assess result robustness.

This review does not require ethical approval as it is based on previously published studies. Its findings will be disseminated through peer-reviewed publications and conference presentations, providing evidence on the prevalence and risk factors of depression in middle-aged and elderly women with diabetes.

CRD420251014849.

Diabetic foot ulcer (DFU) has become a significant public health concern. This research aimed to develop a predictive nomogram model to assess the risk of moderate to severe DFU in patients with diabetes.

Our retrospective study included 499 hospitalized patients with Type 2 Diabetes Mellitus (T₂DM) and moderate to severe DFUs at the Second Affiliated Hospital of Fujian Medical University, from January 2021 to December 2023. Predictive factors were assessed using both univariate and multivariate logistic regression analyses, leading to the establishment of the predictive nomogram. The model's performance was evaluated through receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis, and clinical impact curve.

The predictive model included several risk factors: diabetic retinopathy (DR), diabetic kidney disease (DKD), diabetic peripheral neuropathy (DPN), peripheral angiopathy (PAD), D-dimer, K-time, total cholesterol (TC), Low-Density Lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). The model demonstrated excellent discrimination, with AUC 0.977 (95% CI: 0.965-0.989) in the training cohort and 0.977 (95% CI: 0.958-0.996) in the validation cohort. Calibration results indicated strong agreement between predicted and observed outcomes. Additionally, decision curve analysis indicated that the nomogram provided clinical benefits in both the training and validation cohorts.

This nomogram, which incorporates DKD, DPN, PAD, DR, D-dimer, K-time, TC, LDL-C, and HDL-C, demonstrates strong accuracy and predictive value for assessing the risk of moderate to severe DFUs in patients with diabetes.

Currently, type 2 diabetes mellitus (T2DM) is among the fastest-growing global health emergencies of the century. Emerging evidence from epidemiological studies suggests a potential positive association between exposure to dichlorodiphenyltrichloroethane (DDT) or its byproducts and an increasing risk of T2DM.

We conducted a systematic review and meta-analysis to quantify the association between DDT or its byproducts and T2DM. Additionally, we aimed to identify the sources of heterogeneity contributing to the inconsistency of the results.

Data analysis: assess the quality of the included studies using the Risk Of Bias In Non-randomized Studies of Exposure tool, determine the source of heterogeneity using subgroup analysis, sensitivity analysis and meta regression model based on a fixed-effects model, and analyze the publication bias using funnel plots, Egger's test, and Begg's test.

DDT and its byproducts were associated with the risk of developing T2DM (total OR: 1.13, 95% CI: 1.08-1.15, I² = 40%). Subgroup analysis stratified by biomarkers showed a stronger association between p,p'-DDE and T2DM (OR = 1.13, 95% CI: 1.09-1.17, I²= 58.5%). The results of the funnel plot, Egger's test, and Begg's test showed publication bias and small study effect in studies included in the analysis (p<0.05), but the influence on the results was smaller.

The systematic review and meta-analysis offer quantifiable proof of a positive correlation between exposure to DDT or its byproducts and a higher risk of developing T2DM.

https://inplasy.com, identifier INPLASY20258004.

Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder with limited treatment options. Manual acupuncture and electroacupuncture have been investigated in numerous animal studies for their potential to improve glycemic and lipid profiles, but no comprehensive synthesis exists. This review aims to evaluate the effects of manual acupuncture and electroacupuncture on blood glucose and lipid levels in animal models of T2DM, and to explore potential mechanisms.

A systematic search was conducted in PubMed, Embase, Cochrane, Web of Science, and major Chinese databases from inception to December 2024. Only animal studies employing manual acupuncture or electroacupuncture for T2DM models were included. The methodological quality was assessed using a 10-item CAMARADES checklist. Meta-analyses were performed using STATA 17.0, and subgroup analyses explored the influence of modeling methods, intervention timing, and treatment duration.

A total of 14 studies with 274 animals with T2DM were included. The overall quality of the included reports was rated as moderate or higher. Meta-analysis showed that acupuncture significantly reduced blood glucose [Standardized Mean Difference(SMD)= -3.15, 95% Confidence Interval(CI) (-4.18, -2.12), I-squared (I²)= 85.1%, (P< 0.05)], body weight [SMD = -3.36, 95%CI (-4.77, -1.95), I²= 84.2%,(P<0.05)], triglycerides [SMD=-2.50, 95% CI (-3.00, -2.01), I²= 0.0%, (P< 0.05)], total cholesterol [SMD = -2.60, 95% CI (-3.55,-1.65), I²= 74.9%, (P< 0.05)], and low-density lipoprotein [SMD = -3.36, 95%CI (-5.42,-1.95), I²= 86.2%] (P< 0.05)], and no statistically significant difference was observed in high-density lipoprotein [SMD = 0.61, 95% CI (-0.98, 2.19), I² = 92.1%, (P> 0.05)] compared to the control group. These results suggest that acupuncture can effectively improve blood glucose and lipid levels in animal models of T2DM.

While this study is limited by the number of included studies, the results indicate that acupuncture can effectively improve blood glucose and lipid levels in animal models of T2DM.

https://www.crd.york.ac.uk/prospero/, identifier CRD42024520000.

The burden of dietary risk-induced diseases, including chronic kidney disease due to type 2 diabetes mellitus caused by dietary risks (CKD-T2DM-DR), has been consistently underestimated. This study aims to investigate the burden of CKD-T2DM-DR from 1990 to 2021 globally and regionally.

The global burden of disease (GBD) database served as the data source for analyzing the mortality, agestandardized mortality rate (ASMR), disability-adjusted life years (DALYs), age standardized DALY rate (ASDR), and estimated annual percentage change (EAPC) of CKD-T2DM-DR worldwide from 1990 to 2021. Subsequently, the ASMR, ASDR, and EAPC were further evaluated in different regions, age, gender, and socio-demographic index (SDI) groups. Finally, the burden of CKD-T2DM-DR induced by different dietary risks was reported and compared.

Globally, the mortality, ASMR, DALYs, and ASDR of CKD-T2DM-DR were on the rise from 1990 to 2021. The global mortality of CKD-T2DM-DR in 2021 was 79,988 (95% uncertainty interval [UI] 32,734-128,884), ASMR was 0.96 (95% UI 0.4-1.54) per 100,000 population, DALYs were 1,999,209 (95% UI 856,194-3,167,215), and ASDR was 23.21 (95% UI 9.95-36.61) per 100,000 population. Regionally, low SDI regions exhibited the highest ASDR (27.41 [95% UI 11.32-46.78] per 100,000 population) and ASMR (1.16 [95% UI 0.44-2.02] per 100,000 population), whereas high-middle SDI regions recorded the lowest ASDR (14.7 [95% UI 5.96-23.77] per 100,000 population) and ASMR (0.59 [95% UI 0.24-0.97] per 100,000 population). High SDI regions presented a rapid increase in ASDR and ASMR, with EAPCs of 1.02 (95% CI 0.86-1.19) and 1.4 (95% CI 1.23-1.58), respectively. The correlation analysis supported that ASDR and ASMR were negatively associated with SDI. Additionally, the global burden of CKD-T2DM-DR increased with age and was higher in men than in women. Among the seven associated dietary risks, the DALY and death percents of CKD-T2DM caused by diet low in fruit were the highest, at 4.57% and 4.31%, respectively.

The global burden of CKD-T2DM-DR has been steadily increasing with significant regional variability. Low SDI regions are most severely affected by this challenge, while high SDI regions are experiencing a rapid increase in the burden. The diet low in fruit was identified as the primary dietary risk for CKD-T2DM. This highlights the urgent need for rapid growth in the targeted prevention and health care strategies to alleviate the global burden of CKD-T2DM-DR.

To evaluate the relationship of the atherogenic index of plasma (AIP) and other lipid indices with prediabetes mellitus (Pre-DM) and type 2 diabetes mellitus (T2DM) in patients with ischemic stroke (IS), with a focus on exploring the clinical application value of AIP in the assessment of glucose metabolism disorders.

This study was conducted for the first time based on a large-scale IS cohort. 18,604 patients with IS were enrolled and subjected to comprehensive lipid profile assessments. The correlation between AIP and other commonly used lipid indices was systematically compared. Based on glucose levels, the patients were divided into three groups: normal glucose (NG), Pre-DM, and T2DM. The relationship of AIP and other lipid indices with Pre-DM and T2DM was evaluated through multivariable logistic regression. Furthermore, the dose-response correlation of AIP with Pre-DM and T2DM across varying genders and age groups was explored through the Restricted Cubic Spline (RCS) model, which was employed to analyze non-linear associations between variables.

We found that triglyceride (TG), total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C)/HDL-C, TG/HDL-C, non-HDL-C, remnant cholesterol (RC), RC/HDL-C, and AIP were all positively correlated with Pre-DM and T2DM. Notably, AIP demonstrated the highest specificity in this context. AIP was then divided into tertiles, with the T3 group showing the strongest correlation with both conditions compared with the T1 group. The correlation was stronger among females and patients aged ≥60 years. RCS analysis further indicated a non-linear positive dose-response relationship between AIP and T2DM across all genders and ages.

In IS patients, AIP exhibits a stronger association with Pre-DM and T2DM than other lipid indices, especially in female patients and those aged 60 years and above.