BackgroundThe evaluation of user satisfaction with an automated insulin delivery (AID) system is crucial. The aim was to assess the change in user satisfaction after upgrading from a previous to a next generation sensor integrated in the same AID system.MethodsA prospective intervention study was conducted. Type 1 diabetes subjects simultaneously upgraded from Guardian-Sensor®4 to Simplera-Sync^TM, integrated in the MiniMed^TM-780G system. User satisfaction was evaluated at baseline and after 3 months of use of Simplera-Sync^TM by the Glucose Monitoring Experience Questionnaire (GME-Q), a validated questionnaire designed to evaluate the experience with a glucose monitoring system. Glucose control and use of the system were also compared.ResultsNinety-one subjects were included (age: 38 ± 15 years-old, 59% female). GME-Q global score increased from 3.84 ± 0.49 to 4.40 ± 0.46. All subscales, effectiveness, convenience, and intrusiveness also improved. Sensor use increased from 93% [91, 95] to 98% [96, 99] and time in automode from 94% [92, 97] to 100% [97, 100], with 50% of the subjects achieving 100% of time in automode. A reduction in time in moderate hypoglycaemia and the number of hypoglycaemia episodes was observed.ConclusionUpgrading to a new sensor, as part of an AID system, can improve user satisfaction and allow for increased sensor use and time in automation.

Risk perception is a critical psychological factor that motivates patients with type 2 diabetes (T2DM) to adopt preventive behaviours, and the relationship between health literacy and complication risk perception appears to be influenced by social interaction factors. This study aimed to examine the association between health literacy and complication risk perception, with a particular focus on the mediating roles of patient-provider communication and perceived social support. A total of 533 patients with T2DM were recruited from a tertiary hospital in China and completed questionnaires assessing demographic characteristics, health literacy, patient-provider communication, perceived social support, and complication risk perception. The results indicated that patient-provider communication and social support mediated the relationship between health literacy and complication risk perception. These findings suggest that fostering a positive communication environment and enhancing patients' perceived support from family, healthcare providers, and peers may improve their complication risk perception, thereby encouraging proactive preventive behaviours.

Context Overweight and obesity among Indian women of reproductive age are increasing, posing important risks for pregnancy, particularly in primigravid women. Evidence focused solely on primigravid women remains limited. Aim This study aims to assess maternal and foetal outcomes among primigravid women with high body mass index (BMI) attending a tertiary care hospital in Kolkata. Settings and design This is a prospective observational study conducted over one year in a tertiary care obstetric unit. Methods and materials A total of 144 primigravid women enrolled at ≤12 weeks of gestation were categorised into normal BMI (18.5-24.9 kg/m²) and high BMI (≥25 kg/m²). Maternal outcomes included hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), labour and delivery complications. Foetal outcomes assessed were preterm birth, neonatal morbidity, and NICU admission. Logistic regression was used to estimate adjusted odds ratios (AOR). Results A high BMI was present in 40.3% of participants. High BMI was significantly associated with HDP and GDM. Labour complications and delivery complications were also more frequent. Infants of high-BMI mothers showed higher odds of being born preterm and of NICU admission. Conclusions High early-pregnancy BMI is an important predictor of adverse maternal and neonatal outcomes in primigravid women. Early BMI screening, focused antenatal surveillance, and preconception counselling are essential for risk reduction.

Diabetic foot infections (DFIs) are a major cause of morbidity in low- and middle-income countries such as Pakistan, where antimicrobial resistance (AMR) and the absence of localized guidelines complicate their management. This study aimed to analyze the microbiological profile of DFIs and develop evidence-based, context-specific empirical treatment recommendations.

We conducted a retrospective study at a tertiary care hospital in Pakistan, reviewing all diabetic foot related admissions between January 2022 and December 2023. Patients with clinically suspected infections had wound cultures taken and were classified by infection severity using IDSA/IWGDF criteria. Wound specimens from 400 DFI patients were subjected to culture and CLSI-standard antimicrobial susceptibility testing. Pathogen patterns were analyzed across severity groups. A multidisciplinary stewardship team used these findings, together with international guidelines, to develop severity-specific institutional-based empiric treatment recommendations.

A total of 118 culture-positive samples from 400 admissions were analyzed. Gram-negative organisms predominated (62%), followed by Escherichia coli (25%), Proteus mirabilis (14%), and Pseudomonas aeruginosa (10%). Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 23% and methicillin-sensitive Staphylococcus aureus (MSSA) 10%. E. coli was highly susceptible to tigecycline (86%) and amikacin (83%), while Proteus mirabilis was highly susceptible to carbapenems and piperacillin-tazobactam. MRSA/MSSA remain universally susceptible to vancomycin and linezolid. Based on these patterns, severity-stratified empiric regimens were recommended. Evidence grading supported strong recommendations for moderate to severe infections (SoR: Strong; QoE: Moderate).

This study highlights the limited role of Access antibiotics in DFIs, with Watch agents serving as the main empiric therapy and Reserve drugs reserved for multidrug-resistant cases. Using hospital antibiograms, international standards, and expert consensus, we developed a locally tailored institutional guideline for DFI management, which is expected to enhance patient care and antimicrobial stewardship, with periodic updates required as resistance evolves.

In high-burden nations like India, tuberculosis (TB) continues to be a significant global public health concern. HIV infection, diabetes mellitus, and low socioeconomic status are examples of comorbid illnesses that increase susceptibility to tuberculosis (TB), and the introduction of multidrug-resistant tuberculosis (MDR-TB) has made disease control even more challenging. The time-consuming nature of conventional drug susceptibility testing (DST) emphasizes the critical need for quick biomarkers to forecast treatment outcomes and resistance. Because of their possible impact on host immunity and MDR-TB risk, genetic variations particularly vitamin D receptor (VDR) polymorphisms have drawn attention.

Studies published between 2000 and 2024 were the subject of an extensive examination of the literature. Relevance led to the selection of 213 articles. Keywords including vitamin D, VDR polymorphisms, MDR-TB, pulmonary tuberculosis, and immune response were used to search databases such as PubMed, Web of Science, and Google Scholar. To guarantee comprehensive coverage, both original research articles and reviews were included.

Low serum vitamin D levels were consistently linked to an elevated risk of MDR-TB and pulmonary tuberculosis (PTB), according to the investigation. Certain VDR polymorphisms have often been associated with altered immunological responses and an increased risk of disease, especially mutant forms like FokI and TaqI. Treatment response and disease progression have also been discovered to be influenced by immunological modulation and dietary variables.

These results imply that vitamin D levels and VDR polymorphisms could be useful biomarkers for the diagnosis and prognosis of MDR-TB. Knowing the genetic susceptibility of the host may help develop individualized treatment plans and enhance the management of MDR-TB.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420261295571, identifier CRD420261295571.

To determine coping strategies in caregivers of children with type-1 diabetes mellitus.

This cross-sectional study was conducted at the Outpatient Department of Paediatric Endocrinology, National Institute of Child Health, Karachi, from September 2022 to October 2023, and comprised caregivers aged up to 60 years of children aged 1-14 years who were known cases of type 1 diabetes mellitus. Coping strategy scoring and interpretation was done using the shorter 28-item version of the Coping Orientation to Problems Experienced Inventory. Data was analysed using SPSS 26.

Of the 227 caregivers with mean age 39.93±7.13 years, 106(46.7%) were mothers. Among the children with mean age 12.79±4.27 years, 127(55.9%) were girls. The mean duration of care was 5.71±4.05 years. Coping strategies were found present among 99(43.6%) caregivers. The age of the caregivers with coping strategies was significantly higher compared to those without coping strategies (p<0.001). Among the caregivers with coping strategies, there were significantly more Urdu-speaking individuals than of any other language (p=0.025). Parents whose children were literate were more likely to have coping strategies (p=0.022).

Recognizing that age of the caregivers and language may influence coping strategies, healthcare providers should consider tailoring support and interventions to the specific needs of caregivers in different age groups and linguistic communities. The association between a child's education level and parental coping strategies highlights the importance of involving children in their care management.

To investigate the association between blood group and development of gestational diabetes mellitus among pregnant women.

The retrospective, case-control study was conducted from August 2021 to May 2022 at The Aga Khan Hospital for Women, Garden Karachi, and comprised data from January to December 2020 related to women who had given live birth. All the women had been screened for gestational diabetes mellitus. Data included blood type and rhesus factor phenotype. The risk of gestational diabetes mellitus was assessed. Data was analysed using SPSS 19.

Of the 1,899 pregnant women, 303(16%) had gestational diabetes mellitus and 1,596(84%) were free of it. Blood type had no significant association (p=0.406) with gestational diabetes mellitus, while rhesus positivity tended to be significantly higher in the gestational diabetes mellitus group (p=0.051). Parity was the only parameter for which significant difference was found among the blood groups (p<0.05).

There was a higher incidence of gestational diabetes mellitus in women with rhesus positivity.

The association of type 2 diabetes (T2D) treatment with Alzheimer's disease (AD) is unclear. We examined T2D treatment status in relation to amyloid beta (Aβ) burden and AD-related downstream processes.

This cross-sectional study included 546 cognitively unimpaired adults (mean age = 64.2 ± 3.2 years, 65% women), classified into normal glucose tolerance (NGT; hemoglobin A1c [HbA1c] < 5.7%), prediabetes/untreated T2D (HbA1c ≥ 5.7%), and treated T2D groups. Multiple regression analyses assessed group differences in Aβ (¹⁸F-florbetaben) and tau (¹⁸F-MK-6240) positron emission tomography burden, magnetic resonance imaging-based AD signature cortical thickness, white matter hyperintensity (WMH) volume, and memory performance.

Compared to the NGT group, prediabetes/untreated T2D had greater anterior/posterior cingulate and superior parietal cortex Aβ burden, whereas treated T2D had lower cortical thickness and greater WMHs, independent of demographics and apolipoprotein E ε4 status. No group differences were found in tau or memory outcomes.

Prediabetes/untreated T2D, but not treated T2D, was associated with early Aβ deposition. Diabetes medications may mitigate brain Aβ burden.

As no previous study has focused on the effect of overhanging restorations on alveolar bone loss in diabetic and non-diabetic individuals, this study aimed to compare alveolar bone loss between these groups using panoramic radiographs.

A total of 212 patients (106 diabetic, 106 non-diabetic) who met the inclusion criteria were retrospectively selected from panoramic radiographs taken between January 2023 and July 2025 at Inonu University Faculty of Dentistry. Marginal bone loss adjacent to overhanging restorations was measured as the distance between the cementoenamel junction (CEJ) and the alveolar crest, with contralateral intact or solely occlusally restored teeth serving as controls. All measurements were performed by a restorative dentistry specialist, and intra-observer reliability was confirmed (Cohen's Kappa > 0.80). Data were analyzed using appropriate parametric and non-parametric statistical tests, with a significance level set at p < 0.05.

Overhanging restorations were more frequently observed in molars compared with premolars and on distal surfaces compared with mesial surfaces. No significant difference in alveolar bone loss was found between amalgam and composite restorations. The levels of alveolar bone loss were significantly higher in diabetic patients compared to non-diabetic individuals; the median CEJ-crest distances on the sides with overhanging restorations were 2.71 mm and 2.07 mm, respectively (p < 0.001), while on the contralateral control surfaces, they were 1.76 mm and 1.44 mm, respectively (p = 0.003).

Overhanging restorations are associated with increased alveolar bone loss, and this effect was significantly greater in diabetic patients. These findings highlight the importance of detecting and correcting overhanging restorations, particularly in patients with systemic risk factors such as diabetes, to prevent periodontal destruction.

Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy and associated with type 2 diabetes, which is associated with breast cancer and kidney cancer. However, little is known about the risk of cancer following a GDM diagnosis.

This study aimed to test the hypothesis that a history of GDM associates with increased risk of breast, gynecological, thyroid and kidney cancer.

National cohort study, based on Danish registry data. The study population included a group of women exposed to GDM in their pregnancy leading to delivery between 2000-2019 or 1978-1997, and a 1:10 matched non-exposed group, matched on calendar period of delivery, the woman´s age (birth year) and the woman´s registered region of residence at delivery. Poisson regression adjusting for educational level was conducted.

Of the 314,742 deliveries included, 28,613 deliveries were in the exposed group, 286,129 in the non-exposed. The median follow-up time was 8.1 years. We found no increased risk of the selected cancers combined (adjusted incidence rate ratio (aIRR) 1.05 (95% CI, 0.94-1.18)), breast cancer (aIRR 1.02 (95% CI, 0.89-1.17)), gynecological cancer (aIRR 1.00 (95% CI, 0.79-1.26)), or thyroid cancer (aIRR 1.26 (95% CI, 0.86-1.82)). However, an increased risk of kidney cancer was seen in women with previous GDM compared with women without GDM (aIRR 1.92 (95% CI, 1.10-3.33)), although a very small absolute risk.

No elevated risk was found for the selected cancers combined. Women with previous GDM had an increased risk of kidney cancer, a rare cancer form.