As children living with HIV (CWH) achieve longer life expectancy, they face an emerging 'double burden' of infectious and non-communicable diseases, specifically pediatric overweight and obesity (OW/OB). This risk is exacerbated by weight-inducing Integrase Strand Transfer Inhibitors (INSTIs). We systematically reviewed family-based pediatric weight management interventions for CWH aged 6 to 12 globally.

Following PRISMA guidelines (PROSPERO: CRD42024554376), we searched Medline, Embase, and Cochrane (2007-2024) for clinic-linked behavioral interventions reporting body composition or behavioral outcomes.

From 1026 records and 7 full-text reviews, no studies met the inclusion criteria. Excluded studies lacked clinical integration or targeted adult populations.

This 'null' finding represents a critical evidence gap and clinic concern: CWH receive weight-inducing medications without evidence-based behavioral support. Future research must prioritize integrating care models using implementation science frameworks (RE-AIM/CFIR) to bridge the gap between primary HIV care and obesity management in resource-constrained settings.

Pediatric diabetes, an increasing public health concern in the US, is associated with lifelong health complications and substantial societal costs. The burden is particularly severe among socioeconomically at-risk populations. Medicaid and the Children's Health Insurance Program (CHIP) insure 49% of all youths in the US, disproportionately covering socioeconomically at-risk populations. However, national data on prevalence and trends in pediatric diabetes among Medicaid and CHIP enrollees are lacking.

To provide comprehensive nationwide estimates and trends in the prevalence of type 1 diabetes (T1D) and type 2 diabetes (T2D) among Medicaid and CHIP pediatric enrollees from 2016 to 2021 and to assess variation across demographic and geographic subpopulations.

This repeated cross-sectional study used 2016 to 2021 Transformed Medicaid Statistical Information System Analytical Files to study Medicaid and CHIP enrollees aged 18 years and younger with continuous full-year enrollment in each study year across 43 states (7 states and Washington, DC, were excluded due to unstable continuous enrollment proportions or other data quality issues). Trends were assessed using the Cochran-Armitage test.

Demographic (age, sex, race, and ethnicity) and geographic (census region and urban vs rural) characteristics.

Main outcomes were standardized annual prevalence of T1D and T2D per 1000 enrollees. Subgroup trends were stratified by age, sex, race and ethnicity, region, and urbanicity.

Approximately 25 million to 30 million youths were included in the study each year. Across all study years, enrollees aged 0 to 6 years and 7 to 12 years each accounted for approximately 35% of the Medicaid pediatric population (8 887 176 of 25 537 653 [34.9%] and 9 069 241 [35.6%] in 2016 and 10 025 946 [33.2%] and 10 308 534 of 30 324 022 [34.1%] in 2021, respectively), whereas those aged 13 to 18 years represented approximately 30% (7 484 682 [29.4%] in 2016 and 9 905 058 [32.8%] in 2021). The proportion of male enrollees was slightly higher than female enrollees (13 074 795 [51.2%] males vs 12 452 685 [48.8%] females in 2016 and 15 528 719 [51.2%] vs 14 794 520 [48.8%] in 2021). From 2016 to 2021, pediatric diabetes prevalence among Medicaid-enrolled youths increased from 2.73 to 3.04 per 1000 enrollees (11.4% relative increase; P < .001). T1D increased from 1.99 to 2.12 (6.5%) and T2D from 0.74 to 0.92 (24.3%). T2D increases were especially pronounced among males (48.1%) and residents of the western US (51.8%). Rural residents had a higher prevalence of diabetes across all study years but a substantially lower relative increase compared with urban residents (4.7% vs 13.3%).

In this cross-sectional study of Medicaid-enrolled youths, the prevalence of pediatric diabetes steadily increased, underscoring an increasing public health challenge. The sharp increase in T2D highlights the urgent need for targeted prevention, screening, and management strategies to mitigate long-term health and economic consequences.

Background India has the highest number of people with diabetes in the world. Health services for people with diabetes in India are varied with regard to quality, access, and affordability. We explored the various facets of care being provided for diabetes mellitus. Methods A descriptive phenomenological study (qualitative research) was conducted in Rohtak, Haryana, India, during March-April 2022. Thirty-four participants were recruited via purposive sampling. These included 17 people with diabetes and 17 healthcare workers. In-depth interviews were conducted in a semi-structured format after taking written informed consent. Data were recorded and then transcribed. On analysis, initial codes were grouped into meaningful themes. Results Three themes each were drawn from the qualitative data. The patient interviews yielded diagnosis, management, complications, and emotional burden of the disease. The daily ordeals of people with diabetes were understood better. The healthcare workers' themes were-experiences so far, complications, and policy recommendations. This focused on the healthcare workers' experiences as providers of care. Conclusion Policy decisions, including a structured referral linkage, are needed to improve care for people with diabetes. Accredited social health activists must be incentivized to screen for diabetes at the village level. Newer initiatives under the Ayushman Bharat Digital Mission, Health and Wellness Centres, and the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke are steps in the right direction.

Background Depression is a major psychiatric comorbid condition of type 2 diabetes mellitus (T2DM). Serotonin, the major neurotransmitter implicated in depression, is a tryptophan derivative. Tryptophan is chiefly metabolised through the kynurenine pathway with indolamine-2,3-dioxygenase (IDO) as the rate-limiting enzyme. Hence, serum tryptophan and kynurenine concentrations and their ratio (K/T ratio) as a measure of IDO activity are possible biomarkers of depression in T2DM. Methods Severity of depression in adults with T2DM attending a primary care facility in Delhi was rated using the Hamilton Depression Rating Scale (HAM-D 17 items). Baseline serum tryptophan and kynurenine concentrations, along with their ratio, were estimated. A follow-up HAM-D rating was done after 16 weeks of standard therapy and the quantum HAM-D score improvement was correlated with the K/T ratio. Results Of 106 people with T2DM screened for depression, 52 had syndromal depression and were recruited for the study. There was no significant association between age, sex, marital status, religion, serum tryptophan, and kynurenine levels with respect to the severity of depression, but the mean K/T ratio was significantly higher among those with severe depression (p<0.05). There was a significant correlation between serum kynurenine and HAM-D score improvement at 16 weeks. Conclusion K/T ratio, a measure of IDO activity, was found to be a severity marker for depression in T2DM, without any prognostic significance. Further studies are required to explore the K/T ratio as a state marker, severity marker, and prognostic biomarker of depression in people with T2DM.

Primary septic arthritis is an acute emergency associated with high morbidity and mortality in older adults. Rapid diagnosis and treatment are crucial. The study evaluates 5-year survival and identifies prognostic risk factors in elderly patients with primary septic arthritis, including age, American Society of Anesthesiology Physical Status (ASA PS) classification, Charlson Comorbidity Index (CCI), joint involvement, implants, and pathogen spectrum.

50 patients aged ≥ 60 years treated for primary septic arthritis at two hospitals between 2008 and 2020 were included. Demographic, clinical, and microbiological data were collected retrospectively. Survival was assessed by Kaplan-Meier analysis, with log-rank tests to compare subgroups.

The mean age was 71.2 years. Overall survival was 76% at 1 year and 54% at 5 years. Survival declined significantly with increasing age (p = 0.004), higher ASA PS classification (p < 0.001), higher CCI (p = 0.006), joint involvement (p = 0.027), and presence of implants (p < 0.001). Diabetes mellitus, osteoarthritis, and synovial culture status showed no significant effect. Mean survival by joint ranged from 3.65 for the knee to 2.41 years for the shoulder. Patients with implants had markedly shorter survival (1.1 years vs. 3.84 years). Pathogens were isolated in 70% of cases, most frequently Staphylococcus aureus (38%).

Primary septic arthritis in older adults remains a life-threatening condition with high early- and mid-term mortality. Survival is strongly determined by age, ASA PS classification, CCI, joint involvement, and presence of implants, while comorbidities and pathogen detection show no prognostic relevance.

Background Peripheral neuropathy is a common and debilitating complication of type 2 diabetes mellitus (T2DM). Objective To evaluate the relationship between plasma homocysteine levels and the severity of peripheral neuropathy in patients with T2DM. Methods A cross-sectional study was conducted at Sahiwal Teaching Hospital, Sahiwal, from November 2024 to July 2025, involving 325 patients with T2DM. Plasma homocysteine levels were measured, and peripheral neuropathy severity was assessed using the Michigan Neuropathy Screening Instrument (MNSI) and nerve conduction studies (NCS). Results Elevated plasma homocysteine levels (>15 μmol/L) were found in 34.5% of patients. The prevalence of neuropathy increased with higher homocysteine levels, with 44.5% of patients with normal homocysteine levels exhibiting neuropathy, compared to 66.7% in those with mild elevation and 85.7% in those with severe elevation. A positive correlation was observed between homocysteine levels and neuropathy severity (r = 0.42, p <0.001). Multivariate regression analysis identified homocysteine as an independent predictor of neuropathy severity (β = 0.38, p<0.001), along with diabetes duration and glycated hemoglobin (HbA1c). Conclusion Elevated plasma homocysteine levels are associated with increased severity of peripheral neuropathy in T2DM patients. These findings suggest that homocysteine may serve as a biomarker for identifying T2DM patients at risk for severe neuropathy, with potential implications for early diagnosis and therapeutic interventions.

Diabetes mellitus remains a major global health burden, particularly affecting wound healing in patients with traumatic injuries. Chronic hyperglycemia impairs tissue regeneration and immune function, increasing the risk of infection, delayed recovery, and potential limb loss. We aim to demonstrate the critical importance of glycemic control and multidisciplinary management in enhancing wound healing outcomes among diabetic patients undergoing surgical interventions. using the case of a 65-year-old male with a crush injury to the left foot following a road traffic accident. The patient underwent surgical debridement and split-thickness skin grafting. Postoperative complications prompted further clinical evaluation, revealing poorly controlled diabetes. A multidisciplinary team approach was initiated, incorporating endocrinological, surgical, nutritional, and antimicrobial strategies. Initial graft take was poor, accompanied by signs of systemic infection, including fever, leukocytosis, and hyperglycemia. However, following glycemic and nutritional optimization, wound healing significantly improved, and graft uptake was observed within two weeks. The patient was discharged after approximately two months with satisfactory healing, therefore highlighting the indispensable role of tight glycemic control in the postoperative care of diabetic patients. A multidisciplinary, holistic approach integrating endocrine, surgical, antimicrobial, and nutritional support significantly improves healing outcomes and reduces the risk of limb loss. Early metabolic intervention is essential to optimize recovery and enhance quality of life in diabetic wound care.

This study aimed to investigate the association between systemic inflammatory biomarkers-specifically the systemic inflammatory response index (SIRI), systemic immune inflammation index (SII), and aggregate index of systemic inflammation (AISI)-and the prevalence of diabetic foot ulcer (DFU).

We conducted a cross-sectional analysis using data from three cycles of the National Health and Nutrition Examination Survey (NHANES), supplemented by a single-center retrospective clinical study. Initially, 31,126 participants were screened from NHANES. Binary logistic regression models (both unadjusted and adjusted for covariates) were employed to evaluate the associations between ln SIRI, ln SII, and ln AISI and DFU prevalence. Restricted cubic spline (RCS) analysis was applied to assess nonlinear relationships, and subgroup analyses were performed to examine the stability of associations across strata defined by age, gender, race, body mass index (BMI), smoking status, and hypertension. Additionally, a clinical validation study was conducted from January to December 2023, comprising 34 DFU patients and 68 diabetic controls. We performed multivariable binary logistic regression analyses to assess the independent associations between systemic inflammatory indices and the presence of DFU, adjusting for age, sex, diabetes duration, BMI, and albumin levels. Receiver operating characteristic (ROC) curve analysis was used to preliminarily assess the discriminatory ability of SII, SIRI, and AISI for DFU status.

The cross-sectional analysis included 135 participants with DFU and 1560 without DFU. Logistic regression revealed consistent positive associations between ln SIRI, ln SII, and ln AISI and DFU prevalence in both unadjusted and adjusted models. RCS analysis indicated linear dose-response relationships for all three biomarkers. Subgroup analyses confirmed that these associations remained stable across demographic and clinical subgroups. In the retrospective clinical study, ln SIRI, ln SII, and ln AISI were significantly associated with DFU prevalence, with odds ratios (ORs) as follows: ln SIRI: OR = 2.51 (95% CI: 1.39-4.54), ln SII: OR = 5.44 (95% CI: 2.48-11.91), and ln AISI: OR = 2.75 (95% CI: 1.59-4.74). After adjusting for key confounders, the associations between these biomarkers and DFU remained consistent in both direction and statistical significance. ROC analysis showed that SII was more reliable than the other two for predicting DFU.

By integrating a cross-sectional NHANES-based analysis with a clinical retrospective study, this research demonstrates that elevated levels of SIRI, SII, and AISI are significantly associated with an increased prevalence of DFU. These systemic inflammatory biomarkers may serve as valuable tools for risk assessment in patients with DFU.

The global prevalence of type 2 diabetes mellitus (T2DM) has risen significantly since 1990, contributing substantially to mortality and posing a major public health challenge. While overweight/obesity and insulin resistance, commonly reflected by the triglyceride-glucose (TyG) index, are established risk factors for the development of T2DM, their individual and combined effects on mortality among patients with T2DM remain incompletely elucidated. This study aimed to evaluate the associations between body mass index (BMI) and the TyG index with all-cause and cardiovascular disease (CVD) mortality in a large clinical cohort of type 2 diabetes mellitus (T2DM) patients.

This retrospective cohort study included 15,796 T2DM adults (aged >18 years) from two hospitals in China (2010-2023). The primary outcome was all-cause mortality, with a mean follow-up duration of 2.8 years. BMI was categorized as normal weight (18.5-24.9 kg/m²), overweight (25-29.9 kg/m²), and obesity (≥30 kg/m²). The TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Multiple Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for mortality.

Among 15,796 participants, 1,665 deaths were recorded, including 629 CVD-related deaths. Overweight and obesity were associated with lower all-cause mortality risk (aHR: 0.73, 95% CI: 0.65-0.81 and aHR: 0.86, 95% CI: 0.74-1.00, respectively). Higher TyG index quartiles (Q3 and Q4) were associated with decreased mortality risk (aHR: 0.85, 95% CI: 0.74-0.98; aHR: 0.84, 95% CI: 0.72-0.97). The protective effect of a higher BMI was more pronounced in patients aged 60 years or older.

Our findings revealed that BMI and the TyG index are associated with mortality risk in T2DM patients, particularly in older patients. However, these findings are observational and do not imply causality or validate prognostic use. Further studies using causal inference methods are necessary to inform clinical guidelines.

To compare the predictive performance of the novel Cholesterol, High-Density Lipoprotein, and Glucose (CHG) index for the incident type 2 diabetes mellitus (T2DM) versus the established indices-triglyceride-glucose (TyG), atherogenic index of plasma (AIP), and metabolic score for insulin resistance (METS-IR).

A longitudinal cohort study was performed on 15, 453 participants from the NAGALA cohort (2004-2015) without baseline T2DM. The CHG index was calculated from total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and fasting blood glucose (FBG). Several additional indices were established, including the TyG, AIP, and METS-IR. Cox regression, Kaplan-Meier analysis, restricted cubic spline (RCS) analysis, and time-dependent receiver operating characteristic (ROC) curves were performed to determine the predictive performance, after adjusting for various confounders (e.g., obesity, liver function). Robustness was assessed through sensitivity analyses.

During a 6.13-year follow-up, 373 T2DM cases were recorded. In the fully adjusted models, we found that the CHG index had the highest hazard ratio (HR): 6.18 per unit (95% CI: 3.38-11.27), outperforming the TyG index (HR: 1.39), AIP (HR: 1.80), and METS-IR (HR: 1.07). Quartile analysis revealed a dose-response relationship for CHG (Q4 HR: 4.36 vs. Q1, P < 0.001). Further, the RCS analysis revealed a linear association between CHG and T2DM risk (P for overall trend < 0.001; P for nonlinearity = 0.712). Moreover, the CHG index achieved a satisfactory discriminative accuracy (based on the area under the curve [AUC]: 0.783 vs. TyG: 0.751, AIP: 0.745, METS-IR: 0.780) and its predictive power was consisted over the 12 years (peak AUC: 0.798 at 7 years). Sensitivity analyses for various subgroups (e.g., non-obese, non-fatty liver) confirmed that the obtained results were robust.

The CHG index that integrates cholesterol, HDL-C, and glucose metabolism, showed superior predictive performance for the incidence of T2DM. Suggesting that it effectively captures the multifactorial pathophysiology of the disease. It is based on routine biomarkers making it easily applicable in risk stratification, offering a cost-effective tool for early intervention and precise prevention in clinical and public health settings.