Dry eye is the most common ocular surface disorder that is increasingly acknowledged to be associated with diabetes mellitus. Via metabolic dysregulation and neural injury, diabetes mellitus significantly increases the prevalence of dry eye, adversely affecting patients' quality of life. At present, the diagnosis and treatment of diabetic dry eye are still facing challenges in clinical practice. This article outlines the prevalence and risk factors associated with diabetic dry eye, explores its underlying pathogenic mechanisms, such as advanced glycation end-product accumulation, oxidative stress, corneal neuropathy, and impaired neural regulation, which collectively disrupt the lacrimal functional unit, leading to reduced tear secretion and tear film instability. The clinical manifestations of diabetic dry eye are also reviewed. According to current literature, diagnostic strategies utilizing confocal microscopy and tear fluid biomarkers are proposed. In addition, this review summarizes recent therapeutic advances and potential intervention strategies for diabetic dry eye, with a focus on emerging mechanism-based treatments. Taken together, this review aims to advance research on diabetic dry eye and offer novel insights to support early diagnosis and precision therapy.

Type 2 diabetes mellitus (T2DM) and obesity represent major global health challenges. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as effective treatments for both conditions, providing significant glycemic control and weight-reduction benefits. Orforglipron is an investigational, oral, non-peptide GLP-1RA that does not require complex absorption enhancers or dosing restrictions. Preclinical and early clinical studies have demonstrated promising results in glycemic control and weight reduction. This systematic review and network meta-analysis aims to evaluate the efficacy and safety of various orforglipron doses in improving glycemic control and reducing body weight. We conducted a search across five databases. A frequentist network meta-analysis with random-effects models was performed using MetaInsight (version 3.14) to analyze randomized controlled trials(RCTs) comparing orforglipron with placebo in patients with obesity or diabetes. Efficacy outcomes (HbA1c, body weight, BMI, lipid profile, blood pressure) were reported as mean differences, and safety outcomes (adverse events) as risk ratios, with 95% CIs. Five RCTs involving multiple orforglipron doses (3-45 mg) demonstrated that higher doses, particularly 45 mg, significantly reduced BMI (MD = -3.52 kg/m²), body weight (MD = -9.34%), waist circumference (MD = -7.19 cm), HbA1c (MD = -1.33%), triglycerides (MD = -15.31% for 36 mg), and blood pressure compared to placebo. All doses showed higher rates of total adverse events and treatment discontinuation than placebo, while serious adverse events and specific gastrointestinal symptoms (nausea, vomiting, dyspepsia) were lower than placebo. Orforglipron is particularly suitable for patients preferring oral therapy over injectable GLP-1 receptor agonists. Orforglipron demonstrated significant dose-dependent improvements in patients with obesity (with or without comorbidities) and T2DM, with higher doses (36-45 mg) showing greater efficacy for weight loss and glycemic control, though at the cost of increased treatment discontinuation. Mid-range doses (24-36 mg) may be better suited for patients prioritizing lipid management and blood pressure control while seeking improved tolerability with a lower discontinuation risk.

This study aimed to explore the correlation between free fatty acid (FFA) levels and adverse outcomes in patients undergoing percutaneous coronary intervention (PCI) with or without diabetes mellitus.

In total, 10,230 patients treated with PCI were included in this study and divided into three equal groups according to FFA levels (FFA-L, FFA-M, and FFA-H groups). Subsequently, the patients were further stratified based on their diabetes status. A 5-year follow-up was conducted, with the primary endpoint defined as major adverse cardiovascular and cerebrovascular events (MACCE).

During follow-up, 2108 (20.6%) patients experienced MACCE. In patients without diabetes, no significant difference was observed in the risk of MACCE among the different FFA groups. However, in patients with diabetes, the risk of MACCE was significantly higher in the FFA-L and FFA-H groups than in the FFA-M group [adjusted hazard ratio (HR), 1.238, 95% confidence interval (CI), 1.054-1.454, P = 0.009; adjusted HR: 1.220, 95% CI, 1.054-1.412, P = 0.008; respectively]. The restricted cubic spline curves showed a nonlinear U-shaped relationship between the FFA levels and the risk of MACCE in patients with diabetes, with the lowest risk observed at an FFA level of 372 μmol/L. The results of the subgroup analysis stratified by different clinical presentations and BMI were similar to those of the primary findings.

In patients with diabetes undergoing PCI, both elevated and decreased FFA levels were significantly associated with an increased risk of MACCE. Monitoring FFA levels is essential to help identify those at high risk.

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammatory arthritis and extra-articular involvement. Comorbidities are highly prevalent in patients with RA, in particular cardiovascular disease (CVD), which is responsible for over 50% of premature deaths. This study aimed to describe cardiovascular diseases and their risk factors among patients with rheumatoid arthritis in the Philippine General Hospital (PGH).

To describe cardiovascular (CV) diseases and their risk factors among patients with rheumatoid arthritis.

A retrospective descriptive cross-sectional study was done in the University of the Philippines - Philippine General Hospital (UP-PGH) inpatient and outpatient services. The study included patients 18 years old and above diagnosed with RA and fulfills the 1987 American College of Rheumatology or 2010 American College of Rheumatology-European League Against Rheumatism (ACR/EULAR) classification criteria with no overlap features with other autoimmune connective tissue diseases and with complete records of the information required for the study from January 2019-December 2022. The primary outcomes of interest were the prevalence of CV diseases and CV risk factors. Descriptive statistics were used to summarize the data.

There were 123 patients in the study, 93.4% outpatients, and 95.1% females, with a mean age and disease duration of 51.3 and 9.8 years, respectively. Disease activity was moderate in 35% and high in 9.7%, based on disease activity score (DAS 28) or clinical disease activity index (CDAI) scores. Methotrexate (54%) was the most commonly used conventional synthetic disease-modifying antirheumatic drug (csDMARD). Glucocorticoid use was observed in 51.2%. None of the patients were receiving a biologic DMARD. There were 24 (19.5%) patients with CV diseases, namely myocardial infarction, heart failure, and stroke. There were 87 (70%) patients with at least one CV risk factor and 62 (50.4%) with multiple risk factors. The risk factors identified were: dyslipidemia (43.1%), hypertension (40.7%), elevated body mass index (35.7%), and diabetes mellitus (15.4%). There were five deaths in the hospitalized patients (4%), one due to a myocardial infarction.

The majority (70%) in our cohort had at least one CV risk factor, 19.5% had an identified CV disease, and one died from a myocardial infarction. Dyslipidemia was the most common CV risk factor. The high proportion of patients with CV disease and CV risk factors highlights the need to add the screening and management of CV diseases and risk factors as a priority among patients with rheumatoid arthritis.

This study aimed to investigate the joint and independent associations of type 2 diabetes (T2DM) and body mass index (BMI) with arterial stiffness using carotid ultrasound-based measures.

This retrospective, matched cross-sectional study enrolled 255 participants, including people with T2DM (n=129) and Control group (diabetes-free, n=126). The control group was matched to the T2DM group based on age (±5 years), sex, and BMI category. People with T2DM were diagnosed according to World Health Organization criteria and classified into three BMI-based categories: lean (BMI<25 kg/m², n=48), overweight (BMI=25-29.9 kg/m², n=44) and obese (BMI≥30 kg/m², n=37). Carotid intima-media thickness (IMT) and pulse wave velocity (PWV) were determined using sample images. Univariable and multivariable logistic regression models were used to evaluate the associations between BMI, T2DM and arterial stiffness, adjusted for potential confounders such as age, systolic blood pressure and lipid profiles. Interaction terms tested multiplicative effects.

Compared to people with diabetes-free, those with T2DM had significantly greater IMT and PWV impairments (P<0.001). An increasing BMI category was associated with progressive IMT and PWV increase in people with T2DM (P<0.001). Multi-variable analysis revealed that BMI category had strong associations with carotid IMT (Standardize β 0.715, 95% CI: 113.4, 174.7) and PWV (Standardize β 0.544, 95% CI: 0.81, 1.73), indicating the progressive impact of BMI on arterial stiffness. No interaction was observed between T2DM and BMI (IMT: P-interaction=0.95; PWV: P-interaction=0.56), indicating independent effects.

This study demonstrates additive but non-synergistic effects of T2DM and BMI on arterial stiffness, with BMI driving the majority of vascular impairment. However, the cross-sectional design precludes causal inferences. The findings underscore the clinical relevance of weight management in people with T2DM.

Annual metabolic monitoring is strongly recommended for patients with type 2 diabetes (T2D) prescribed second-generation antipsychotics (SGA). Our objective was to study the rates of monitoring and control in the period after index SGA prescription following T2D diagnosis, relative to those prescribed first-generation antipsychotics (FGA) and neither. Among 469,503 adults in Epic Cosmos, we estimated therates ofmonitoring(%) ofweight, HbA1c, LDL, and renal function for Years 1 to 3 using marginal logistic models. We adjusted for demographic, clinical covariates, encounter frequency, and Charlson Comorbidity Index. Despite more healthcare visits, SGA and FGA groups had declining monitoring rates across all years. Relative to those prescribed neither, renal function was monitored more frequently among patients prescribed SGA and FGA only in Year 1, while HbA1c and LDL were monitored less for all years. Rates ofmetabolic control were higher than national averages, but similar over time and did not differ between groups. Poor metabolic monitoring following SGA prescription may hinder risk management for T2D complications among this vulnerable population.

Helping patients self-managing diseases like type 1 diabetes (T1D) requires informatics tools delivering real-time predictions with explainable, actionable guidance. However, many healthcare AI solutions lack actionable recommendations and user-friendly explanations, limiting clinical impacts. We introduce APEA, a pediatric T1D self-management Ambient-AI assistance tool, integrating glucose multi-trajectory-scenarios Prediction, interactive, context-aware large language model Explanations, and just-in-time adaptive intervention policy optimization for Actionable real-time suggestions through reinforcement learning. Using T1DEXIP dataset (262 pediatric T1D patients, multi-center), our results showed improved glucose control outcomes: 45% over human management, 69% over infusion-pump management. Although constrained by small sample size and severe class imbalance, APEA addresses healthcare AI implementation gaps by bridging what might happen, what can be done about it, and why it makes clinical sense. APEA offers a transferable framework for other chronic conditions that demand continuous, personalized, just-in-time adaptive interventions.

Stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging offers a non-invasive alternative for invasive coronary angiography (ICA) in diagnosing coronary artery disease (CAD), however often yields inconclusive results. This study aimed to characterize patterns of agreement and discordance between stress SPECT and ICA, and to evaluate potential risk stratification.

We retrospectively analyzed 915 patients with suspected CAD who underwent stress SPECT followed by ICA within three months (enrollment: 2019-2020). Clinical, demographic, and imaging data were extracted from medical records. Variables associated with diagnostic agreement were identified using univariate logistic regression. A predictive model combining SPECT results with clinical variables was developed using backward stepwise logistic regression and evaluated by AUC-ROC.

Diagnostic agreement between stress SPECT and ICA was observed in 624 patients (68.2%), while 291 patients (31.8%) demonstrated discordant results. Agreement was associated with use of nitrates (OR 3.18, 95% CI 1.31-7.73), antiplatelet therapy (OR 2.57, 95% CI 1.86-3.56), renal failure (OR 2.34, 95% CI 1.43-3.84), and type II diabetes mellitus (OR 1.78, 95% CI 1.28-2.48), whereas female sex (OR 0.50, 95% CI 0.34-0.73), smoking (OR 0.72, 95% CI 0.50-1.03), and higher body mass index (BMI; OR 0.95 per kg/m², 95% CI 0.92-0.99) were associated with disagreement. The final multivariable model included stress SPECT results, sex, BMI, smoking status, serum creatinine, renal failure, type II diabetes mellitus, and use of antiplatelets and nitrates and demonstrated improved discrimination compared with SPECT alone (AUC 0.72 vs. 0.54, p < 0.001).

In this exploratory study, clinical factors were associated with an agreement between stress SPECT and ICA. Incorporating clinical context alongside SPECT findings may help inform risk stratification.

To explore the role of Tai Chi training in improving Type 2 Diabetes Mellitus (T2DM) based on gut microbiota, serum inflammatory factors, and intestinal mucosal barrier function.

Thirty-six patients with T2DM underwent 6 months of Tai Chi training. Body composition, biochemical indicators (fasting blood glucose, glycated hemoglobin, etc.), serum inflammatory factors (Tumor Necrosis Factor-α (TNF-α), Interleukin-6 (IL-6), etc.), and gut microbiota (16S rRNA sequencing) were measured.

After 6 months of Tai Chi training, significant reductions were observed in body weight, BMI, waist circumference, and body fat percentage (p < 0.05), while lean body mass increased significantly (p < 0.05). Fasting blood glucose, glycated hemoglobin, insulin resistance index (HOMA-IR), and total cholesterol levels decreased significantly (p < 0.01). C-reactive protein (CRP), TNF-α, IL-6, IL-1β, and IL-8 levels decreased significantly (p < 0.01), while the anti-inflammatory factor IL-10 increased significantly (p < 0.01). The Chao1 and Shannon indices increased significantly (p < 0.05). The abundance of beneficial bacteria increased significantly, while the abundance of harmful bacteria decreased significantly (p < 0.01). Markers of intestinal mucosal barrier function, including D-lactate and zonulin, decreased significantly (p < 0.01), while the level of milk fat globule-EGF factor 8 (MFG-E8) increased significantly (p < 0.01).

Tai Chi training can improve blood glucose homeostasis, gut microbiota richness and diversity, intestinal mucosal barrier function, and systemic inflammatory status in T2DM patients. Tai Chi training may be an important approach for personalized treatment of T2DM.

Severe hypoglycemia increases the risk of cardiovascular disease (CVD) in people with diabetes. Large cohort studies and scientific statements show that severe hypoglycemia is linked to higher rates of coronary heart disease, cardiovascular events, and mortality in both type 1 and type 2 diabetes. This risk is especially high in individuals with significant vascular risk, such as older adults and those with multiple cardiovascular risk factors. Hypoglycemia triggers several pathophysiological changes that increase cardiovascular risk. These include activation of the sympathoadrenal system, promotion of proinflammatory and prothrombotic states, arrhythmogenic changes, and increased hemodynamic stress. Experimental evidence shows that recurrent hypoglycemia worsens microvascular dysfunction and promotes adverse cardiac remodeling, especially in people with diabetes. While the link between hypoglycemia and cardiovascular events is well established, the causality remains debated. Hypoglycemia may directly contribute to cardiovascular disease or indicate underlying vulnerability, especially in patients with advanced disease or comorbidities. Minimizing hypoglycemic episodes is recommended for all patients with diabetes, particularly those with established cardiovascular disease, due to the clear association with adverse outcomes.