Epidemiological association between psoriasis and T2DM suggests shared pathophysiology that are to be explored. Microarray expression profiles for psoriasis and T2DM were obtained from the Gene Expression Omnibus (GEO) database. The "limma" package in R software was used to screen the differentially expressed genes (DEG). GO and KEGG enrichment analysis were further conducted to explore the functions of co-DEGs. By intesecting genes of the key disease-related modules from WGCNA with co-DEGs, candidate co-driver genes were identified and their PPI network was constructed. Hub genes with good diagnostic potential were obtained by ROC analysis and their expression was further compared in validation datasets as well as clinical samples. The crucial co-driver genes, identified by a consistently differential expression pattern, were further subjected to a series of analyses, including Gene Set Enrichment Analysis (GSEA), immune cell infiltration analysis, gene-chemistry networks analysis, gene-transcription factors (TF) network analysis, and gene-miRNA regulatory network analysis. In our study, 71 co-DEGs were identifed from psoriasis and T2DM training datasets. KEGG analysis revealed enrichment of pathways including toll-like receptor signaling pathway, cytokine-cytokine receptor interactions, chemokine signaling pathway, NOD-like receptor signaling pathway and cytosolic DNA-sensing pathway. By intersecting the critical WCGNA modules with co-DEGs, 33 candidate co-driver genes were obtained. 11 of them showed interactions with others on PPI network and 7 revealed good diagnostic value with AUC > 0.7 by ROC analysis. 4 genes, namely BEX5, EPHX2, GPRASP1, and RBP4 were finally identified as crucial co-driver genes with a consistent differential expression pattern in both training and validation datasets as well as validation experiments using clinical samples. GSEA analysis revealed that these crucial co-driver genes were involved in cytokine receptor interaction, proteasome, ribosome, apoptosis and so on. Immune cell infiltration and correlation analyses highlighted their roles in the immune microenvironment. Lastly, these genes targeted 76 skin and metabolic diseases and 135 chemicals were predicted to exert an modulatory effect of their expression. 13 TFs and 79 miRNAs were identified to modulate their expression. The integrated bioinformatics analysis conducted in our study identified co-DEGs and enriched immune-inflammatory pathways, providing novel insights into the pathogenesis underlying the comorbidity of psoriasis and T2DM. The crucial co-driver genes warrants further experimental validation and exploration to unveal the common pathophysiology.

Diabetes management in resource-limited settings faces challenges in screening, guideline-based treatment, and healthcare access. The IMPACT Diabetes study evaluated a community-based, technology-enabled task-shifting intervention for diabetes care in India. A cluster randomized controlled trial was conducted in 16 villages/peri-urban areas across 8 primary health centers (PHCs) in two states in India. Accredited Social Health Activists (ASHAs) screened 1,785 community participants, identifying 418 individuals with diabetes. The intervention group received nine months of CDSS-supported care delivered by ASHAs under physician supervision, while the control group received usual care. The primary outcome was the proportion of participants achieving ≥ 0·5% reduction in glycated haemoglobin (HbA1c) from baseline. Secondary outcomes included healthcare utilization and medication adherence. A significantly higher proportion of intervention participants achieved HbA1c reduction ≥ 0·5% compared to the control group (21.8% vs. 10.3%, p < 0.05). Intervention participants had more frequent physician visits (85·0% vs. 29·8%), higher glucose-lowering medication adherence (63·0% vs. 43·1%, p < 0·05), and better engagement with diabetes management practices. Qualitative findings demonstrated that the intervention was acceptable and feasible for patients, ASHAs, and physicians, empowering ASHAs in chronic disease care. This study demonstrates that task-shifting and digital health tools can improve diabetes outcomes in low-resource settings. Future research should explore long-term sustainability and cost-effectiveness.

We evaluated the real-world efficacy of intravitreal faricimab for diabetic macular edema (DME) and its relationship with visual and retinal anatomical changes using optical coherence tomography. We retrospectively assessed 174 patients (214 eyes) with DME from 13 Japan Clinical REtina Study Group (J-CREST) sites who received ≥ 1 faricimab injection and were followed ≥ 6 months, and compared treatment-naïve (with no prior anti-VEGF treatment) and previously treated groups. Both groups showed significant improvements in best-corrected visual acuity (BCVA) and central subfield thickness (CST BCVA gain was greater in the treatment-naïve group (p = 0.0109), whereas CST reduction showed little difference (p = 0.31). Resolution of cystoid macular oedema, diffuse retinal thickening, and subretinal fluid (SRF) was observed in both groups. Resolution of inner nuclear layer (INL) oedema and SRF significantly correlated with ≥ 0.2 log MAR BCVA improvement in the treatment-naïve group (p = 0.043 and p = 0.022, respectively). Mean number of injections was comparable between groups. One case of anterior chamber inflammation occurred; however, no serious systemic events were observed. In conclusion, faricimab significantly improved visual and anatomical outcomes in DME, especially in treatment-naïve eyes. Early resolution of INL oedema and SRF may serve as a potential biomarker for visual prognosis.

Diabetes distress, arising from the relentless demands of diabetes management, is notably higher in culturally diverse groups. Psychosocial interventions may reduce diabetes distress through cultural tailoring that addresses beliefs and language barriers. This scoping review aimed to map the availability, key features and impact of psychosocial interventions addressing diabetes distress in culturally diverse groups.

This scoping review followed the Arksey and O'Malley framework.

Five databases (PubMed, PsycINFO, Cochrane Library, CINAHL and Web of Science) were searched for peer-reviewed publications (2013-2024).

The included studies involved participants from culturally diverse groups who were diagnosed with diabetes and engaged in psychosocial interventions. Our search did not restrict diabetes type, but all included studies enrolled adults with type 2 diabetes. Studies in English, with no restrictions on study design and geographical location were included. The review excluded studies focusing on caregivers of patients with diabetes, healthcare providers, Native and Indigenous groups, and lifestyle interventions focused on physiological outcomes.

Study characteristics, participant demographics, intervention features and outcomes (including participant satisfaction and attrition) were extracted and synthesised thematically by intervention type. Findings are presented narratively.

The review included 13 studies. All psychosocial interventions included diabetes education alongside psychosocial strategies, with most being short-term (four months or less) and delivered in person. Small to moderate reductions in diabetes distress were observed in all but three studies. Empowerment-based interventions produced short-term reductions; longer interventions showed more gradual change. These interventions also improved knowledge of diabetes management, self-efficacy, self-management behaviours and social support. In contrast, peer-led interventions showed limited effectiveness in improving psychosocial outcomes. Mixed evidence was found for the value of family-based interventions.

This review recommends the integration of psychosocial interventions into healthcare plans and highlights several gaps in the evidence base, including limited cultural adaptations beyond linguistic modifications, and a limited focus on South Asian and Middle Eastern populations. Future research should consider multi-site RCTs, longitudinal designs and refinement of intervention designs to improve accessibility, cultural relevance, and sustainability over time.

To examine (1) the mediating roles of self-efficacy and future-oriented time perspective (FTP) in the association between workplace culture of health (COH) and diabetes self-management and (2) the moderating effect of diabetes distress on the relationship between self-efficacy and FTP among employees with type 2 diabetes mellitus (T2DM).

A cross-sectional survey.

This study was conducted among employees with T2DM recruited from the Endocrinology Outpatient Departments at three tertiary hospitals in Taiyuan City, Shanxi Province, China, between March and October 2024.

The participants were 462 employees with T2DM who had been employed at their current organisations for at least 3 months following their T2DM diagnosis.

Data on demographics, diabetes-related and work-related factors, workplace COH, self-efficacy, time perspective, diabetes distress and self-management performance were collected via a survey. The moderated mediation effects were examined using Hayes's PROCESS macro.

Workplace COH was associated with diabetes self-management both directly (β=0.251, 95% CI 0.080 to 0.422, p<0.01) and indirectly (indirect effect=0.303, 95% CI 0.190 to 0.419). Two significant indirect pathways were identified: (1) workplace COH → self-efficacy → diabetes self-management (indirect effect=0.207, 95% CI 0.110 to 0.308); (2) workplace COH → self-efficacy → FTP → diabetes self-management (indirect effect=0.093, 95% CI 0.051 to 0.144). However, the indirect pathway: workplace COH → FTP → diabetes self-management was not significant (indirect effect=0.004, 95% CI -0.055 to 0.063). Additionally, a significant interaction (β=-0.356, 95% CI -0.566 to -0.146, p<0.01) indicated that diabetes distress moderated the relationship between self-efficacy and FTP.

This study demonstrated that workplace COH was associated with diabetes self-management both directly and indirectly, specifically through self-efficacy alone and serially through self-efficacy and FTP; it also confirmed that diabetes distress weakens the effect of self-efficacy on FTP, thereby providing a basis for developing interventions to improve self-management among employees with T2DM.

Although coronary computed tomography angiography (CCTA) is useful for risk stratification in patients with diabetes, limited data is available regarding its prognostic value in asymptomatic patients with type 2 diabetes mellitus (T2DMs). Therefore, we aimed to evaluate the utility of CCTA in coronary artery disease (CAD) risk stratification in T2DMs compared to that in patients without diabetes mellitus (non-DMs).

We selected 565 T2DMs and 1,130 non-DMs using propensity score matching from the Evaluation of Subclinical Coronary atherosclerosis for Risk Stratification Using the Coronary Computed Tomography Angiography (ESCORT) study of 5,142 asymptomatic individuals. We evaluated CCTA findings and confirmed the occurrence of major adverse cardiac events (MACE; cardiac death, non-fatal myocardial infarction, and unstable angina) and total cardiac events (TCE; MACE plus coronary revascularization) during follow-up using Cox proportional hazards analysis and Kaplan-Meier survival curves.

Over a median follow-up of 47 months, MACE and TCE occurred significantly more in T2DMs than in non-DMs (4.2% vs. 1.7% and 7.8% vs. 4.3%, respectively, all P < 0.001). The Cox regression model identified T2DMs, obstructive stenosis, and proximally located plaques as independent predictors of MACE and TCE (all P < 0.05). Kaplan-Meier curve analysis revealed that survival rate was dependent on stenosis grade (log-rank P < 0.001) and differed significantly in the presence of T2DMs among patients with obstructive stenosis (P < 0.05).

While diabetes is an independent risk factor for CAD, its impact on survival rate varies with the severity of CAD, highlighting the value of CCTA as a prognostic tool for CAD risk stratification in asymptomatic T2DMs.

ClinicalTrials.gov Identifier: NCT01416532.

The use of glucagon-like peptide-1 receptor agonists (GLP-1RA) in patients with type 2 diabetes mellitus (T2DM) has increased substantially over the past several years. The purpose of this study was to determine whether GLP-1RA use affects outcomes after hip hemiarthroplasty (HA) for femoral neck fractures (FNFs). A retrospective cross-sectional analysis of a local hospital system database was conducted between 2016 and 2023 to identify patients with T2DM aged at least 18 years who underwent HA for FNFs and were on a GLP-1RA at the time of injury. A 1:1 random patient sample of those who underwent HA and were not on a GLP-IRA was used as a control. Patient characteristics and Elixhauser comorbidity index were recorded. Outcomes included hospital length of stay, aspiration pneumonitis during index hospitalization, inpatient readmissions and emergency department encounters within 365 days, medical complications, surgical site infection, implant complications, revision hip surgery, and in-hospital mortality/discharge to hospice within 30, 90, and 365 days. Binary logistic regression was done to assess the 30-day risk of medical and the 365-day risk of implant postoperative outcomes. Four hundred ninety-nine patients (GLP-1RA, N = 248; No GLP-1RA, N = 251), with T2DM, who underwent HA for FNF were included for analysis. GLP-1RA use was not markedly associated with medical complications within 30, 90, or 365 days; implant complications or revision surgery within 365 days; in-hospital mortality/discharge to hospice within 30 or 90 days; postoperative aspiration; length of stay; or inpatient readmissions or emergency department encounters. GLP-IRA use was associated with a decreased risk of in-hospital mortality/discharge to hospice within 365 days. When controlling for confounding variables, the use of GLP-IRA was not associated with any adverse outcome measured in the study (P > 0.05). GLP-1RA use in T2DM patients undergoing HA for FNF is not associated with an increased risk of early postoperative medical and surgical complications.

Frailty is highly prevalent among older adults with type 2 diabetes mellitus (T2DM) and may contribute to adverse health outcomes, particularly in institutionalized settings. Despite its clinical relevance, the prognostic value of frailty among nursing home residents with T2DM remains underexplored. This study aimed to assess the association between frailty, assessed using the Frailty Index (FI), and 12-month all-cause mortality among older adults with T2DM residing in French Caribbean nursing homes.

Data were drawn from the KASEHPAD (Karukera Study on Aging in Nursing Homes) study, a prospective, longitudinal cohort conducted across six nursing homes in Martinique and Guadeloupe. Frailty was assessed at baseline using a 30-item deficit accumulation model to compute the FI (range: 0-1). Mortality data were collected over a 12-month follow-up period. Associations between FI and mortality were analyzed using logistic regression and Cox proportional hazards models.

The study included 94 participants with T2DM (mean age: 81.1 ± 10.0 years; 42.6% male). The mean FI was 0.30 ± 0.14. Over the 12-month follow-up, 28 participants (29.8%) died. In unadjusted logistic regression models, each 0.01-point increase in FI was associated with a 6% increase in the odds of death (Odd Ratio (OR) = 1.06; 95% CI: 1.02-1.11; p = 0.002). After adjusting for age and sex, frailty was marginally associated with 1-year mortality (OR = 1.05; 95% CI: 1.00-1.10; p = 0.056), but was not significantly associated with time to death in the Cox model (Hazard Ratio [HR] = 1.03; 95% CI: 0.99-1.07; p = 0.139).

Frailty measured by the FI showed a tendency to be associated with short-term mortality among older adults with type T2DM living in nursing homes. These findings underscore the need for larger studies to further assess the prognostic utility of the FI in informing care planning and clinical management in this vulnerable population.

Diabetic retinopathy screening (DRS) rates have historically been low among underserved populations due to barriers in accessing traditional eye care. Although artificial intelligence (AI)-powered DRS provides a potential strategy to improve screening rates, its optimal integration into primary care workflows within federally qualified health centers (FQHCs) requires rigorous evaluation. The clinical workflow of the Diabetic Retinopathy Screening Point-of-Care Artificial Intelligence (DRES-POCAI) trial in FQHCs integrates AI-powered DRS with electronic health records (EHRs) to automate results and prompt referrals, aiming to improve screening rates and facilitate early diagnosis and timely treatment.

To increase DRS rates, facilitate early-stage DR detection, improve timely eye specialist follow-up, and assess the effect of DRS on patients' knowledge, attitudes, self-efficacy, and satisfaction.

DRES-POCAI is a patient-level, multiclinic, open-label, parallel superiority randomized clinical trial at 2 FQHC sites of San Ysidro Health in San Diego County, California. The study recruitment targets 848 active FQHC patients aged 22 years or older with diabetes, no DRS in the prior 11 months, and scheduled medical visits during the intervention period. Patients with a history of retinopathy or retinal vascular occlusion and other physical or mental conditions are excluded. The study started in June 2024, with recruitment anticipated to conclude in August 2025 and follow-up until February 2026.

The intervention arm receives DRS at their primary care clinic using an AI-powered DRS system, with retinal image analysis to identify more than mild DR and vision-threatening DR. Results are immediately available in the EHRs, and practitioners receive risk-stratified referral recommendations. The usual care arm receives referrals to an FQHC optometrist or external eye care practitioner, with results transmitted to the medical home later.

The primary outcome is DRS completion status. Secondary outcomes include DR diagnosis stage, specialist referrals, and participants' DR knowledge, attitudes, and intentions regarding future AI-powered DRS.

Findings will be disseminated in peer-reviewed publications after data collection and analysis.

DRES-POCAI will determine the effectiveness of an AI-powered DRS intervention to increase DRS rates in FQHC primary care workflows.

ClinicalTrials.gov Identifier: NCT06721351.

Immune dysregulation, polyendocrinopathy, enteropathy, and X-linked(IPEX) syndrome caused by FOXP3 mutations is rare. FOXP3 is a transcription factor required for the regulatory T cell (Treg) development/function.

We aimed to characterize the clinical, immunologic, and genetic features of a single-center cohort of IPEX syndrome.

We present the clinical/immunological/genetic features of 12 patients with IPEX syndrome. We used whole exome and Sanger sequencing for the diagnosis/familial segregation. We performed immunophenotyping and measured Treg percentage and FOXP3 expression in peripheral blood by flow cytometric analysis.

Median age at diagnosis was 2.5 years (range: 0.3-22 years). Common clinical manifestations were infections (n = 9, 75%), allergies (n = 8, 67%), autoimmunity (n = 7, 58%), enteropathy (n = 7, 58%), and lymphoproliferation (n = 3, 25%). Atypical initial presentations included class IV lupus nephritis, a SCID-like immunophenotype (CD3⁺ T cells: 4% [100/µL]; CD4⁺ T cells: 3%, CD8⁺ T cells: 1%, CD19⁺ B cells: 81%, CD16/56⁺ NK cells: 13%), and isolated hypogammaglobulinemia persisting for years during follow-up. At the time of diagnosis, three (25%) patients had leukopenia, six (50%) had lymphopenia and two (17%) had neutropenia. Eosinophilia was observed in 42% of patients (25% mild, 17% moderate). Six different variants in FOXP3 were characterized in 12 patients from nine unrelated families. Four (33%) patients underwent hematopoietic stem cell transplantation (HSCT). Overall, three (25%) patients died due to infections. One patient died due to HSCT-related catheter complications, one patient died in an accident. Among the transplanted patients, two are alive and well. Among the non-transplanted patients, five are alive and are being followed up at our center. Treg (CD4⁺CD127^-/lowCD25⁺Foxp3⁺) percentage was low in eight patients compared to healthy controls (p < 0.001). FOXP3 expression was low in all the patients compared to healthy controls.

Atypical presentations make the diagnosis of IPEX syndrome challenging. This study expands the current knowledge of IPEX syndrome by describing a single-center cohort with certain atypical manifestations and by confirming previously reported rare phenotypes. Elucidating the genetic basis of immunodeficiency diseases contributes to improving diagnostic approaches and patient management.