Early postoperative ileus (EPOI) delays recovery after radical cystectomy, but reported definitions and associated factors vary. This retrospective study evaluated 549 adults with bladder cancer who underwent curative-intent laparoscopic radical cystectomy and urinary diversion between January 2014 and December 2022. EPOI was defined by the presence of at least two prespecified clinical or radiological criteria between postoperative days 3 and 30. Candidate factors were evaluated using univariate analyses and multivariable logistic regression. Model discrimination and calibration were assessed, and 1,000-resample bootstrap internal validation was performed. An exploratory subgroup analysis assessed inflammatory markers measured within 24 h after surgery. EPOI occurred in 76 patients (13.84%). After multivariable adjustment, female sex was associated with lower odds of EPOI, whereas smoking history, diabetes mellitus, previous abdominal surgery, greater intraoperative blood loss, and higher lymph node yield were associated with higher odds. The apparent area under the receiver operating characteristic curve (AUC) of the primary model was 0.881, and the optimism-corrected AUC was 0.869. In the 138-patient inflammatory-marker subgroup, postoperative white blood cell count and C-reactive protein were higher in patients who subsequently met the prespecified EPOI criteria; white blood cell count showed exploratory discrimination with an AUC of 0.727. These findings identify patient- and surgery-related factors associated with EPOI, but the model, data-derived thresholds, and biomarker findings require prospective multicenter external validation before clinical use.

CKD is a major complication of T2DM and a leading cause of end-stage kidney disease. Because urinary albumin-to-creatinine ratio (UACR) and eGFR have recognized limitations, additional biomarkers may help characterize kidney dysfunction. HCY is frequently elevated in CKD and may reflect pathways of renal injury. We evaluated the association of HCY with kidney dysfunction and its cross-sectional discrimination of CKD status in Vietnamese adults with T2DM.

A descriptive cross-sectional study was conducted among adult outpatients with T2DM recruited at UMC HCMC (Campus 2) from December 2023 to December 2025 using convenience sampling. CKD was defined as eGFR < 60 mL/min/1.73 m² and/or UACR > 30 mg/g. HCY and other laboratory parameters were measured using standardized protocols; eGFR was calculated using the 2021 CKD-EPI creatinine-cystatin C equation. Correlation, logistic regression, and ROC analyses were performed. Albuminuria alone was examined in a sensitivity analysis, and AUCs were compared using DeLong's test.

Among 201 participants, 164 (81.6%) met the study-defined CKD criteria. HCY was higher in participants with CKD and increased across worsening eGFR and albuminuria categories. HCY correlated more strongly with creatinine and cystatin C (r = 0.67 for both) and eGFR (r = -0.59) than with UACR (r = 0.26). Higher HCY remained associated with CKD after adjustment for age and HbA1c (adjusted OR = 1.27, 95% CI 1.14-1.42). The HCY-only AUC was 0.79; the Youden-derived threshold was 11.35 μmol/L (sensitivity 0.76; specificity 0.78). For albuminuria alone, the association persisted (OR = 1.08, 95% CI 1.03-1.14), but discrimination was modest (AUC = 0.63). The multivariable AUC was 0.812 and did not differ significantly from the HCY-only AUC (DeLong p = 0.325).

Higher HCY was associated with CKD and kidney dysfunction, with a stronger relationship to filtration markers than to albuminuria. These cross-sectional findings do not establish screening or prognostic utility. The 11.35 μmol/L threshold is exploratory and requires external validation.

The optimal bariatric procedure for patients with severe obesity (BMI ≥ 50 kg/m²) remains debated. This study compares standard laparoscopic sleeve gastrectomy (LSG) with an emerging metabolic intervention, LSG with proximal jejunal bypass (LSG + PJB).

A retroprospective study (January 2022-December 2024) included 48 patients with severe obesity, divided into LSG (n = 25) and LSG + PJB (n = 23) groups. Outcomes evaluated included percent excess weight loss (%EWL), percent total weight loss (%TWL), HbA1C, complete diabetes mellitus (DM) remission, operative time, length of stay (LOS), and complications. The study protocol was approved by the Institutional Review Board of Rajavithi Hospital (Approval No. 68184).

At 12 months, both groups achieved significant weight reduction. LSG + PJB showed higher mean %EWL (52.05% vs. 42.27%) and %TWL (28.74% vs. 24.71%) than LSG, though statistically insignificant. However, LSG + PJB demonstrated significantly superior metabolic outcomes, including a higher complete DM remission rate (100% vs. 66.7%, p = 0.047) and greater reductions in HbA1C (p = 0.001), fasting blood sugar (p = 0.005), and C-peptide (p = 0.026). While operative time was longer for LSG + PJB (183.3 vs. 113 min), LOS and major complications were comparable. Notably, the LSG group experienced higher rates of constipation (16%, p = 0.045) and GERD (12%, p = 0.086).

Both procedures effectively achieve weight loss in patients with severe obesity. Nevertheless, LSG + PJB yields significantly superior glycemic control and DM remission with a comparable safety profile, making it a highly effective surgical alternative, particularly for patients with comorbid Type 2 diabetes.

Examine the factors associated with continuous glucose monitoring (CGM) device prescriptions in a primary care facility.

We conducted a retrospective study of 1476 patients with Type 1 and Type 2 diabetes receiving care at a single primary care facility between 2020 and 2024. We examined the associations between receiving a CGM prescription and demographic characteristics, health factors, de-identified physician information, and insurance status. We conducted univariate analysis using chi-square tests. Multivariate logistic regression models accounted for multiple factors predicting receiving a CGM prescription.

The average CGM prescription rate per physician was less than 4%. Various factors were significantly associated with receiving a CGM prescription. Notably, younger patients on insulin, with Type 1 diabetes, and higher glycated hemoglobin (HbA1C) values were more likely to be prescribed a CGM device. Patients with nutritional and metabolic diseases or abnormal lab values were less likely to receive a CGM prescription.

Our findings are similar to those of other CGM studies, which show that CGM prescriptions are significantly higher among patients who are younger and who have Type 1 diabetes. There is a need for future studies that aim to better understand CGM prescribing decision-making among PCPs to inform the development of targeted interventions to improve CGM prescribing rates for all eligible patients.

ObjectiveTo examine the association between serum 25-hydroxyvitamin D and visceral fat area in adults with type 2 diabetes and assess the exposure-response pattern.MethodsThis retrospective cross-sectional study included 1271 adults with type 2 diabetes. Serum 25-hydroxyvitamin D was analyzed as a continuous variable and by quartiles. Multivariable linear regression models were sequentially adjusted for demographic, lifestyle, and metabolic factors, with body mass index added separately in the fully adjusted model. A generalized additive model was used to assess the exposure-response relationship. Prespecified subgroup analyses were also performed.ResultsVisceral fat area differed across quartiles of serum 25-hydroxyvitamin D, with a lower median value in Q4 than in Q1 (87.0 vs. 96.0 cm²; p = 0.002). Higher serum 25-hydroxyvitamin D was associated with lower visceral fat area in the multivariable model without body mass index (β = -0.77, 95% confidence interval: -1.13 to -0.41; p < 0.0001) and in the body mass index-adjusted model (β = -0.53, 95% confidence interval: -0.80 to -0.27; p < 0.0001). In quartile analyses, participants in Q4 had lower visceral fat area than those in Q1 in the body mass index-adjusted model (β = -10.04, 95% confidence interval: -16.19 to -3.89; p = 0.0015), whereas the associations for Q2 and Q3 were not statistically significant; nevertheless, a significant trend was observed across quartiles (p for trend = 0.0005). The generalized additive model suggested an approximately linear inverse association between serum 25-hydroxyvitamin D and visceral fat area.ConclusionsIn adults with type 2 diabetes, higher serum 25-hydroxyvitamin D levels were associated with lower HDS-2000-estimated visceral fat area, although the association was attenuated after adjustment for body mass index. This cross-sectional association should not be interpreted as independent of overall adiposity or unmeasured lifestyle, comorbidity, and treatment-related factors. Longitudinal studies are needed to clarify temporality.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely prescribed for type 2 diabetes mellitus (T2DM) and obesity. Whether GLP-1 RA use is associated with altered long-term pancreatic cancer risk remains uncertain, with conflicting evidence from prior observational studies. We aimed to evaluate the association between initiation of GLP-1 RA therapy and incident pancreatic cancer risk compared with six classes of antidiabetic agents.

We conducted a retrospective, new-user cohort study using the TriNetX global federated electronic health record network. Adults with T2DM initiating GLP-1RA therapy were compared with incident users of insulin, metformin, dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium-glucose cotransporter-2 (SGLT2) inhibitors, sulfonylureas, and thiazolidinediones in six separate propensity score-matched analyses (1:1, greedy nearest-neighbor algorithm, caliper 0.1 pooled standard deviations). Matching was performed on 39 baseline covariates,, including demographics, comorbidities, procedures, and medication exposures. The primary outcome was incident pancreatic cancer (ICD-10-CM C25) occurring between 365 and 7,300 days after the index prescription. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression.

After propensity score matching, GLP-1 RA users compared with insulin users had a lower hazard of pancreatic cancer (HR 0.43, 95% CI 0.35, 0.53; absolute risk: GLP-1 RA 0.15% vs. insulin 0.11%; absolute risk difference [ARD] 0.04% points). In contrast, users of metformin (HR 1.39, 95% CI 1.16, 1.66; ARD 0.04% points), sulfonylureas (HR 1.37, 95% CI 1.13, 1.65; ARD 0.07% points), thiazolidinediones (HR 1.30, 95% CI 1.001, 1.678; ARD 0.15% points) and DPP-4i (HR 1.31; 95% CI 1.06, 1.61; ARD 0.08% points) had significantly higher hazards of pancreatic cancer compared with GLP-1 RA users. No significant difference was observed between GLP-1 RA users and users of SGLT2 inhibitors (HR 1.08, 95% CI 0.87, 1.34).

In this large, real-world, propensity score-matched analysis, the direction and magnitude of the association between GLP-1 RA use and pancreatic cancer risk varied by comparator agent. GLP-1 RA use was associated with a lower hazard of pancreatic cancer relative to metformin, sulfonylureas, thiazolidinediones, and DPP-4i while no significant difference relative to SGLT2i, and a higher hazard relative to insulin.

Aim: The aim of this study is to investigate the effectiveness of a group-based intervention of patients with T2DM on self-efficacy. The main objective of the study was to explore the appropriateness and feasibility of diabetes intervention as a motivational strategy to enhance self-care of patients with T2DM and its possible integration in primary care from health professionals.

Materials and Methods: A quasi -experimental study was conducted with a pre- and post-test design in an experimental group and a control group, in Larissa Greece, at the patients with T2DM during their regular visits in Primary Care Units.

Results: The study samples were comprised 2 groups from forty one patients each. None of the patients in either group had received intervention programme previously. The study was conducted throughout in 4 sessions during the period of 3 months. Self-efficacy scores in intervention group differed statistically significantly in all items before and after the experimental procedure, (p<0.05). Intervention group achieved significantly higher scores compared with the control group in certain items (Diet, Medical therapy, Medication-feet check, and Physical activity p=0.001, p=0.001, p=0.001 and p=0.007, respectively).

Conclusions: Our study confirms the positive effect of a group-based intervention programme of patients with T2DM on self-efficacy. Future research should assess the viability of group-based intervention to be extended to more adults with T2DM in the community.

To investigate associations between polyendocrine metabolic ovarian syndrome (PMOS) and maternal and neonatal outcomes and explore interactions with BMI and ethnicity.

This was a prospective nested cohort study of pregnant women with risk factors for hyperglycemia enrolled in an international, multicenter, randomized controlled trial of gestational diabetes mellitus (GDM) treatment. We compared baseline and pregnancy characteristics, evaluated adverse maternal and neonatal outcomes by PMOS status, and used multivariable regression models to evaluate factors (maternal age, baseline BMI, ethnicity, parity, smoking, and level of education) that independently affected maternal and neonatal outcomes.

Of 3,645 participants, PMOS prevalence was 17.1% (95% CI 15.9, 18.3). At booking visits, women with PCOS (vs. without) were younger (30.6 ± 4.7 vs. 31.3 ± 5.2 years; P < 0.001) and had higher median (interquartile range) BMI at baseline (29.8 [25.1-35.7] vs. 28.1 [24.1-33.9] kg/m2; P < 0.001), and more were primigravid (30.2% [n = 188] vs. 25.7% [n = 778]; P = 0.022). There were positive associations between PCOS and early GDM, with an adjusted odds ratio (aOR) of 1.37 (95% CI 1.10, 1.72), a composite of adverse neonatal outcomes (aOR 1.28 [95% CI 1.04, 1.58]), admission to a neonatal special care nursery or neonatal intensive care unit (aOR 1.32 [95% CI 1.05-1.65]), and negative associations between PMOS and gestational age at birth (-1.60 days [95% CI -2.82, -0.39]) and birth length (-0.33 cm [95% CI -0.61, -0.04]). No interactions were found with baseline BMI and ethnicity.

PMOS was associated with higher odds of early GDM, and neonatal outcomes were poorer on adjusted analyses, highlighting independent pregnancy risks in PMOS and the need to identify, monitor, and treat women with PMOS to mitigate risks of adverse pregnancy outcomes.

Pulmonary hypertension (PH) frequently coexists with type 2 diabetes mellitus, obesity, and heart failure with preserved ejection fraction (HFpEF), particularly in World Symposium on Pulmonary Hypertension (WSPH) Group 2 disease. Glucagon-like peptide-1 (GLP-1) receptor agonists and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists improve several cardiometabolic conditions and have anti-inflammatory and vascular effects. Whether these agents directly modify pulmonary haemodynamics or clinical outcomes in PH remains unknown.

A structured narrative review was conducted using PubMed/MEDLINE and Google Scholar from database inception through March 2026, with additional studies identified by reference-list screening. Search terms encompassed GLP-1 receptor agonists, dual GIP/GLP-1 receptor agonists, pulmonary hypertension, pulmonary vascular remodelling, endothelial dysfunction, inflammation, and HFpEF. The structured search yielded 491 unique PubMed/MEDLINE records. Of these, 189 were assessed at full-text level alongside 40 additional articles identified through reference-list screening; 67 publications were included in the final synthesis. Evidence was organized by mechanism, experimental model, WSPH group, and whether PH evidence was direct or indirect.

GLP-1 receptor expression has been demonstrated in pulmonary arterial smooth muscle in human and non-human primate tissue and in selected alveolar cell populations in rodent studies; however, available studies do not establish greater expression in pulmonary than systemic vascular smooth muscle. GLP-1 receptor signalling modulates inflammatory, endothelial nitric oxide, endothelin-1, and mitochondrial pathways relevant to PH. In monocrotaline- and hypoxia-induced models that primarily resemble Group 1 pre-capillary pulmonary arterial hypertension (PAH), liraglutide reduced right ventricular pressures or hypertrophy and pulmonary vascular remodelling, while semaglutide improved right ventricular mitochondrial and functional measures in an experimental pressure-overload model. By contrast, available human evidence is observational or derived indirectly from HFpEF studies, involves populations likely enriched for Group 2 or unclassified PH, and lacks prespecified, catheterization-confirmed PH endpoints. Consequently, these studies do not establish that GLP-1-based therapy prevents or treats PH.

Current evidence supports a mechanistic hypothesis and a preclinical signal, not clinical efficacy in PH. Future cardiometabolic and HFpEF trials should incorporate standardized PH and right ventricular measures, and dedicated prospective studies with haemodynamic classification are required before GLP-1-based therapies can be considered for PH.