Patients with type 2 diabetes mellitus (T2DM) have an increased risk of osteoporosis and fragility fractures. Chronic low-grade inflammation and nutritional imbalance are key underlying mechanisms. The neutrophil percentage-to-albumin ratio (NPAR) is a novel biomarker reflecting both processes, but its role in osteoporosis remains unclear. This study aimed to investigate the association between NPAR and bone mineral density (BMD), as well as prevalent osteoporosis, in patients with T2DM.

This retrospective cross-sectional study included 259 patients with T2DM. Osteoporosis was diagnosed according to the World Health Organization (WHO) criteria based on dual-energy X-ray absorptiometry results. Logistic regression was used to assess the association between NPAR andprevalent osteoporosis. Linear regression evaluated its relationship with BMD at the femoral neck and total hip. Receiver operating characteristic analysis assessed its concurrent discriminative capacity for prevalent osteoporosis.

NPAR levels were higher in the osteoporosis group (P = 0.004). NPAR was independently associated with osteoporosis (OR = 3.42, 95% CI: 1.10-10.64, P = 0.034). It was negatively associated with femoral neck BMD (b = -0.08, 95% CI: -0.14 to -0.02, P = 0.009) and total hip BMD (b = -0.08, 95% CI: -0.14 to -0.01, P = 0.020). The AUC was 0.62 (95% CI: 0.54-0.71, P = 0.004).

Given its modest concurrent discriminative ability, NPAR should be interpreted in combination with other clinical indicators rather than used as an independent screening marker for disease diagnosis, but may provide supplementary information regarding prevalent osteoporosis in patients with T2DM.

Diabetic ketoacidosis (DKA) seasonal variations among children and adolescents with type 1 diabetes mellitus (T1DM) have been widely studied; however, findings remain inconsistent. Although several studies reported a higher incidence during colder months, others showed no consistent patterns. This study investigated whether DKA frequency and severity vary across seasons, particularly in humid cities.

This retrospective cohort analyzed children and adolescents with T1DM admitted to a tertiary hospital with DKA (2015-2025). Data included demographics, seasonal admission trends, clinical severity, and outcomes. Statistical analyses involved the Chi-square and ANOVA tests.

A total of 369 DKA cases were analyzed, with mean age of 14.7 years and 62.6% were females. Most had established T1DM (88.6% with prior DKA episodes). Severe cases showed significantly higher heart rates, lower GCS scores (p < 0.001), higher HbA1c levels (p = 0.001), longer hospital (p = 0.007) and ICU (p = 0.003) stays. Diastolic blood pressure also correlated with severity (p = 0.036). Although DKA severity showed no significance seasonal association (p = 0.865), winter peak was observed, suggesting confounding factors or bias in seasonal patterns.

The DKA admission peaked in winter, particularly in December; however, this trend was not clinically significant. Confounding factors, including infection or delayed care, may explain this variation. The findings emphasize focusing on modifiable patient factors, including year-round glycemic control, education, and timely interventions, to reduce DKA recurrence.

To investigate the effects of glucagon-like peptide-1 receptor agonist (GLP-1RAs) on renal function in type 2 diabetes mellitus (T2DM) patients and compared their efficacy to sodium-glucose co-transporter-2 inhibitors (SGLT-2i) in managing diabetic nephropathy.

This is a retrospective cohort study conducted at King Fahad University Hospital, including 115 adults (≥18 years) with T2DM and baseline estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73m², treated with GLP-1RAs or SGLT-2i for over 1 year. Patients on renal replacement therapy, nephrotoxic drugs, or with incomplete records were excluded. Data were analyzed with Jeffrey's Amazing Statistics Program; the significant value is p < 0.05.

Participants were treated with either SGLT-2i (67.8%) or GLP-1RAs (32.2%). Both groups showed minimal improvements in glycemic control, hemoglobin A1c decreased from 7.86% to 7.66% (SGLT-2i) and from 8% to 7.76% (GLP-1RAs). Estimated GFR minimally improved by 0.5-1.2 mL/min/1.73m² (GLP-1RAs) and changed by -1.2 to +10.1 mL/min/1.73m² (SGLT-2i). Urine albumin/creatinine ratio dropped by 13.35 mg/g with GLP-1RAs but increased by 49.86 mg/g with SGLT-2i.

Both medications offered comparable glycemic and renal benefits. The GLP-1RAs, however, demonstrated more favorable effects on albuminuria, suggesting potential for superior renal protection in nascent diabetic nephropathy.

Background and objective Diabetic kidney disease (DKD) is among the most common and serious complications of diabetes mellitus and is a major cause of chronic kidney disease (CKD) worldwide. Conventional biochemical markers such as serum creatinine, estimated glomerular filtration rate (eGFR), and albumin-creatinine ratio (ACR) primarily reflect functional impairment and may fail to detect early structural renal changes. Shear wave elastography (SWE) and renal resistive index (RRI) are emerging non-invasive imaging modalities that may help in the early identification of renal fibrosis and vascular alterations in diabetic nephropathy. The present study aimed to evaluate and compare SWE and RRI findings in diabetic patients with and without CKD and to assess their correlation with conventional renal function parameters. Methods This cross-sectional analytical observational study was conducted in the Department of Radiodiagnosis at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, from April 2025 to March 2026. A total of 150 diabetic patients were enrolled, including 75 patients with clinically proven CKD and 75 diabetic patients without CKD who served as controls. Clinical and laboratory parameters, including serum creatinine, eGFR, ACR, and BMI, were recorded. Ultrasonography, Doppler evaluation, and SWE of both kidneys were performed using a Philips EPIQ-7 GI ultrasound machine (Philips Healthcare, Best, the Netherlands). Mean SWE values were recorded in kilopascals (kPa), while RRI was assessed using Doppler ultrasonography. Results A total of 150 diabetic patients were enrolled, including 75 with CKD and 75 without CKD. The groups were comparable in age (59.19 ± 7.95 vs. 58.80 ± 8.58 years; p = 0.775), sex distribution (49 (65.3%) males vs. 45 (60.0%) males; p = 0.613), and BMI (24.36 ± 3.03 vs. 23.58 ± 3.21 kg/m²; p = 0.130). Patients with CKD had significantly lower eGFR (59.92 ± 36.08 vs. 111.52 ± 12.72 ml/min/1.73 m²; p < 0.001) and higher serum creatinine (2.63 ± 1.37 vs. 1.36 ± 0.46 mg/dl), ACR (201.17 ± 214.51 vs. 11.57 ± 7.57 mg/g), RRI (0.69 ± 0.07 vs. 0.51 ± 0.10), and SWE values (11.19 ± 2.82 vs. 8.31 ± 0.82 kPa) (all p < 0.001). Among CKD patients, 20 (26.7%) were in Stage 1 and 20 (26.7%) in Stage 2, 10 (13.3%) in Stage 3, 15 (20.0%) in Stage 4, and 10 (13.3%) in Stage 5. SWE showed a strong negative correlation with eGFR (r = -0.777) and a positive correlation with ACR (r = 0.791) (both p < 0.001). RRI demonstrated an area under the curve (AUC) of 0.924 with 72% sensitivity and 100% specificity, while SWE showed an AUC of 0.899 with 100% sensitivity and 68% specificity for predicting CKD. Conclusions SWE and RRI are valuable non-invasive imaging biomarkers for the assessment of DKD. Both parameters showed a significant association with renal dysfunction and CKD severity. SWE demonstrated high sensitivity, while RRI demonstrated high specificity for identifying CKD. These modalities may serve as useful non-invasive adjuncts for assessment and risk stratification in diabetic patients. Further longitudinal studies are required to establish their role in early detection, monitoring, and prognostic evaluation.

The proportion of mothers older than 35 years is increasing; however, research examining the age at which pregnancy is considered high risk across different races and countries is limited. Therefore, this study aimed to determine the cut-off age at which adverse obstetric outcomes significantly increase by investigating age-specific incidence rates of major adverse obstetric outcomes in Republic of Korea (South Korea).

We analyzed the Korean National Health Insurance claims database between 2015 and 2021, focusing on women with obstetric complications classified using the International Classification of Diseases, Tenth Edition. The maternal cut-off age was defined as the age at which the outcome was most predictive in receiver operating characteristic curve analysis. Multivariate logistic regression was used to estimate the adjusted odds ratio (OR) and 95% confidence interval (CI) for the association between maternal age and adverse obstetric outcomes.

The study included 1,862,393 women with singleton pregnancies. Of these, 33.67% were aged ≥ 35 years and 5.07% were aged ≥ 40 years. The incidence of adverse obstetric outcomes increased linearly and positively with maternal age. The maternal cut-off age, determined using receiver operating characteristics analysis, was 35 years for pregnancy-induced hypertension (PIH), 33 for gestational diabetes mellitus (GDM), 33 for placenta previa, 32 for placental abruption, 34 for preterm delivery, and 34 for low birth weight (LBW). In multivariate analyses, adjusted OR revealed adverse obstetric outcomes: PIH (OR, 1.29; 95% CI, 1.27-1.32), GDM (OR, 1.73; 95% CI, 1.72-1.75), placenta previa (OR, 1.81; 95% CI, 1.78-1.85), placental abruption (OR, 1.30; 95% CI, 1.24-1.36), preterm delivery (OR, 1.32; 95% CI, 1.29-1.34), and LBW (OR, 1.33; 95% CI, 1.31-1.35). For the composite outcome, maternal cut-off age was found to be 33 years (OR, 1.57; 95% CI, 1.56-1.59), with an area under the curve of 0.573.

This nationwide study defined the cut-off age for advanced maternal age in Korean women, showing that obstetric risks begin to increase in the early 30s. These population-specific thresholds may help guide clinical practice and improve maternal and perinatal outcomes.

Type 2 diabetes poses a growing global health challenge, with dietary behaviours and food choices playing a critical role in its management. This study assessed dietary practices, food preferences, and nutrition-related determinants among patients with type 2 diabetes in the Wa Municipality of Ghana, and further evaluated overall dietary behaviour using a dietary behaviour index derived from key dietary behavioural indicators.

A cross-sectional survey was conducted among 208 adult respondents selected from diabetes clinics in the municipality using structured interviewer-administered questionnaires and 24-hour dietary recalls. Descriptive statistics were used to summarize demographics, food-choice determinants, dietary practices, and 24-hour food-group consumption. A total dietary behaviour score was computed from 10 dietary behaviour indicators, classified into a dietary behaviour index. Independent samples t-tests and one-way analysis of variance were used to examine differences in dietary behaviour score across selected participant characteristics at a significance level of p<0.05.

Most participants were female (69.2%), aged 45-64 years (49.0%), married (73.6%), had no family history of diabetes (48.1%), and had no formal education (39.4%). Major influences on food choices included food availability (79.8%), financial constraints (76.0%), appetite (71.6%), and nutrition advice from healthcare providers (72.1%). In the previous 24 hours, a high proportion of participants reported consuming meat, poultry, and fish (90.4%), whereas fewer reported consuming eggs (17.8%), fruits other than those rich in vitamin A (26.9%), and healthy fats (38.5%); 67.3% reported consuming foods containing trans fats. Participants had limited nutrition knowledge - 53.4% did not understand the glycaemic index, 60.6% did not know which carbohydrates raise blood sugar levels, and 63.9% never read nutrition labels. Most participants indicated moderate dietary behaviour (65.4%), while 23.6% had good dietary behaviour and 11.1% had poor dietary behaviour. Total dietary behaviour scores were significantly associated with eating situation (p=0.001), meal decision making (p=0.004), and nutrition label use (p<0.001), but not with gender (p=0.070), religion (p=0.254), or family history of diabetes (p=0.112). Participants demonstrated predominantly moderate dietary behaviour, with important gaps in fruit intake, carbohydrate monitoring, application of glycaemic knowledge, and nutrition label use. Household food arrangements and nutrition literacy were found to be more strongly associated with healthier dietary behaviour than basic sociodemographic characteristics.

Context-specific interventions that strengthen practical nutrition education, improve food label literacy, and support household-level dietary decision making may improve diabetes dietary management in this setting.

Diabetes mellitus represents a growing public health crisis across Africa, with prevalence rates increasing due to urbanization, lifestyle transitions, and epidemiological transition. Despite numerous technological advances in diabetes management, including continuous glucose monitoring (CGM), access to these innovations remains limited across the continent.

This narrative review examines the current state, opportunities, challenges, and prospects of CGM technology in African diabetes care, with emphasis on the socioeconomic, infrastructural, and cultural factors influencing implementation.

A comprehensive review of peer-reviewed literature, clinical trials, and implementation studies from African contexts was conducted, incorporating evidence on CGM technology, diabetes epidemiology, healthcare systems, and policy frameworks across African nations.

CGM technology offers substantial benefits for glycaemic control, complication reduction, and patient empowerment. However, widespread adoption in Africa faces significant barriers including prohibitive costs, limited healthcare infrastructure, supply chain challenges, inadequate healthcare workforce training, and sociocultural factors. Emerging clinical trials in South Africa, Kenya, and Malawi demonstrate feasibility and clinical benefits, though large-scale implementation remains constrained.

While CGM holds important potential at transforming African diabetes care, successful integration requires multisectoral collaboration, innovative financing mechanisms, capacity building, and feasible implementation strategies. Policy frameworks that support equitable access, regulatory harmonization, and sustainable scale-up models are essential for realizing CGM's full potential across the continent.

To investigate whether older individuals (≥70 years) with heart failure receive guideline-recommended heartfailure medications less frequently than younger individuals.

Older individuals had a higher prevalence of heart failure and greater polypharmacy but were treated lessoften with guideline-based therapies, including aldosterone antagonists and beta-blockers, even after adjustment forrenal function and comorbidities. In contrast, calcium channel blockers were prescribed more frequently in geriatricpatients.

Older individuals with heart failure appear to be undertreated with evidence-based therapies, highlightingage-related gaps in guideline-concordant care.

In Germany, heart failure (HF) is the most common diagnosis in hospitalized patients. Its prevalence rises significantly with age. In addition, age-related conditions, such as hypertension, coronary artery disease, obesity, and diabetes mellitus, contribute to an elevated risk of heart failure. It is assumed that older patients are more likely to receive treatment that does not conform to the guidelines because of frequent comorbidities, such as chronic renal disease and pre-existing polypharmacy.

Data from a prospective cohort study on chronic HF (MyoVasc study, N = 3289; NCT04064450), were analyzed. Participants underwent a 5-h highly standardized examination, including assessment of medication with subsequent categorization according to the anatomical therapeutic chemical (ATC) coding system. Study participants were categorized as older adults aged ≥ 70 years and subsequently compared to younger adults regarding frequency of medication intake. Poisson regression with robust standard errors with adjustment for age, sex, cardiovascular risk factors, comorbidities, and kidney function was used to analyze medication intake by age status in subjects with chronic HF stages C/D.

The analyzed sample comprised 1281 older adults (mean age: 75.4 ± 3.6 years, 33.1% women, 66.9% men) and 2,008 younger adults (mean age: 57.7 ± 8.5 years, 35,2% women, 64.8% men). A total of 68.5% (n = 878) of the older individuals presented with HF stage C/D, compared to 43% (n = 863) in younger adults. On average, older individuals took 6.53 (standard deviation (SD) ± 3.14) drugs as compared to younger participants taking 4.65 (SD ± 3.45) drugs regardless of the severity of HF. Poisson regression analysis demonstrated that older individuals received aldosterone antagonists less frequently (Prevalence Ratio (PR): 0.64, 95%CI 0.54; 0.77, p < 0.0001). This effect persisted after additional adjustment for kidney function (PR: 0.53, 95%CI 0.44; 0.63, p < 0.0001). Beta-blockers were used significantly less frequently in older adults compared to younger adults (PR: 0.93, 95%CI 0.88; 0.99, p = 0.016). In contrast, calcium channel blockers were prescribed significantly more often in the older group (PR: 1.22, 95%CI 1.01; 1.48, p = 0.035). Additionally, older adults with impaired renal function received loop diuretics less frequently (PR: 0.88, 95%CI 0.78; 0.99, p = 0.033).

The present study identified age-related disparities in the use of guideline-based therapy for heart failure. These differences persisted even after adjusting for renal dysfunction, a common and relevant comorbidity in the aged population. These findings suggest a potential underutilization of evidence-based heart failure therapies in older individuals with heart failure.

NCT04064450.

Diabetic kidney disease (DKD) is a leading cause of end-stage kidney disease (ESKD). The kynurenine pathway, responsible for tryptophan metabolism, is linked to inflammation and renal injury. This study aimed to assess the predictive value of serum tryptophan and kynurenine pathway metabolites in diagnosing DKD and differentiating disease stages in patients with type 2 diabetes mellitus (T2DM).

A total of 164 individuals (134 with T2DM and DKD, 30 healthy controls) were included in this cross-sectional study. Serum tryptophan, kynurenine, kynurenic acid, quinolinic acid, picolinic acid, 3-hydroxykynurenine, and indoleamine 2,3-dioxygenase (IDO) levels were measured using ELISA. Analyses included ANOVA, correlation, logistic regression, and ROC curves.

Tryptophan levels were significantly reduced, while kynurenine pathway metabolites were elevated in DKD patients. eGFR showed negative correlations with kynurenine, kynurenic acid, IDO, and 3-hydroxykynurenine. ROC analysis revealed kynurenic acid, IDO, and 3-hydroxykynurenine as accurate markers for DKD staging. Logistic regression identified IDO, kynurenine, and kynurenic acid as independent predictors. Kynurenine pathway metabolites, particularly kynurenic acid and IDO, exhibit high diagnostic performance for detecting and staging DKD.

Kynurenic acid, IDO, and 3-hydroxykynurenine demonstrated strong discriminative capacity across DKD stages (AUC up to 0.951), and IDO was identified as an independent predictor of DKD. These metabolites may serve as complementary biomarkers for early risk stratification in DKD.

Children and adolescents with type 1 diabetes mellitus (T1D) are at increased risk of developing additional autoimmune diseases. However, data on the frequency, spectrum, and timing of these comorbidities in long-term pediatric cohorts remain limited. This study aimed to evaluate the prevalence, clinical characteristics, and temporal relationships of autoimmune diseases in children and adolescents with T1D, as well as to identify factors associated with their occurrence.

This retrospective study included 639 children and adolescents with T1D who were followed at a tertiary pediatric endocrinology center between January 2004 and October 2018. Demographic, clinical, laboratory, and autoantibody data were reviewed. Autoimmune diseases were identified through routine annual screening and clinical follow-up. Temporal relationships between T1D and autoimmune disease diagnoses were analyzed. Multivariable logistic regression was used to assess factors associated with additional autoimmune diseases.

At least one additional autoimmune disease was identified in 120 subjects with diabetes (18.8%). The most frequent comorbidities were autoimmune thyroiditis (AIT, 12.7%) and celiac disease (CD, 5.9%), followed by vitiligo (1.3%), autoimmune gastritis/pernicious anemia (0.15%), and autoimmune hepatitis (0.15%). Female sex was independently associated with the presence of additional autoimmune diseases (OR = 1.61, 95% CI 1.07-2.41, p = 0.022). Most autoimmune diseases were diagnosed either concurrently with or after T1D onset, clustering within the first two years. A moderate positive correlation was observed between age at diagnosis of T1D and age at diagnosis of AIT (r = 0.586, p < 0.001), with older age at diagnosis of T1D associated with a shorter interval between T1D onset and the diagnosis of AIT. Similarly, age at diagnosis of T1D was strongly correlated with age at diagnosis of CD (ρ = 0.723, p < 0.001).

Autoimmune comorbidities, particularly AIT and CD, are common in pediatric T1D, with most diagnoses occurring within the first two years around diabetes onset. These findings support intensified and closer screening-especially during the early disease course and in female subjects with diabetes-to enable earlier detection and improved long-term management. This study provides valuable epidemiological data from Türkiye and contributes to global pediatric T1D literature.