Type 2 diabetes mellitus (T2DM) poses a critical public health challenge in the Republic of the Marshall Islands, where prevalence rates are among the highest globally. Despite the central role of self-management in diabetes care, adherence and utilization of health services remain inadequate and are major contributors to diabetes-related morbidity and mortality. We aimed to identify factors influencing self-management and to explore the sociocultural context shaping these behaviors using an explanatory sequential mixed methods approach. From March to May 2023, we surveyed 123 randomly selected T2DM outpatients aged 18 years and older in Majuro Atoll. We assessed self-management practices, illness perception, diabetes knowledge, clinical characteristics, and sociodemographic factors, and used regression analysis to identify key predictors of self-management. Subsequently, semi-structured interviews with ten patients and three healthcare providers were conducted and analyzed thematically. Findings revealed that 76% of participants demonstrated inadequate self-management. Despite 90% recognizing diet as a causative factor, dietary control scored lowest among self-management domains, highlighting a disconnect between awareness and action. A higher perceived threat of illness was associated with poorer self-management, suggesting that fear may discourage rather than encourage coping action. While attending diabetes education classes was positively associated, diabetes knowledge level was not a significant predictor. Three key themes emerged as barriers to self-management that lie beyond individual control: i.Dysfunctional healthcare service delivery, ii. Diabetes fatalism, and iii. Food desert. This study highlights the need for culturally tailored health education, psychological support to counter diabetes fatalism along with strengthening health systems to better respond to patient needs, and policies to improve food security, which are critical to improving diabetes outcomes in this high-risk population.

Anemia is a common complication in individuals with type 2 diabetes mellitus (T2DM), particularly in regions where thalassemia and iron deficiency are prevalent. However, the relative contribution of genetic hemoglobin disorders in this context has not been well characterized. This study aimed to determine the prevalence of anemia and to identify factors associated with its occurrence among patients with T2DM in northeastern Thailand.

A cross-sectional study was conducted among 210 patients with T2DM attending two community health-promoting hospitals in northeastern Thailand. Data on sociodemographic characteristics, hematologic indices, renal function, iron status, and thalassemia genotypes were collected. Anemia was defined according to World Health Organization criteria. Factors associated with anemia were evaluated using multivariable logistic regression analysis, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported.

The prevalence of anemia was 54.3%. Thalassemia and related hemoglobinopathies were present in 60.5% of participants, and iron deficiency in 39.5%. Independent predictors of anemia included two or more α-globin gene defects or Hb E co-inherited with α-thalassemia (adjusted OR: 37.8; p = 0.002), Hb E trait (OR: 3.6; p = 0.006), iron deficiency (OR: 3.7; p < 0.001), and chronic kidney disease stages 2 (OR: 3.5; p = 0.002) and 3-4 (OR: 15.7; p < 0.001).

Anemia was highly prevalent among patients with T2DM in this community-based cohort from northeastern Thailand. Thalassemia-related genotypes, iron deficiency, and chronic kidney disease were significantly associated with anemia. These findings highlight the importance of considering inherited hemoglobin disorders when evaluating anemia in T2DM patients in hemoglobinopathy-endemic regions.

Myeloperoxidase (MPO) and neutrophil elastase (NE) are key neutrophil enzymes involved in oxidative stress, inflammation, and neutrophil extracellular trap formation, all of which have been implicated in the pathogenesis of diabetic kidney disease (DKD). However, MPO and NE mRNA expression in peripheral blood leukocytes (PBL) across DKD stages remains insufficiently characterized. This study evaluates the association between DKD severity and MPO and NE mRNA expression in PBL.

Seventy patients with type 2 diabetes were categorized into A1 DKD (normoalbuminuria), A2 DKD (moderately increased albuminuria), and A3 DKD (severely increased albuminuria) based on urine albumin-to-creatinine ratio (ACR). MPO and NE mRNA levels were quantified by qPCR from total RNA extracted from PBL. The groups were comparable in age, sex, BMI, diabetes duration, fasting glucose, lipid profile, and leukocyte counts. Systolic blood pressure and serum creatinine were significantly higher in A3 DKD compared with A1 DKD. MPO and NE expression did not differ between A1 and A2 DKD. In contrast, both MPO and NE mRNA levels were significantly elevated in A3 DKD compared with A1 and A2 DKD. Both markers correlated positively with urine albumin and ACR. Multivariable regression confirmed that the associations between MPO and NE expression and albuminuria were independent of clinical covariates.

MPO and NE mRNA expression selectively increases in A3 DKD and is independently associated with albuminuria, indicating enhanced neutrophil activation in advanced DKD. These findings highlight MPO and NE as potential mechanistic markers of severe DKD and warrant further validation in larger, longitudinal studies.

This study aimed to determine the prevalence and associated factors with thyroid dysfunction within a large cohort participating in the Rafsanjan Cohort Study (RCS), part of the Prospective Epidemiological Research Studies in Iran (PERSIAN).

A cross-sectional study based on RCS.

The study was carried out in Rafsanjan, a region in the southeast of Iran.

Participants were chosen using a cluster sampling technique. A total of 9991 participants between the ages of 35 and 70 years from both genders participated in the initial phase of the RCS.

Thyroid dysfunction was determined based on self-reported diagnosis.

The association of thyroid dysfunction with gender, age, body mass index (BMI), physical activity, substance use, education and Wealth Score Index (WSI) was assessed using multivariable logistic regression.

Among 9867 participants, thyroid dysfunction prevalence was 8.98%. Women had 6.56 times higher odds compared with men (OR: 6.56, 95%CI 5.03 to 8.55). BMI ≥30 had 22% higher odds compared with BMI <25 (OR: 1.22, 95% CI 1.01 to 1.50). Middle high WSI and high WSI were positively associated with thyroid dysfunction (OR: 1.35, 95% CI 1.11 to 1.65 and OR: 1.61, 95% CI 1.17 to 2.23, respectively). Former smoking was associated with increased odds of thyroid dysfunction (OR: 1.65, 95% CI 1.14 to 2.38). Age groups 46-55 years and ≥56 years exhibited higher odds of hypothyroidism compared with 35-45 years (OR: 1.47, 95% CI 1.15 to 1.87 and OR: 1.61, 95% CI 1.24 to 2.09, respectively).

This study shows the elevated burden of thyroid dysfunction among women and older adults and highlights modifiable associated factors such as BMI and smoking history. These findings emphasise the need for targeted screening and lifestyle interventions in high-risk groups. Future longitudinal studies are warranted to elucidate causal pathways.

Selecting the most effective treatment strategy for patients with distal esophageal and proximal gastric adenocarcinoma remains a clinical challenge. Although existing evidence supports the use of adjuvant therapies, the optimal sequencing of these treatments is still debated. Given that distant metastasis is the most common cause of death in this patient population, early initiation of systemic therapy may theoretically improve survival. This study aimed to evaluate the effectiveness of using the FLOT chemotherapy regimen as induction therapy before neoadjuvant chemoradiotherapy in treating distal esophageal and proximal gastric cancer.

In this single-arm, phase II clinical trial, patients with resectable, locally advanced adenocarcinoma of the distal esophagus and proximal stomach (T1-T4b, N0-N3, M0) who presented at two teaching hospitals affiliated with Mashhad University of Medical Sciences (Imam Reza and Omid Hospitals, Mashhad, Iran) were screened for eligibility. Eligible patients received two cycles of induction FLOT chemotherapy. This was followed by neoadjuvant chemoradiotherapy consisting of weekly paclitaxel and carboplatin, with a total radiotherapy dose of 45-50.4 Gy delivered in 1.8-2 Gy/fraction. Surgery was performed 4-6 weeks after completion of chemoradiotherapy. The primary endpoint was pathological tumor response.

Among the 57 enrolled patients, 40 (70.2%) underwent surgical resection and pathological evaluation (mean age: 56.5 ± 8.9 years, range: 24-64). Based on abdominal CT and/or endoscopic ultrasound (EUS), most tumors were staged as T3 (23 patients, 40.4%) and N1 (26 patients, 45.6%). Induction FLOT was administered to all patients, with 51 patients (89.5%) completing both cycles. Additionally, the majority received more than four weekly cycles of concurrent chemoradiotherapy (42 patients, 73.6%). Pathological examination of surgical specimens revealed a complete pathological response (pCR) in 11 patients (27.5%), partial response in 10 (25%), minimal response in 12 (30%), and poor response in 7 (17.5%). The neoadjuvant regimen was generally well tolerated, with most patients experiencing either no side effects or only Grade 1 hematologic or gastrointestinal toxicity.

Induction FLOT chemotherapy followed by neoadjuvant chemoradiotherapy appears to be a safe and well-tolerated treatment strategy for patients with distal esophageal and proximal gastric adenocarcinoma, yielding complete pathological response in approximately one-third of surgically treated and pathologically evaluable patients.

IRCT20210706051800N1 on 20,220,919.

Targeted type 2 diabetes screening campaigns aim to improve patients' quality of life and life expectancy and reduce healthcare costs, although different setups may yield varying detection outcomes. The aim of this study is to assess whether at-home self-sampling improves the detection rates of prediabetes and diabetes compared with standard mobile unit screening.

Between June 2022 and November 2024, the Danish Diabetes Association offered free capillary HbA1c tests to individuals at high risk of diabetes based on the Leicester's Risk Assessment score. Two community-based screening setups were applied: (a) a mobile unit using a point-of-care device and (b) at-home self-sampling screening tests using mailed Hemoglobin Capillary Collection System analyzed by high-performance liquid chromatography.

In total, 4051 individuals were tested via the mobile unit and 5609 via the at-home setup. In the mobile unit setup, the proportion of individuals aged ≥65 years was 54.3%, whereas in the at-home setup, they constituted 38.1%. HbA1c ≥48 mmol/mol (≥6.5%) was found in 3.1% of participants in the mobile unit and 3.5% in the at-home setup, while HbA1c values of 42-47 mmol/mol (6.0-6.4%) occurred in 9.1% and 15.2%, respectively.

Mobile units and at-home self-sampling are complementary screening approaches, finding similar rates of screen detection with HbA1c ≥48 mmol/mol (≥6.5%), though the latter is more efficient in detecting individuals with HbA1c values of 42-47 mmol/mol (6.0-6.4%).

To evaluate the association between flash glucose monitoring (FGM) metrics and perinatal outcomes in pregnant women with type 1 diabetes (T1DM).

This retrospective cohort study included pregnant women with T1DM who used FGM. The primary outcome was a composite endpoint including fetal or neonatal mortality, large-for-gestational-age (LGA) birth weight, neonatal intensive care unit (NICU) admission, or neonatal hypoglycemia. Glycated hemoglobin (HbA1c) levels were assessed together with time in range (TIR), time below range (TBR), and time above range (TAR) within pregnancy-specific glucose targets, as well as glucose variability.

A total of 70 women were included, with a median age of 36 years (IQR, 31-38), body mass index (BMI) 27±5kg/m², diabetes duration 20±8 years, and pregestational HbA1c 7.3±1.4%. Among them, 21.7% were smokers, 4.5% had hypertension, 10.1% had dyslipidemia, and 41.2% had diabetic retinopathy. Women who experienced the composite endpoint exhibited significantly lower TIR and higher TAR across all trimesters, greater glycemic variability (CV) during the first (1T) and third trimesters (3T), and a higher glucose management indicator (GMI) in the third trimester. Logistic regression analysis showed that a TIR<69.5% during the second trimester (2T) increased the risk of the composite endpoint by 10.56-fold (P=.015). Similarly, CV≥31.85% during the first trimester was associated with a 6.42-fold increased risk (P=.039). A model combining these 2 variables achieved a sensitivity of 94.3% and a specificity of 50%.

Glycemic control assessed through FGM metrics, particularly TIR during the second trimester and CV during the first trimester, is associated with adverse maternal-fetal outcomes in pregnant women with T1DM.

Cognitive-behavioral interventions have shown positive results in type 2 diabetes mellitus (T2DM) self-management; however, the lack of detailed descriptions of these interventions makes their replication difficult. This study aims to identify behavioral change techniques (BCT) for improving adherence to medication, diet, and exercise in adults with T2DM.

We conducted a systematic search in June 2024 across PubMed, Cochrane, Web of Science, PsycINFO, and CINAHL to identify studies published since 2013 that examined BCTs aimed at improving treatment adherence in adults with T2DM.

A total of 6 articles - including randomized controlled trials, a scoping review, and systematic reviews - were included, addressing adherence to medication, diet, and exercise. BCTs associated with improved adherence and reported across multiple studies included action planning (1.4), social support (unspecified) (3.1), social support (practical) (3.2), instruction on how to perform a behavior (4.1), information about health consequences (5.1), prompts and cues (7.1), and credible source (9.1).

The findings highlight the importance of clearly structured intervention descriptions and the use of robust theoretical frameworks. Future interventions should incorporate components targeting patient education, skill development, and support networks to enhance adherence to dietary recommendations, physical activity, and pharmacological treatment.

Low-density lipoprotein cholesterol (LDL-C) level is one important modifiable risk factor for cardiovascular diseases. This study aimed to describe the characteristics of primary health care patients with hypertension, coronary artery disease, or diabetes according to their LDL-C levels and to observe changes in these levels and medications during the 36-month follow-up.

This study was based on a clinical trial, conducted in a health centre in Siilinjärvi, Finland, between 2017 and 2021. A total of 507 patients with hypertension, coronary artery disease, or diabetes were divided into four groups based on their baseline LDL-C levels to align with the dyslipidaemia guideline risk categories as follows: LDL-C (mmol/L) in Group 0 (< 1.4), Group 1 (1.4-1.8), Group 2 (>1.8-2.6), and Group 3 (> 2.6).

The mean age at baseline was 69 years (58% females). All patients in Groups 0 and 1 already used lipid-lowering medication. A lower LDL-C level at baseline was statistically significantly associated with higher age, lower blood pressureand lower alcohol consumption. There were changes in the pharmacologically active substances prescribed in all groups. During the 36-month follow-up, the mean LDL-C values decreased statistically significantly in group 3 (-0.76 mmol/L, 95% CI -0.90 to -0.62, -21%, p < .001: [ANCOVA]). The highest increase in lipid-lowering medication prescriptions occurred within this group.

This study provides a perspective on real-word treatment patterns and changes in medications prescribed as the recommendations change over time. During a period of increasing pharmacotherapeutic opportunities, this study, conducted in everyday clinical practice suggests that common lipid-lowering medications (atorvastatin and rosuvastatin) are most frequently used for primary health care patients, and are associated with a significant decrease in LDL-C levels. A greater decrease was observed among patients with higher baseline LDL-C values. Despite decreases in LDL-C, this study suggests that the gap remains between guideline-recommended treatment targets and achieved LDL-C levels.

Diabetic kidney disease (DKD) is a major cause of end-stage renal disease, but the metabolic changes associated with its progression are still not well understood. Lactate, traditionally regarded as a byproduct of glycolysis, has been increasingly recognized in recent studies in association with broader metabolic and regulatory processes. This study aimed to evaluate the association between serum lactate and renal dysfunction in DKD and to explore candidate molecular pathways linking lactate-associated metabolic alterations to DKD-related renal injury using animal experiments, clinical cohort analyses, and exploratory bioinformatic approaches.

We established DKD in rats by combining right nephrectomy with streptozotocin-induced diabetes to examine metabolic and kidney changes. Clinical associations were evaluated using data from 593 DKD patients in the MIMIC-IV database and were further examined in an independent eICU validation cohort. Associations between serum lactate and renal function were analyzed using correlation and multivariable regression. Candidate molecular pathways were explored using integrated network-based bioinformatics, including target prediction, protein-protein interaction analysis, enrichment analysis, and molecular docking.

DKD rats showed significantly elevated serum lactate and evidence of kidney injury, with lactate strongly correlating with the kidney function marker cystatin C (ρ = 0.748, P = 0.0081). In clinical data, elevated lactate was independently associated with higher serum creatinine (β = 0.13, 95% CI: 0.004-0.256, P = 0.044), and this positive association was further supported in the external eICU cohort. Network analysis identified 43 overlapping targets linking lactate to DKD, highlighting hub proteins such as PTGS2, EGFR, TP53, ESR1, MAPK3, and MMP9, mainly enriched in inflammation, fibrosis, and metabolism-related pathways.

Elevated serum lactate was associated with renal dysfunction in DKD across animal and clinical datasets. In ICU-based clinical cohorts, this association suggests that lactate may reflect concurrent metabolic and hemodynamic stress related to renal dysfunction, rather than serving as a DKD-specific biomarker or causal mediator. Exploratory bioinformatic analyses identified candidate inflammatory, fibrotic, vascular, and metabolic pathways that may provide molecular context for this association. These computational findings should be interpreted as hypothesis-generating and require further experimental validation.