Severe hypertriglyceridemia (SHTG), characterized by plasma triglycerides (TG)>11.3 mmol/L is a rare but serious complication in children who develop diabetic ketoacidosis (DKA). However, the current body of evidence is predominantly composed of case reports, highlighting a substantial gap in both the understanding and management of this condition.

This was a retrospective electronic medical record review of pediatric patients with DKA complicated by SHTG who were referred to the Beijing Children's Hospital over a 10-year period.

A total of 21 pediatric patients with DKA complicated by SHTG were identified, with a male-to-female ratio of 8:13. The median age at diagnosis was 11.3 years [interquartile range (IQR) 10.5-13.2, range 2.0-17.4], with approximately 76.2% (16/21) of patients aged ≥10 years. Among these patients, 10 were diagnosed with type 1 diabetes mellitus, 5 with type 2 diabetes mellitus, and 6 with unclassified diabetes mellitus. 17 patients were newly diagnosed with diabetes, whereas 4 had a history of pre-existing diabetes. Notably, 3 of these 4 patients had discontinued insulin prior to admission. In terms of complications, 7 patients had acute pancreatitis. Regarding treatment, all patients received insulin therapy, among whom 7 patients were treated with plasmapheresis. Compared with insulin therapy alone, the plasmapheresis group showed a shorter median time to achieve the TG level <5.6 mmol/L, though this finding should be interpreted cautiously due to potential selection bias. Among the 7 patients who received plasmapheresis, 4 developed venous thrombosis. During follow-up, patients who underwent plasmapheresis maintained stable lipid profiles and achieved complete resolution of thrombosis.

We present the largest single-center experience on SHTG in pediatric patients with DKA, with a particular focus on plasmapheresis. We recommend early assessment of dyslipidemia and pancreatic enzymes in patients with DKA. Insulin therapy remains the cornerstone of management. However, in children who show unsatisfactory reduction in triglyceride levels or persistent abdominal pain despite insulin treatment, prompt initiation of plasma exchange may be considered as a rescue therapy to rapidly lower TG levels, which could potentially mitigate the risk of developing or worsening acute pancreatitis. This hypothesis requires validation in larger prospective studies.

Aging is a critical risk factor for the progression and complications of type 2 diabetes mellitus (T2DM). However, routine clinical indicators fail to accurately quantify biological senescence burden in T2DM patients. This study aimed to screen plasma protein signatures associated with metabolic senescence in T2DM using Olink targeted proteomics and to construct a novel biological aging evaluation model for diabetic populations.

A total of 21 healthy controls and 66 T2DM patients were enrolled. Plasma protein profiles were detected via Olink proteomics. Differentially expressed proteins (DEPs) were identified and subjected to GO and KEGG functional enrichment analyses. Random forest and LASSO regression analyses were applied to screen core T2DM-related protein molecules. T2DM patients were further stratified by a 55-year cutoff, a well-recognized critical threshold for metabolic senescence. After adjustment for sex, BMI, glycated hemoglobin (HbA1C), and hypoglycemic medication use, age-independent senescence-related proteins were identified to establish a multi-protein predictive model. A 1000-time Bootstrap resampling procedure was performed for internal validation to evaluate model discrimination and stability.

A total of 84 DEPs (P < 0.05) were identified between T2DM patients and healthy controls, mainly enriched in cytokine-cytokine receptor interaction, lipid metabolism, and atherosclerosis pathways. Machine learning screened six core proteins with high discriminatory value for T2DM, including MERTK, BOC, TNFRSF10A, CCL3, AGRP, and PD-L2. Within the T2DM cohort, nine age-dependent plasma proteins were independently identified (FDR < 0.05), among which VSIG2, LPL, S100A11, and CST5 exhibited the most robust correlations (FDR < 0.01). A three-protein model comprising VSIG2, S100A11, and S100A5 achieved favorable discriminative performance (AUC = 0.874), which was superior to conventional clinical indicators including BMI (AUC = 0.572) and HbA1c (AUC = 0.593). Bootstrap validation confirmed reliable model stability with a correction optimism of -0.024, a bias-corrected AUC of 0.900, and an overfitting degree of -2.65%. Functional analyses indicated that candidate proteins were primarily involved in immune homeostasis, lipid remodeling, inflammatory responses, and calcium signaling.

This study identified novel T2DM-associated plasma biomarkers and established a robust three-protein signature (VSIG2, S100A11, S100A5) for age stratification and biological senescence evaluation in T2DM. The proposed model compensates for the limitations of routine clinical indices, providing a promising non-invasive serological tool for precise risk stratification and individualized intervention in elderly diabetic patients.

To investigate the association between static balance function parameters and prediabetes, and to develop a nomogram integrating center-of-pressure path length, Romberg ratios, and sex, thereby evaluating its potential as a candidate functional screening tool.

A cross-sectional observational design was adopted. A total of 97 patients with prediabetes and 44 age-matched healthy controls were consecutively enrolled from January 2024 to June 2025 at the Third People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine. General characteristics and static balance parameters under four sensory conditions were compared between groups. Variables were first screened via Least Absolute Shrinkage and Selection Operator (LASSO) regression, followed by multivariable logistic regression to identify independent associations. A nomogram was then constructed. Model discrimination and calibration were assessed using the receiver operating characteristic curve, Hosmer-Lemeshow test, and 1000-bootstrap internal validation (corrected C-statistic, calibration slope/intercept, Brier score). Effect sizes were quantified using Cohen's d.

Compared with the healthy control group, the prediabetes group exhibited significantly higher values for Y-COP and COP-PL under Condition 1, RRA and RRT under Condition 2/1, as well as Y-COP, COP-EA, and COP-PL under Conditions 3 and 4 (all P < 0.05). LASSO regression retained T1 COP-PL, T3 COP-PL, T4/T3 RRA, and RRT as candidate variables. Multivariable logistic regression showed that female sex (vs. male, OR = 0.208, 95% CI: 0.044-0.973; P = 0.046), T1 COP-PL (per unit increase, OR = 0.990, 95% CI: 0.980-0.999), T3 COP-PL (per unit increase, OR = 1.016, 95% CI: 1.008-1.023), and T4/T3 RRA (per unit increase, OR = 1.013, 95% CI: 1.007-1.020) were independently associated with prediabetes. A nomogram incorporating these variables yielded an AUC of 0.972. After bootstrap internal validation, the corrected AUC was 0.964 (95% CI: 0.941-0.991), with a calibration slope of 0.806, intercept of -0.011, and Brier score of 0.075, indicating good discrimination and calibration. Cohen's dvalues for T1 COP-PL, T3 COP-PL, and T4/T3 RRA were -0.40, 1.45, and 1.39, respectively, reflecting moderate to large effect sizes.

Static balance indices including T1 COP-PL, T3 COP-PL, and T4/T3 RRA are associated with prediabetes. The nomogram combining these measures with sex demonstrated robust performance in internal validation, offering a functional perspective that may aid in the auxiliary screening of prediabetes. Nevertheless, as a cross-sectional exploratory study, these associations do not imply causality, and the model requires external validation before its clinical generalizability can be determined.

Type 2 diabetes mellitus (T2DM) has increasingly been identified as a risk factor for sensorineural hearing loss, whereas the association between different antidiabetic therapies and hearing thresholds remains poorly characterized. This retrospective observational study evaluated 240 patients with T2DM and 105 normoglycemic controls who underwent standardized pure-tone audiometry at the Audiology Section of the University of Palermo between February 2025 and January 2026. Hearing thresholds were measured using the pure tone average (PTA-mean) at 0.5, 1, 2, and 4 kHz, corresponding to speech-relevant frequencies. Multivariable analysis of covariance, adjusted for age, sex, body mass index, and smoking status, showed that subjects with T2DM had significantly higher PTA-mean values compared to controls (64.4 ± 17.1 dB vs. 56.4 ± 14.8 dB; p = 0.007), indicating worse hearing thresholds. Among specific antidiabetic treatments, GLP-1RAs, metformin, and pioglitazone were associated with lower PTA-mean values. Furthermore, pharmacological class analysis showed that GLP-1 receptor agonists and biguanides were associated with more favorable hearing thresholds. These findings suggest that antidiabetic pharmacotherapy may show class-specific associations with auditory function, supporting the need for prospective studies to evaluate whether hearing outcomes should be considered in the broader management of diabetes-related comorbidities.

To investigate the correlation between the degree of placental calcification, umbilical artery hemodynamic parameters, and delivery outcomes in patients with gestational diabetes mellitus (GDM).

A total of 190 GDM patients admitted to our hospital were retrospectively selected as the research subjects; gestational weeks ranged from 28 to 42. According to the placental calcification degree detected by ultrasound before delivery, they were divided into Grade 0 (n=62), Grade I (n=58), Grade II (n=45), and Grade III (n=25). Clinical data of all subjects were collected, and the umbilical artery hemodynamic parameters [systolic peak velocity/end-diastolic velocity (S/D), resistance index (RI), pulsatility index (PI)] and delivery outcome-related indicators were compared among groups. Spearman rank correlation analysis was used to explore the correlation between placental calcification degree and umbilical artery hemodynamic parameters. Multivariate Logistic regression analysis was used to screen independent risk factors for adverse delivery outcomes in patients with GDM.

There were significant differences in umbilical artery S/D, RI and PI among patients with different placental calcification degrees (F=108.75, 82.73, 158.20, all P<0.001). Spearman rank correlation analysis showed that placental calcification degree was positively correlated with umbilical artery S/D, RI and PI in patients with GDM (r=0.760, 0.730, 0.817, all P<0.001). There were statistically significant differences in cesarean section rate, preterm delivery rate, fetal distress rate and macrosomia rate among groups (χ²=42.984, 16.052, 47.556, 11.798, all P<0.001). Multivariate Logistic regression analysis showed that Grade II placental calcification, Grade III placental calcification, and umbilical artery S/D ≥3.0 were independent risk factors for adverse delivery outcomes in patients with GDM.

Placental calcification degree was closely correlated with umbilical artery hemodynamic parameters in patients with GDM. Grade II and Grade III placental calcification and umbilical artery S/D ≥3.0 could all affect the occurrence of adverse delivery outcomes in patients with GDM.

Insulin patch pumps offer advantages over multiple daily injections (MDI) for pediatric diabetes, but randomized trial evidence in Chinese children remains limited.

To evaluate the efficacy and safety of a tubeless insulin patch pump (Equil™) compared with MDI in children and adolescents with diabetes.

This multicenter, open-label, randomized, crossover, non-inferiority trial was conducted at seven pediatric endocrinology centers in China (September 2021 - October 2022). Patients aged 3-17 years with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) were randomized 1:1 to receive continuous subcutaneous insulin infusion (CSII) via Equil™ or MDI via insulin pen for 5 days, followed by crossover. The primary outcome was mean blood glucose (MBG). Non-inferiority margin was pre-specified as 0.386 mmol/L. Secondary outcomes included glycemic variability (standard deviation of blood glucose, SDBG), glycated albumin (GA), total daily insulin dose (TDD), hypoglycemia frequency, and adverse events. Patient satisfaction was assessed using a study-specific 11-item questionnaire.

Of 74 enrolled patients, 72 (97.3%) completed the study. CSII demonstrated non-inferiority to MDI for MBG (8.43±1.88 mmol/L, n=74, vs 9.00±2.04 mmol/L, n=72); mean difference -0.606 mmol/L; 95% CI -0.988 to -0.223; upper CI limit -0.223 < non-inferiority margin 0.386. No significant differences were observed for secondary outcomes (SDBG: 3.019 vs 3.357; GA change: 2.52±3.03% vs 2.02±3.25%, p=0.184; TDD: 132.17±78.43 vs 147.52±91.59 IU, p=0.159; hypoglycemia events: 114 vs 106). Adverse event rates were similar (75.7% vs 69.4%, p=0.399); no serious adverse events occurred. Patient satisfaction was significantly higher with CSII (total score 21.03±4.47 vs 22.00±3.99; mean difference -0.97, 95% CI -1.75 to -0.19; p=0.015), with 68.1% of patients preferring the patch pump.

The Equil™ patch pump is non-inferior to MDI in terms of glycemic control and safety for pediatric diabetes patients, with higher patient satisfaction. These findings support the patch pump as an effective alternative for children and adolescents requiring exogenous insulin therapy.

The safety profile and long-term outcomes of retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in patients with diabetes mellitus (DM) remain inadequately characterized. We evaluated procedural and extended follow-up results in this cohort.

This single-center retrospective study enrolled adults undergoing retrograde CTO-PCI; individuals with incomplete data, malignancy, or end-stage renal disease were excluded. Primary and secondary outcomes were all-cause mortality and major adverse cardiovascular events (MACE), respectively. Intergroup comparisons used standard univariate tests. Cumulative hazard functions were estimated via the Nelson-Aalen method, and multivariable Cox proportional hazards models were performed to adjust for clinical confounders and identify variables associated with MACE.

In total, 836 patients met the criteria. Success rates for collateral channel (CC) tracking (92.0% in the DM group vs. 95.0% in the non-DM group, P=0.08), retrograde PCI success (87.4% in the DM group vs. 91.3% in the non-DM group, P=0.07), and final recanalization (89.4% in the DM group vs. 92.0% in the non-DM group, P=0.20) were statistically similar. In-hospital complication rates were minimal and comparable (all P>0.05). Follow-up data were obtained for 767 patients (91.7%) over a median of 1,041 days. Patients with DM experienced a significantly higher risk of MACE (19.2% in the DM group vs. 13.9% in the non-DM group, P=0.046), primarily driven by increased all-cause mortality (9.3% in the DM group vs. 4.5% in the non-DM group, P=0.007) and cardiac death (7.4% in the DM group vs. 2.2% in the non-DM group, P<0.001). After multivariable adjustment for clinical confounders, DM remained a strong independent predictor of higher long-term all-cause and cardiac mortality.

Retrograde PCI is technically safe and effective in CTO patients with DM. However, this cohort carries a significantly higher long-term risk of mortality and MACE than non-diabetic counterparts, necessitating intensified post-procedural risk-factor management.

Diabetes is a globally prevalent chronic metabolic disorder characterized by defective insulin secretion and/or insulin resistance, often leading to various severe complications. As a traditional Chinese medicine, Panax ginseng has a long-standing history in the adjunctive treatment of diabetes, with ginsenoside Rb1 being one of its most important active constituents. This review systematically summarizes recent advances in basic and clinical research concerning ginsenoside Rb1 in the prevention and treatment of diabetes, with a focus on its pharmacological effects and molecular mechanisms in improving insulin resistance, protecting pancreatic β-cell function, and delaying diabetic complications. Accumulated evidence demonstrates that ginsenoside Rb1 exerts anti-diabetic effects through multi-target and multi-pathway mechanisms, specifically involving the regulation of glucose and lipid metabolism, inhibition of oxidative stress and inflammatory responses, and modulation of autophagy, exhibiting significant therapeutic potential. Based on its favorable pharmacological activities, ginsenoside Rb1 holds promise as a lead compound for diabetes drug development. Future research should further focus on the validation of its molecular targets and the exploration of pathways for clinical translation.

Previous studies have shown that although advances in primary percutaneous coronary intervention (PCI) and medical therapy have significantly improved the survival of patients with ST-segment elevation myocardial infarction (STEMI), the long-term burden of post-infarction heart failure (HF) remains. Studies on sex differences in the occurrence of HF after STEMI are limited. The aim of this study is to investigate the risk factors and gender differences of HF in STEMI patients after PCI.

We conducted a retrospective cohort study, including a total of 1,040 consecutive patients with STEMI. Clinical, laboratory and surgical-related data of the patients were collected. The primary endpoint was the incidence of new-onset HF, and the secondary endpoint was all-cause mortality during the follow-up period. The cumulative event survival rate was estimated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards regression analyses were used to determine the independent predictors of HF. Through subgroup and interaction analyses, the consistency of the association between gender and heart failure in different clinical subgroups was evaluated.

Compared to men, women were significantly older, had a higher prevalence of diabetes, and experienced longer door-to-balloon times. During follow-up, women exhibited a significantly higher crude incidence of HF (25.88% vs. 17.86%, P = 0.007) and all-cause mortality (12.72% vs. 6.53%, P = 0.002). Kaplan-Meier analysis confirmed a higher risk of HF in women (Log-rank P = 0.006). In univariate Cox analysis, female sex was associated with an increased risk of HF. However, after conducting multivariate adjustments, women no longer served as an independent predictor for HF. Significant interactions were observed between sex and diabetes mellitus (P _interaction  = 0.010) and Killip class (P _interaction < 0.001). Women with diabetes, a longer time from symptom onset to first medical contact, and a Killip class of II or above have a much higher risk of developing heart failure. Mediation analysis indicated that diabetes mellitus acted as a significant mediator, explaining 21.76% of the total effect of sex on new-onset HF.

Women have higher HF morbidity and mortality after STEMI, but this difference is mainly driven by their older age and greater burden of comorbidities, not just biological sex.

When diabetic foot ulcers (DFUs) complicated by necrotizing fasciitis (NF) show persistent culture positivity for extensively drug-resistant Acinetobacter baumannii (XDR-AB), systemic antimicrobial options are severely limited, posing a severe challenge to limb salvage. Exploring integrative intervention strategies in this setting is of great clinical significance.

A 59-year-old patient was admitted with a 20-day history of a right foot ulcer and a 10-year history of poorly controlled type 2 diabetes mellitus. The patient was initially diagnosed with diabetic foot ulcer, which progressed to lower-limb necrotizing fasciitis and septic shock requiring intensive care unit (ICU) supportive treatment. Due to persistent recovery of XDR-AB from wound cultures and severely limited effective systemic antibiotic options, the team used traditional Chinese medicine (TCM) as adjunctive therapy alongside standard debridement, vacuum sealing drainage (VSD), and intensive care support. Following the intervention, the patient's systemic inflammatory markers gradually stabilized despite persistent culture positivity, without recurrent sepsis. With the progressive clearance of necrotic tissue and the growth of healthy granulation tissue, the team successfully performed staged skin grafting while wound cultures remained positive on days 65 and 109, with complete graft take after both procedures. After 115 days of comprehensive treatment, the right lower limb wound stabilized, and the limb was successfully salvaged, allowing for a smooth discharge.

For complex cases of DFUs complicated by NF and XDR-AB culture positivity where antibiotics are severely restricted, the addition of TCM to standard multidisciplinary care was associated with infection control and wound repair and may represent an exploratory limb-salvage approach. However, its generalizability and exact efficacy require further validation through subsequent research.