Diabetic Patients must monitor their Blood Glucose (BG) continually to control their glycemia at least twice a day using a finger prick. Patients visit a laboratory every three months for glycated hemoglobin (HbA1c). According to the World Health Organization (WHO), the constitution of Iraqi diabetes patients is 13.9%. An Internet of Things (IoT) based framework for non-invasive BG monitoring is recently developed. We aim to enhance the Continuous Glucose Monitoring (CGM). Starting with a review of IoT technologies and some of CGM commercial devices recommended by ISO 15197 standard. A questionnaire sheet is distributed to determine how much patients in Iraq knew about their health situation and whether they are interested in using new IoT technologies. Women patients are volunteered to check their BG using both finger prick (FP) and a CGM device for comparing. The suggested method is to connect CGM to a smart device to show alarm messages when needed. The results show how important to introduce patients about new technologies. A CGM and FP results are checked for similarity using statistical package. The findings demonstrated that, significantly at P < 0.05, there were no differences between both methods based on the standard Ambulatory Glucose Profile (AGP) report. This study shows how Iraqi's patients feel when using a CGM and new IoT technologies. CGM output is accurate but appeared every 15 min which may be uncomfortable. A method is suggested to transfer CGM output to a smart device to be controlled by algorithms, where an alarm message is showed every 8 h when BG is normal or a colored alarm will appear. GMI% will be calculated every two weeks using data stored in the cloud to estimate HbA1c level depending on Markov chain. This figures how BG changes in a shorter timeframe, helping in fine-tune diabetes management plans.

Fenofibrate is a fibric acid derivative used in the management of severe hypertriglyceridemia, a condition that may lead to serious maternal and fetal complications during pregnancy. However, evidence regarding the safety of fenofibrate exposure in pregnancy remains extremely limited, and the available human data are largely restricted to isolated case reports. The aim of this study was to evaluate pregnancy outcomes of women who consulted a university teratology information service (TIS) due to fenofibrate exposure during pregnancy. The data for this retrospective case series include consultation records and follow-up interviews of pregnant women who consulted the TIS at Marmara University Hospital due to fenofibrate exposure between 2012 and 2025. Eleven pregnancies with fenofibrate exposure were identified, and pregnancy outcomes were available for 10 pregnancies. Six pregnancies resulted in live births and four resulted in stillbirth. Due to one twin pregnancy, a total of 11 infants were recorded, including seven live-born and four stillborn infants. No major congenital malformations were identified among live-born infants. One child was reported to have been diagnosed with autism during follow-up. Although the proportion of stillbirths in this series appears higher than expected, most affected pregnancies were complicated by significant maternal comorbidities, including severe hypertriglyceridemia, diabetes mellitus, hypertension, and acute pancreatitis, which are known risk factors for adverse pregnancy outcomes. Therefore, the observed stillbirths may be related to underlying maternal disease rather than fenofibrate exposure. Overall, the findings of this case series do not suggest a clear teratogenic signal associated with maternal fenofibrate exposure during pregnancy.

The objective of this study was to assess the variations in cardiovascular autonomic modulation during reactive hyperemia in diabetic patients with and without cardiovascular autonomic neuropathy (CAN).

The study subjects were 35 patients with T2DM without macrovascular complications of diabetes and 40 age and sex matched healthy subjects as the control group. Electrocardiogram and photoplethysmography recordings were performed at rest and during a reactive hyperemia test, which consisted of a 5-min arterial occlusion followed by release. Autonomic nervous system function was evaluated using heart rate variability analysis (time-frequency methods) and the sympathetic skin response.

Healthy subjects showed a significant increase in low-frequency (LF) power immediately after vascular release, with an average latency of 339.64 ± 53.86 ms and amplitude of 3467.41 ± 2333.68 ms². In diabetic patients with CAN, the response was faster but less intense (latency: 300.00 ± 20.22 ms, amplitude: 907.15 ± 2688.0 ms²). Diabetic patients without CAN showed a similar latency (300.06 ± 37.64 ms) but the amplitude is overall the lowest (505.73 ± 489.37 ms²).

The reactive hyperemia test reveals an alteration in the temporal dynamics of autonomic activity, as reflected by the low-frequency component in heart rate variability analysis, in diabetic patients. These patients exhibit a reduced response amplitude and a faster or reactive response, especially those with cardiovascular autonomic neuropathy, suggesting altered autonomic modulation that could serve as an early marker of autonomic dysfunction.

To investigate the diagnostic and differential value of gastrocnemius shear wave elastography (SWE) combined with body mass index (BMI) in different stages of Type 2 diabetes mellitus (T2DM) related sarcopenia in elderly patients and to analyze sex differences.

A total of 269 participants were classified into four groups according to the AWGS 2019: healthy controls (n = 62), those with T2DM without sarcopenia (n = 68), those with T2DM with possible sarcopenia (n = 64), and those with T2DM with sarcopenia (n = 75). SWE was used to measure the elastic modulus of the dominant-side gastrocnemius under relaxed (E-rest) and contracted (E-cont) conditions. Logistic regression was used to construct prediction models for total and sex-stratified populations, which were evaluated in three scenarios: core diagnosis, early risk identification, and differential factor analysis.

The patients with T2DM in the sarcopenia group were the oldest, had the longest diabetes duration, and had the lowest BMI, ASMI, handgrip strength, and E-cont; conversely, E-rest did not show significant intergroup differences. Lower E-cont and lower BMI were independent risk factors. The combined model showed excellent performance in the core diagnosis scenario (AUC 0.988; sensitivity 92.0%; specificity 95.4%), and the sex-stratified models also demonstrated strong performance (AUC 0.984 for males and 0.991 for females). The protective effect of E-cont was stronger in females (OR 0.710) than in males (OR 0.806), whereas the protective effect of BMI was stronger in males (OR 0.358) than in females (OR 0.388). The AUCs were 0.954 for early risk identification and 0.966 for differential factor analysis. The T2DM with possible sarcopenia group exhibited a low E-cont/high BMI pattern, whereas the T2DM with sarcopenia group exhibited a low E-cont/low BMI pattern.

E-cont is an early indicator of T2DM-related muscle decline. The combined model showed good diagnostic and differential performance across sarcopenia stages, with sex differences. The model serves as a noninvasive tool for risk stratification.

An 82-year-old man was diagnosed with pancreatic body cancer after worsening of his diabetes mellitus. Computed tomography and staging laparoscopy revealed an unresectable pancreatic cancer with peritoneal metastasis, and systemic chemotherapy was initiated. After 76 months of chemotherapy, including up to third-line treatment, continuation of chemotherapy was difficult because of adverse events. Repeat staging laparoscopy revealed the absence of visible peritoneal metastases and negative peritoneal lavage cytology results. Therefore, distal pancreatectomy was performed as a conversion surgery. The patient has been alive 22 months postoperatively. Here, we report a case of conversion surgery after long-term chemotherapy for pancreatic cancer with peritoneal metastasis.

To explore how cardiovascular risk communication is constructed, negotiated and enacted in practice to persons with type 2 diabetes.

Qualitative.

Individual interviews were conducted with 14 HCPs in primary care. Data were analysed using the constructivist grounded theory method.

The core category, 'Striving to enhance cardiovascular risk awareness in persons with type 2 diabetes while balancing responsibility and uncertainty', captures the challenges in making CVD risk understandable and meaningful for patients. Four categories describe the HCPs' work: Navigating a complex assessment of cardiovascular risk, struggling to communicate cardiovascular risk in a pedagogical way, trying to build a trusting relationship and simultaneously highlighting the disease severity, and experiencing loneliness and requesting organisational changes.

Healthcare professionals (HCPs) recognised their significant responsibility for cardiovascular risk communication, but simultaneously experienced uncertainty about how to assess patients' individual CVD risk. Diabetes specialist nurses described feelings of professional isolation, limited medical support from physicians and a lack of shared responsibility within the diabetes care team. HCPs also requested sufficient organisational resources.

Communicating cardiovascular risk remains difficult. Strengthening the role of HCPs in risk communication and ensuring they adopt a more person-centred approach are essential to improving risk communication in primary healthcare.

To assess cardiovascular risk and reveal patients' understanding, HCPs must go beyond education, build trust and understanding, and balance encouragement with demands.

COREQ checklist.

No patient or public contribution.

Charcot Foot (CF) is a neuropathy-induced condition that can lead to fractures and dislocation, warranting long-time offloading in total contact cast (TCC). It is unknown whether CF or its treatment increases the risk of venous thromboembolism (VTE). This study aims to retrospectively investigate the risk of VTE in people with CF during and after treatment.

Individuals with diabetes mellitus and active CF treated with TCC at Skåne University Hospital (Lund and Malmö, Sweden) were screened for inclusion in a retrospective cohort study. Baseline characteristics and occurrences of VTE were retrieved using medical records. Causes of death were retrieved from the National Cause of Death Register.

209 individuals with 241 CF episodes were included and followed for 6.8 (3.8-11) years. No VTE was diagnosed during TCC treatment. Two individuals (0.96%) developed VTE after uncasting but before discharge (86-157 days after uncasting; while using boot and orthotic walker, respectively), whereas the other eight individuals (3.8%) had VTE diagnosed after end of CF treatment and follow-up. Hemodialysis was associated with increased VTE risk after CF diagnosis (HR 13 [3.25-50], p < 0.001, accounting for all observed VTE occurrences).

No VTE occurred during TCC treatment, whereas the risk of VTE during the entire CF treatment period was 0.96%.

Climate change is emerging as a clinically relevant driver of cardiometabolic risk, particularly among individuals with diabetes. Increasing frequency and severity of extreme weather events, including heat waves, cold exposure, and air pollution, can disrupt physiological homeostasis and access to essential healthcare resources. People with diabetes are uniquely vulnerable due to impaired thermoregulation, increased risk of dehydration, and high prevalence of cardiovascular and kidney disease.

Temperature extremes impose significant cardiovascular stress. Heat exposure promotes dehydration, hemoconcentration, and increased cardiac workload, contributing to ischemia, arrhythmia, and heart failure. Cold exposure increases vascular resistance and blood pressure, further elevating cardiovascular risk. In parallel, air pollution and wildfire smoke amplify systemic inflammation, oxidative stress, and endothelial dysfunction, accelerating atherosclerosis and increasing the likelihood of acute cardiovascular events. Clinical risk is further modified by age, comorbidities, socioeconomic factors, and access to healthcare infrastructure. Clinically, these findings support anticipatory management strategies, including patient education on heat and cold exposure, proactive medication adjustment, and closer monitoring during periods of environmental stress. Effective mitigation requires a multilevel approach, including patient education, medication management, disaster preparedness, and climate-resilient health systems. Integrating environmental data into clinical care and the use of predictive tools may enable proactive risk reduction. Climate change should be recognized as an emerging cardiovascular risk multiplier in diabetes, requiring coordinated action across clinical care, public health, and policy.

Diabetes in pregnancy requires sustained self-care and clear guidance across hospital, home, and primary care settings. Conventional educational materials may be less accessible to women facing social vulnerability or limited health literacy. Culturally grounded communication may improve the understandability and relevance of discharge guidance.

We conducted a methodological study in two public tertiary maternity hospitals in Fortaleza, Brazil, to develop and content-validate an educational cordel, a traditional Brazilian form of rhymed popular literature. The material was developed through a structured evidence search, collaboration with health researchers and cordelistas, and pilot testing. It was evaluated by 22 hospitalized pregnant women with gestational diabetes mellitus or pre-existing type 2 diabetes and by 40 expert judges. Item-level Content Validity Indices (I-CVIs), scale-level CVI by averaging item values (S-CVI/Ave), Cronbach's alpha, and Kendall's coefficient of concordance were calculated.

All target-population items achieved an I-CVI of 1.00, and the S-CVI/Ave was 1.00. The evaluation responses showed modest internal consistency (raw alpha = 0.67; standardized alpha = 0.66). Among expert judges, I-CVIs ranged from 0.95 to 1.00 and the S-CVI/Ave was 0.99. Internal consistency of expert responses was high (raw alpha = 0.96; standardized alpha = 0.97), whereas Kendall's W was 0.039, indicating weak concordance in the relative ranking of items despite high absolute favorable agreement.

The educational cordel showed strong preliminary evidence of content validity, cultural relevance, and acceptability for hospitalized pregnant women with diabetes. The findings support further testing in larger and more diverse samples, using standardized measures of understandability and actionability and designs that evaluate effects on knowledge, self-care, continuity of care, and clinical outcomes.

Gestational diabetes mellitus (GDM) is a pregnancy complication associated with abnormal placental trophoblast function. Pyroptosis has been implicated in GDM pathogenesis, yet the role of m6A modification in this process remains unclear. We hypothesized that METTL14 regulates trophoblast pyroptosis through m6A-dependent modulation of the lncRNA MEG8/WNT7A axis. This study investigated the mechanism of METTL14 in pyroptosis of placental trophoblasts in GDM. HG-treated HTR8/SVneo cells were used as a cell model. METTL14, WNT7A, and lncRNA MEG8 expression was detected by RT-qPCR and western blot. Placental damage, cell injury, and pyroptosis markers were assessed. YTHDF2-mediated m6A enrichment on lncRNA MEG8, the interaction between lncRNA MEG8 and EZH2, and H3K27me3 enrichment on the WNT7A promoter were analyzed. Results showed that lncRNA MEG8 was upregulated, while METTL14 and WNT7A were downregulated. METTL14 overexpression reduced placental damage and trophoblast pyroptosis. Mechanistically, METTL14 suppressed lncRNA MEG8 expression through YTHDF2-mediated m6A methylation. Reduced lncRNA MEG8 decreased EZH2 recruitment to the WNT7A promoter, lowered H3K27me3 levels, and consequently promoted WNT7A expression. Rescue experiments confirmed that lncRNA MEG8 overexpression or WNT7A knockdown attenuated the suppressive effect of METTL14 on pyroptosis. In conclusion, METTL14 acts as an upstream regulator that inhibits trophoblast pyroptosis and ameliorates GDM-induced damage through the lncRNA MEG8/WNT7A axis via YTHDF2-mediated m6A modification, highlighting METTL14 as a potential therapeutic target.