According to real-time data from Gujarat, which has the third highest score in the country nationally (7.55%), shows that behavioral, psychological, and economic stressors are associated with elevating HbA1c levels. The current investigation of multifaceted connection within the educational pharmaceutical care interventional program (EPCIP) timeline provides important information about regional causes of inadequate glycaemic control and aids in the development of tailored diabetes management strategies.

The primary objective of this study was to examine the association between longitudinal variations in HbA1c and a structured hospital-based EPCIP delivered by clinical pharmacists. In addition, secondary objective was focused on behavioral, medication adherence, psychological, and economic characteristics of patients in the control group (n = 139) and intervention group (n = 141) across five visits conducted in Gujarat, India.

A randomized, parallel‑group trial was conducted at the Saarathi Institute of Diabetes Sciences, Anand, India, enrolling 280 patients with type 2 diabetes mellitus aged 18-75 years. Eligible participants (HbA1c > 7%, on oral hypoglycemic agents and/or insulin therapy) were recruited and allocated into control (n = 139) and intervention (n = 141) groups using adaptive randomization minimization. The intervention comprised a structured patient‑education framework focusing on self‑management and adherence. Over a 16‑month period (64 weeks), patients in the intervention group attended one educational and one discussion session at each follow‑up (0, 4, 8, 12, and 16 months). Associations between HbA1c and behavioral outcomes (Knowledge, Attitude, Practice [KAP] questionnaire), adherence (Morisky Medication Adherence Scale [MMAS‑8]), psychosocial outcomes (Diabetes Distress Scale [DDS‑17], WHOQOL‑BREF), and economic outcomes (Cost of Illness Questionnaire [COIQ]) were analyzed using regression models to estimate linear relationships across visits between groups.

The EPCIP intervention group showed progressively stronger longitudinal correlations in HbA1c stability (r = 0.74 to 0.89, p=0.000), surpassing the control group (r = 0.62 to 0.74). At Visit 5, significant correlations were observed between HbA1c and indirect cost (r = 0.160, p = 0.022), and medication adherence (MMAS: r = -0.243, p = < 0.001). Total KAP scores maintained consistent negative correlations (r = -0.042, p=0.030), while emotional (r = 0.141, p = 0.044) and physician-related distress (r = 0.593, p < 0.001) notably decreased. Regimen distress normalized (r = -0.019, p = 0.792). Quality of life scores improved post-intervention across physical (r = -0.078, p = 0.006), psychological (r = -0.033, p = 0.047), social (r = -0.047, p = 0.005), and environmental domains (r = -0.113, p = 0.001), indicating EPCIP's multidimensional impact.

Stronger longitudinal HbA1c correlations and increased MMAS scores demonstrated the significant improvements in glycaemic stability and behavioural adherence brought about by the EPCIP intervention. Multidimensional psychosocial improvement is reflected in the consistent inverse relationships between overall KAP and decreases in diabetes-related distress domains (DDS17). EPCIP's holistic impact is shown by post-intervention gains across WHOQOL-BREF domains, confirming its validity as a patient-centred approach to long-term diabetes care.

Present clinical trial registered with clinical trial registry of India and national institute of medical statistics.

CTRI/2024/05/067435, Date of Registration:15/05/2024. URL: https://ctri.nic.in/Clinicaltrials/regtrial.php?modid=1%26;compid=19%26;EncHid=12771.59772https://ctri.nic.in/Clinicaltrials/rmaindet.phptrialid=103273%26;EncHid=42604.82156%26;modid=1%26;compid=19.

To evaluate the efficacy of circumferential surgery, involving combined anterior and posterior approaches, in the management of multisegmental cervical pyogenic spondylitis (CPS).

A retrospective analysis was conducted on 12 patients with multisegmental CPS who underwent circumferential surgical intervention between January 2015 and November 2023. The study evaluated medical records, spinal alignment correction, postoperative complications, and neurological functional recovery.

In total, 12 patients (8 men and 4 women; mean age: 57.1 years) met the inclusion criteria. Identified risk factors included diabetes mellitus in four patients, a history of substance abuse in two patients, and long-term immunosuppressive therapy following organ transplantation in one patient. Preoperatively, nine patients presented with spinal cord or nerve root compression. All patients underwent circumferential surgery with anterior column reconstruction using autologous bone grafts; titanium alloy plates were additionally used in two cases. Posterior stabilization was achieved using pedicle screws or lateral mass screws. The mean number of corpectomies performed was 3.7 (range, 3-5); the mean number of fused levels was 4.8 (range, 4-7). The mean follow-up duration was 19.4 (range, 6-38) months. Cervical alignment improved significantly, with the mean C2-7 Cobb angle changing from - 5° preoperatively to 3° postoperatively. Neurological function significantly improved in all patients (P = 0.023), and successful bone fusion was achieved in 11 patients (91.7%) at the final follow-up. Pathogens were identified in seven cases, including Staphylococcus aureus Staphylococcus epidermidis (n = 2), Klebsiella pneumoniae (n = 1), and Escherichia coli (n = 1). All patients received intravenous antibiotic therapy for 4-6 weeks postoperatively, followed by oral antibiotic treatment for an additional 6-8 weeks. No intraoperative complications were reported. Postoperatively, one patient developed pneumonia with respiratory failure, and another experienced posterior cervical wound infection.

Circumferential surgical intervention combined with appropriate antibiotic therapy appears to be an effective treatment strategy for achieving satisfactory outcomes in patients with multisegmental CPS.

Controlled Blood pressure (BP) in hypertensive patients is essential in reducing the risk of cardiovascular diseases. Even a slight reduction in BP control may significantly improve cardiovascular outcomes. Several factors have been associated with controlled BP. We aimed to determine the prevalence of controlled BP among hypertensive patients and its associated factors in a Malaysian primary health clinic.

A cross-sectional study was conducted among Malaysian adults aged 18 years and above with underlying hypertension who attended a public healthcare clinic located in a suburban area of Melaka, Malaysia, from December 2024 to February 2025. Participants were selected via systematic random sampling. Data were collected through self-administered questionnaires, medical records, and clinical blood pressure measurement. Blood pressure control status was determined based on clinic blood pressure readings measured during visits. Documented home blood pressure monitoring (HBPM) records, when available in the medical records, were reviewed as supplementary clinical information. A multiple logistic regression was conducted to determine the factors associated with controlled blood pressure.

A total of 460 hypertensive patients were included in this study, with a response rate of 96.8%. Only 41.5% of the participants (n = 191) had controlled BP. The median age was 64 (IQR:17) and the majority were female (57.4%, n = 264). The significant factors associated with controlled blood pressure among the study population were increasing age (aOR = 1.037, 95% CI [1.018,1.057], p < 0.001), female gender (aOR = 2.092, 95% CI [1.388,3.151], p < 0.001), participants who took one or two anti-hypertensive (aOR = 1.921, 95% CI [1.145,3.224],p = 0.013) and (aOR = 2.830, 95% CI [1.637,4.895], p < 0.001) respectively, participants without diabetes (aOR = 1.689, 95% CI [1.112,2.566], p = 0.014), and participant who had documented HBPM (aOR = 4.489, 95% CI [2.337,8.623], p < 0.001).

The findings suggest that the prevalence of controlled blood pressure, 41.5% is still low among the study population. Controlled blood pressure was associated with increasing age, female gender, patients on fewer than three antihypertensive medications, hypertensive patients without diabetes mellitus, and those who have documented home blood pressure monitoring.

Acute mesenteric ischemia (AMI) is a life-threatening pathological condition characterized by obstruction of blood flow to the intestine, it is rare and usually presents with non-specific gastrointestinal symptoms. Embolic, thrombotic and non-obstructive pathology are the main causes of this disease. Treatment varies from case to case depending on clinical and imaging findings. Open surgery is often required in advanced cases.

A 79-year-old female presented with sudden-onset severe generalized abdominal pain associated with nausea, vomiting, and poor oral intake. Her medical history included atrial fibrillation, valvular heart disease, diabetes mellitus, and prior coronary artery bypass surgery. Physical examination revealed abdominal pain disproportionate to clinical findings. Contrast-enhanced CT-scan findings were highly suggestive of extensive acute mesenteric ischemia. Exploratory laparotomy confirmed widespread necrosis of the small intestine, extending from approximately 40-50 cm distal to the ligament of Treitz to the ileocecal junction. Extensive bowel resection was performed, followed by creation of a double-barrel jejunoileostomy. Postoperatively, the patient developed short bowel syndrome (SBS) and remained clinically stable with dependence on total parenteral nutrition (TPN).

This report emphasizes the importance of consulting emergency physicians in such cases, as their awareness of mesenteric ischemia, their appropriate diagnosis, and prompt management play a crucial role in increasing survival rates and achieving faster recovery in patients.

Not applicable.

Metabolic syndrome affects over 30% of the global population and is characterised by insulin resistance, obesity and dyslipidaemia, all of which significantly increase the development of chronic metabolic disorders including type 2 diabetes mellitus (T2DM). Over time, existing antihyperglycaemic treatments typically become ineffective due to changes in disease progression, highlighting the importance for the continued development of new therapeutic agents which exert their effects through diverse/ novel mechanisms.This chapter reviews the emerging role of trace amine-associated receptor 1 (TAAR1) as a regulator of metabolic function. Whilst research into TAAR1 agonism has predominantly focused within the central nervous system for application in schizophrenia treatments, emerging preclinical and clinical evidence demonstrates that TAAR1 activation enhances glucose-stimulated insulin secretion and regulates dopaminergic pathways in addiction and reward processes. Comparisons with incretin mimetic therapies, including semaglutide - a glucagon-like peptide-1 (GLP-1) receptor agonist - reveal significant mechanistic overlap, alongside potential advantages including a more favourable metabolic safety profile. Collectively these findings position TAAR1 as a promising target with the potential to address both physiological and neurobehavioural aspects of metabolic disease.

Population-based surveillance is essential for quantifying the burden of diabetes and monitoring temporal changes. In Denmark, nationwide health registers enable long-term surveillance of type 1 diabetes (T1D) and type 2 diabetes (T2D). We aimed to estimate trends in prevalence, incidence, mortality and years of life lost to diabetes in Denmark from 1996 to 2024.

We conducted a nationwide register-based cohort study from 1996 to 2024. We used an updated national diabetes register integrating hospital, prescription, clinical, and laboratory data to identify diabetes type and date of onset. Prevalence was estimated annually using a binomial model. Incidence, mortality and standardized mortality ratios (SMR) were analyzed using age-period-cohort models. Analyses were stratified by sex and diabetes type. A multistate model was used to assess the lifetime risk and years of life lost to diabetes.

As of January 1, 2025, a total of 366 174 individuals (6.1% of the population) had diabetes identified through national healthcare registers; of these, 8.2% had T1D and 91.8% had T2D. Since 1996, diabetes prevalence more than tripled, largely driven by an overall annual increase in T2D of ~4.1%. T1D prevalence remained stable, with increases in individuals aged <40 years and decreases in older age groups. From 1996 to 2024, a total of 567 510 incident diabetes cases were recorded, of which 4.6% were T1D. T1D incidence declined on average by 1.1% annually, with increasing rates at younger ages and declining rates at older ages. T2D incidence showed a non-linear pattern, with a decline from 2010 to 2015 followed by an increase in recent years, resulting in an overall upward trend from 1996 to 2024. Men had higher T2D incidence than women across age and calendar years. Mortality declined for T1D after 2008 and for T2D until 2012, then stabilized. SMRs decreased for T1D after 2008 but increased for T2D, converging by 2025.

In Denmark, diabetes prevalence and incidence increased markedly since 1996, largely driven by T2D. Although mortality declined, particularly for T1D, excess mortality remains, emphasizing the need for continued surveillance and prevention efforts.

Peripheral diabetic neuropathy (PDN) is a complication of diabetes mellitus that affects nerves and has great epidemiological and clinical relevance. It affects more than 2/3 of diabetic patients, compromising their quality of life and life expectancy. This chapter reviews the main electrophysiological alterations in excitability and conductibility observed in sciatic (somatic) and vagus (autonomic) nerves in experimental models of PDN, with emphasis on nerve extracellular recording. Initially, the clinical and pathophysiological aspects of PDN are outlined, followed by a brief review of experimental models of diabetes, particularly those induced by streptozotocin. The electrophysiological basis of compound action potential (CAP) generation is described, and key CAP parameters are discussed as indicators of functional nerve integrity. Experimental evidence demonstrates that diabetes induces consistent alterations in the sciatic nerve, characterized by reduced CAP amplitude and conduction velocity, increased duration of CAP waves, reflecting increased temporal dispersion of CAP components, and decreased nerve excitability. These changes worsen with disease duration and higher glycemic levels and may be detected even in pre-diabetic conditions. In contrast, the vagus nerve exhibits a more selective pattern of dysfunction. Recent experimental studies reveal that diabetes mellitus, at least at initial stages of disease evolution, preferentially affects myelinated vagal fibers, leading to reduced conduction velocity, increased component duration, and excitability, while unmyelinated fibers remain relatively preserved. Overall, the findings summarized in this chapter support the use of CAP recordings as a robust experimental approach for investigating the progression and mechanisms of PDN and for evaluating potential therapeutic interventions.

Dietary vitamins play a role in antioxidant defense and immunoregulation. However, prospective studies exploring the association between vitamin intakes during pregnancy and the child's risk of type 1 diabetes are limited.

This population-based prospective cohort study aimed to investigate the association between maternal intake of vitamins A, C, D, and E during pregnancy and the risk of type 1 diabetes in children.

We included 85,244 children born between 2002 and 2009 in the Norwegian Mother and Child Cohort Study (MoBa), with follow-up until December 31, 2021. Maternal intake of vitamins from food and dietary supplements from conception to 22^nd week of pregnancy was assessed with a validated food frequency questionnaire. Cox proportional hazards regression was used to estimate hazard ratios (HR), adjusting for background factors.

During follow-up, 529 (0.6%) children were diagnosed with type 1 diabetes at a mean age of 9.4 (SD 4.1) years. No associations were observed between maternal pregnancy intake of vitamin A (HR 0.993; 95% CI 0.983-1.003 per 100 μg), vitamin C (HR 1.000; 95% CI 0.993-1.007 per 10 mg), vitamin D (HR 0.991; 95% CI 0.978-1.003 per 1 μg), or vitamin E (HR 0.999; 95% CI 0.996-1.004 per 10 mg) and the risk of type 1 diabetes in the child when adjusted for potential confounders. The results were similar when intakes were assessed separately from food and dietary supplement, and after restriction to children with HLA DQ2- and/or -DQ8 risk haplotypes.

This prospective cohort study did not support the hypothesis that higher maternal intake of vitamins A, C, D, and E during pregnancy would decrease the risk of type 1 diabetes in the child. Corroborated with previous evidence, our findings support a general pattern of null associations.

Despite increasing evidence, the specific long-term effects of type 1 diabetes (T1D) and type 2 diabetes (T2D) on the functions of the hippocampus and prefrontal cortex (PFC) remain poorly understood. This study aimed to provide a comprehensive comparison of the chronic neurobiological, cognitive, and behavioral consequences of prolonged hyperglycemia in experimental models of T1D and T2D. By combining behavioral assessments with biochemical and neurochemical analyses, the study sought to identify diabetes type-specific patterns of dysfunction within the hippocampus and PFC. Adult rats were randomly assigned to three groups: Sham, T1D, and T2D. T1D was induced by a single intraperitoneal injection of streptozotocin (STZ), while T2D was established by administering nicotinamide (NA) 15 min prior to STZ injection. Behavioral assessments and Cognitive functions were conducted during the final phase of the experimental period. Following behavioral testing, blood samples were collected for biochemical analyses. The PFC and hippocampus were dissected for evaluation of oxidative stress markers, inflammatory mediators, acetylcholinesterase (AChE) activity, BDNF levels, and Na⁺/K⁺-ATPase activity. Additionally, a histological examination of these brain regions was performed to assess neuronal integrity using Nissl staining. After 100 days of hyperglycemia, both T1D and T2D rats exhibited significant functional and structural alterations in the hippocampus and PFC. T2D was significantly associated with pronounced oxidative stress and inflammatory responses, related with anxiety- and depression-like behaviors (P < 0.05). In contrast, T1D induced more extensive cognitive decline, neurochemical and structural disruption, including marked BDNF depletion, significant Na⁺/K⁺-ATPase reduction, and elevated AChE activity (P < 0.05), suggesting greater neuronal stress and degeneration compared to T2D. These findings highlight diabetic encephalopathy as a multifactorial disorder involving concurrent impairments in neurotrophic support, metabolic regulation, and neurotransmitter balance, with T2D characterized by greater oxidative stress and inflammation, and T1D exhibiting more severe neurochemical and structural damage.

The growing popularity of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has driven off-label prescriptions and supply shortages, raising equity concerns for First Nations peoples disproportionately affected by diabetes. Pharmaceutical companies have simultaneously accelerated their marketing through disease-awareness campaigns, sponsored events and telehealth models, with many campaigns prominently featuring women of colour, including First Nations women. In this perspective article, we argue, from a commercial determinants of health perspective, that pharmaceutical companies often influence perceptions of body image, medicines policy and prescribing without addressing the systemic conditions driving First Nations health inequity. We urge clinicians and policymakers to ensure decisions remain free from commercial influence.