Diabetic ketoacidosis (DKA) is a life-threatening metabolic emergency requiring prompt insulin therapy. Although intravenous (IV) insulin infusion remains the standard treatment, early initiation of subcutaneous (SC) basal insulin during IV therapy may improve outcomes. We evaluated the efficacy and safety of early basal insulin administration in adults with DKA.

A systematic review and meta-analysis following PRISMA 2020 guidelines searched PubMed, Embase and Cochrane Library from inception to February 2026 for randomised controlled trials (RCTs) comparing early SC basal insulin plus IV insulin versus IV insulin alone in adults with DKA. Primary outcomes were time to DKA resolution and hospital length of stay. Secondary outcomes included total fluid requirement, hypoglycaemia, rebound hyperglycaemia, recurrent DKA, electrolyte disturbances and mortality. Meta-regression explored sources of heterogeneity.

Eight RCTs involving 407 participants were included. Early basal insulin significantly reduced time to DKA resolution (MD -4.06 h, 95% CI -5.53 to -2.58; p < 0.0001; I² = 56.3%), with consistent findings in sensitivity analysis (MD -3.44 h; I² = 0%). Total fluid requirements decreased by approximately 400 mL, although clinical significance was modest. No significant differences were observed in hospital length of stay, rebound hyperglycaemia, recurrent DKA, hypoglycaemia, hypokalaemia, or mortality. Meta-regression showed no significant effect modification by age, BMI, sample size, or male proportion.

Early SC basal insulin combined with IV insulin significantly shortens DKA resolution time and modestly reduces fluid requirements without increasing adverse events. While no significant effects were observed on hospital stay or recurrence outcomes, these findings support the safety and potential clinical benefit of early basal insulin use in DKA management. Larger multicentre trials are warranted.

This study aimed to investigate the association between serum FSH levels and both the prevalence and incidence of T2DM among middle-aged and older men.

This study utilised data from 1097 men aged ≥ 40 years, who participated in the population-based Tehran Lipid and Glucose Study. Participants were followed over six phases between 2002 and 2021. FSH levels were measured at baseline, and participants were followed for incident T2DM over 3774.78 person-years. Multivariable logistic and Cox regression models were used to examine associations between FSH levels and prevalent and incident T2DM, adjusting for demographic and metabolic confounders. Subgroup analyses were performed by age group (< 50 vs. ≥ 50 years).

At baseline, the prevalence of T2DM was 18.41%, and no significant association was observed between FSH levels and T2DM prevalence after full adjustment (OR: 1.0; 95% CI: 0.98-1.03). During follow-up, 302 new T2DM cases were identified. In the fully adjusted Cox model, higher FSH levels were independently associated with a lower risk of developing T2DM (HR: 0.96; 95% CI: 0.93-0.99). The inverse association was especially evident in men aged ≥ 50 years (HR: 0.96; 95% CI: 0.93-0.99), whereas no significant association was found in younger men.

Higher serum FSH levels were independently associated with a reduced risk of incident T2DM in men, particularly among those aged ≥ 50. These findings suggest a potential protective metabolic role of FSH in older men. Further research is warranted to elucidate the non-reproductive roles of FSH in men.

In Erbil, Iraq, the rising burden of type 2 diabetes (T2D) calls for effective preventive strategies targeting modifiable behaviors. This study aimed to evaluate the effect of a structured health education program on preventive practices and metabolic improvements related to T2D among high school teachers in Erbil.

This quasi-experimental study was conducted from October 27, 2024, to June 1, 2025, in five major high schools in Erbil, using purposive sampling method. Data were collected using a self-structured questionnaire assessing sociodemographic characteristics and 15 preventive practices and metabolic improvement related to T2D. Paired sample t-tests, one-way ANOVA, post-hoc Tukey tests, effect sizes, and multiple linear regression analyses were performed using SPSS version 27 (IBM Corp., Armonk, NY), with p < 0.05 considered statistically significant.

A total of 102 high school teachers participated in the study, equally divided into intervention and control groups (n = 51 each). The health education program led to significant improvements in preventive practices and metabolic improvement, with the overall practice score increasing from 45.08 to 59.58 in the intervention group (p < .001), while no significant change was observed in the control group (44.54 to 44.35, p = 0.677). Marked behavioral gains included increased HbA1c testing, physical activity, label reading, and reduced sugary beverage intake. Clinical outcomes such as BMI, fasting glucose, and lipid profile also improved significantly post-intervention. A very large effect size was observed for the overall practice score (d = 1.94). Regression analysis identified group assignment, younger age, female gender, and family history of diabetes as significant predictors of improved post-intervention scores.

Structured quality health education was associated with significant improvement in preventive practices and metabolic risk reduction measures that translated to favorable clinical outcomes among high school teachers. Policymakers and healthcare providers should implement targeted educational programs in schools to enhance health literacy, support behavioral change, and reduce the burden of type 2 diabetes in at-risk populations.

To describe compliance with the interventions defined as drivers of the HEARTS-based integrated model for noncommunicable disease control in Peru.

All Ministry of Health institutional health service providers (IHSPs) that are implementing the HEARTS initiative were invited to participate. The assessment was conducted between January and May 2025. Compliance was measured using the maturity index (MI), scored on a five-level scale ranging from incipient to fully mature. The percentage of IHSPs meeting the intervention targets for drivers of the MI for hypertension (HTN), type 2 diabetes mellitus (T2DM), and chronic kidney disease (CKD) was calculated.

Of 1000 IHSPs implementing the model, 92% reported their MIs for HTN, 92% for T2DM, and 93% for CKD. Overall, 82.3% of facilities were at maturity level 1 for HTN, 75% were at level 1 for T2DM, and 99.5% were at level 1 for CKD. For HTN, the target with the highest level of compliance was immediate initiation of pharmacological therapy, achieved by 75% of IHSPs. For T2DM, the targets most frequently met were timely delivery of screening results and early treatment optimization, achieved by 49% of IHSPs. For CKD, the target with the highest level of compliance was availability of a standardized treatment protocol, achieved by 17% of IHSPs.

Although most IHSPs were only at the incipient maturity level, compliance was achieved for some interventions. Priority activities to improve care were identified.

Obesity-related type 2 diabetes (DM) is increasing rapidly and at present reaching epidemic proportions in some Worldwide populations. The aim of this study was to provide new knowledge on the interplay between genetic and lifestyle obesity-related risk factors in populations with the highest incidence of obesity-related diabetes could provide an important tool to help prevent or delay diabetes onset in high-risk groups.

Community free-living individuals visiting primary health centers were recruited to the study following informed written consent. Demographic and clinical characteristics, physical activity, dietary intake and biological markers of DM were measured at baseline and follow up. Validated questionnaires were used to assess physical activity and dietary intakes. A Cox proportional hazards analysis was used to examine the risk of developing diabetes diagnosed using the WHO cut-of-points criterion of HbA1c ≥ 6.5% at follow after adjusting for known clinical risk indicators.

A total of 375 Community free-living locals UAE citizens subjects, 348 (93%) of them females and 253 non-locals' expatriates [187 (73%)] females were recruited and followed up for a period of 427 ± 223 days. Using WHO cut-of-points for diagnosing DM (HbA1c ≥ 6.5%), 31 (6%) subjects out of 545 followed up developed DM. Overall local United Arab Emirates (UAE) citizens reported significantly lower levels of physical activity in comparison to non-local expatriates. The Cox proportional hazard model analysis revealed that being obese, UAE national and physically inactive is associated with a significantly increased risk of DM after adjusting for other prognostic indicators [non-UAE national: Odd ratio (95% CI): 0.13 (0.04, 0.47); p=0.002; physically active: 0.31 (0.11, 0.90); p=0.002]. The Kaplan Meier figures show the significantly increased risk of developing DM in physically inactive local UAE citizens compared with expatriates' residents (p<0.05). In contrast risk of developing DM was no different between physically very active UAE nationals compared to non-nationals at follow up (P>0.5).

Our finding suggests that physical inactivity in high-risk groups is the most important risk factor for developing DM. Urgent actions are needed to increase physical activity in this high-risk group coupled with further research to understand the reasons for this striking indigenous population variability.

We investigated whether albuminuria is more consistently associated with diabetic retinopathy (DR) severity than estimated glomerular filtration rate (eGFR) and whether it corresponds to an ischemic retinal phenotype on optical coherence tomography angiography (OCTA).

This two-part cross-sectional study first analyzed 949 adults with diabetes from the National Health and Nutrition Examination Survey (NHANES) to evaluate the associations of albumin-to-creatinine ratio (ACR) and eGFR with the DR outcomes. An independent single-center cohort of 168 adults with type 2 diabetes, including a nested 134-participant OCTA subset, was then used to examine the associations of urine ACR (UACR) and eGFR with the clinical DR endpoints and retinal perfusion metrics.

In the NHANES, each doubling of ACR was independently associated with higher odds of AnyDR and SevereDR, with stronger association for SevereDR (odds ratio, OR = 1.30), whereas eGFR showed no independent association. In the clinical cohort, each doubling of UACR was associated with higher odds of moderate-or-worse DR and vision-threatening diabetic retinopathy (VTDR) (OR = 2.86 and 2.70, respectively), while eGFR remained non-significant. In the OCTA subset, a higher UACR was associated with greater widefield non-perfusion and lower macular perfusion density, whereas eGFR was not associated with either OCTA endpoint.

Across the studied cohorts, albuminuria was consistently associated with more severe DR and an ischemic OCTA phenotype, whereas eGFR did not show an independent association within the observed kidney function range. Spot urine ACR testing may serve as a practical biomarker for stratifying retinal microvascular ischemia risk.

The progression of rapidly progressive diabetic retinopathy (PDR) in type 2 diabetes mellitus (T2DM) is characterized by substantial inter-individual variability. To develop and validate a nomogram for individualized risk prediction and stratification of rapidly progressive PDR in T2DM by incorporating diabetes duration, glycated hemoglobin (HbA1c), 24-hour urinary protein quantification, growth differentiation factor 15 (GDF15), Diabetic Retinopathy Severity Scale (DRSS) grade, and foveal avascular zone area.

This retrospective study enrolled 342 patients with T2DM (1999 WHO criteria), randomly assigned to training (n=240) and validation (n=102) sets (7:3 ratio). Baseline demographic, clinical, metabolic, renal, inflammatory biomarker, and ophthalmic imaging data were collected. Predictive variables were selected via univariate analysis and least absolute shrinkage and selection operator (LASSO) regression. Independent predictors identified by multivariable logistic regression were incorporated into a nomogram. For comparison, Random Forest, multivariable logistic regression, and Gradient Boosting Machine models were also developed. Model performance was assessed using the area under the receiver operating characteristic curve (AUC-ROC), calibration curves, and decision curve analysis (DCA).

Univariate analysis identified six significant factors (all P < 0.05): diabetes duration, HbA1c, 24-hour urinary protein quantification, GDF15, DRSS grade, and foveal avascular zone area. LASSO regression retained all six, and multivariable logistic regression confirmed them as independent risk factors for rapidly progressive DR in T2DM (all P < 0.05). Three machine learning models were constructed. The Random Forest model achieved the numerically highest validation AUC (0.780) compared with Gradient Boosting Machine (0.741) and multivariable logistic regression (0.698), though the DeLong test showed no statistically significant difference between Random Forest and Gradient Boosting Machine (P = 0.38). Calibration curves showed good consistency between predicted and observed probabilities. DCA indicated high clinical net benefit of the model at 0.1-0.8 threshold probability vs other models and extreme strategies.

A novel risk prediction model for rapidly progressive PDR in T2DM was developed and validated by integrating multidimensional parameters. Demonstrating favorable discrimination, calibration, and clinical utility, this model provides a promising tool for early identification of high-risk individuals and optimization of personalized intervention strategies.

Gestational diabetes mellitus (GDM) is a frequent metabolic complication of pregnancy associated with significant maternal and neonatal morbidity. Its prevalence is notably higher among South Asian women, likely due to increased baseline insulin resistance and genetic predisposition. Conventional screening using the oral glucose tolerance test (OGTT), typically performed at 24-28 weeks of gestation, often identifies GDM after metabolic alterations are already established, thereby limiting opportunities for early intervention. This has led to growing interest in identifying reliable first-trimester biomarkers for early risk prediction. Adipokines, which play a crucial role in metabolic regulation and inflammation, have emerged as promising candidates. Omentin, an insulin-sensitizing adipokine predominantly secreted by visceral adipose tissue, has been implicated in glucose homeostasis. This study aimed to evaluate first-trimester serum omentin levels as a predictor of GDM and to assess its association with fetomaternal outcomes.

A prospective cohort study was conducted over a period of 18 months from July 2024 to December 2025 at Vardhman Mahavir Medical College (VMMC) and Safdurjung Hospital. Pregnant women aged 18-35 years with a singleton pregnancy and a normal two-hour OGTT at their first antenatal visit were enrolled. First-trimester venous blood samples were collected under standardized conditions, and serum omentin levels were measured using enzyme-linked immunosorbent assay (ELISA). Participants underwent repeat 75-g OGTT at 24-28 weeks and again at 32-34 weeks of gestation. All participants were followed until delivery to monitor the development of GDM and to document relevant maternal and neonatal outcomes.

Lower first-trimester serum omentin levels were significantly associated with subsequent development of GDM and demonstrated moderate predictive utility on receiver operating characteristic curve (ROC) analysis, with an area under the receiver operating characteristic curve (AUROC) of 0.683. At the optimal cutoff value, specificity was 83%, and the negative predictive value was 90.8%, indicating a strong capacity to identify women at low risk for developing GDM. A trend toward increased adverse fetomaternal outcomes was observed among women with lower omentin levels.

First-trimester serum omentin shows promise as an early predictive biomarker for GDM. Its incorporation into routine antenatal screening protocols may improve early risk stratification and facilitate timely preventive interventions. These findings support the potential role of adipokine-based screening strategies in enhancing current approaches to GDM detection and improving overall pregnancy outcomes.

Nontuberculous mycobacteria (NTM) are increasingly recognized as causes of human infection. Mycolicibacterium neoaurum (formerly Mycobacterium neoaurum), a rapidly growing mycobacterium, is a rare pathogen, usually associated with catheter-related bloodstream infections. Pulmonary involvement is exceptional. We report the first documented case of pulmonary infection due to Mycobacterium neoaurum (M. neoaurum) in Morocco. A 39-year-old man with type 2 diabetes mellitus and refractory ulcerative colitis was hospitalized for severe autoimmune blistering disease and subsequently developed fever, productive cough, night sweats, and hypoxemia. Laboratory findings were indicative of an inflammatory syndrome. Chest imaging revealed a right upper lobe cavitary lesion. Bronchoalveolar lavage culture yielded acid-fast bacilli after eight days, identified as M. neoaurum by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF). Empirical ciprofloxacin therapy administered for four weeks resulted in marked clinical and biological improvement. This case highlights the rare pulmonary pathogenicity of M. neoaurum and underscores the importance of considering uncommon NTM in cavitary lung disease, particularly in patients with complex comorbidities. Advanced diagnostic tools, such as MALDI-TOF, are crucial for accurate identification.

Type 2 diabetes mellitus is associated with microvascular complications that may contribute to both cardiovascular and neurological morbidity.

To evaluate the association of coronary microvascular dysfunction with stroke risk, cognitive decline, and selected hematologic/metabolic biomarkers in patients with type 2 diabetes mellitus without major vessel occlusion.

This analytical cross-sectional study was conducted at the Department of Cardiology, Jinnah International Hospital, Abbottabad, Pakistan, from May 2025 to November 2025. A total of 255 patients with type 2 diabetes mellitus were enrolled using non-probability consecutive sampling. Coronary microvascular dysfunction was assessed through clinical evaluation and available cardiovascular investigations in patients without significant epicardial coronary artery obstruction.

The mean age of the participants was 54.7 ± 10.9 years, and 146 (57.3%) were male. Coronary microvascular dysfunction was identified in 112 (43.9%) patients. Cognitive decline was significantly more frequent among patients with coronary microvascular dysfunction than those without it (46.4% vs. 29.4%, p = 0.006). Elevated stroke risk was also higher in patients with coronary microvascular dysfunction (43.8% vs. 23.1%, p = 0.001). Patients with coronary microvascular dysfunction had longer diabetes duration (10.1 ± 4.3 vs. 7.4 ± 3.6 years, p = 0.001), higher glycosylated hemoglobin levels (8.9 ± 1.6% vs. 7.8 ± 1.4%, p = 0.001), higher low-density lipoprotein cholesterol levels (142.1 ± 27.5 vs. 128.4 ± 28.7 mg/dL, p = 0.004), and greater frequencies of hypertension (63.4% vs. 46.9%, p = 0.012) and dyslipidemia (55.4% vs. 41.3%, p = 0.028).

Coronary microvascular dysfunction was common among patients with type 2 diabetes mellitus and was significantly associated with cognitive decline, elevated stroke risk, and adverse metabolic profiles. Early identification of microvascular dysfunction may improve vascular risk stratification and guide preventive strategies in diabetic patients.