Background Type 2 diabetes mellitus (T2DM) is a major global health burden. Despite being the preferred first-line therapy, metformin use is sometimes limited by gastrointestinal intolerance, creating a need for alternative management strategies. A promising oral antidiabetic substitute, imeglimin, a first-in-class tetrahydrotriazine, has a distinct mitochondrial mechanism of action. However, its real-world efficacy and tolerability as a direct replacement for metformin in GI-intolerant patients remain uncharacterized. Methods This retrospective observational study was conducted on 100 adult patients with T2DM who had documented metformin intolerance and were initiated on imeglimin monotherapy or combination therapy for three months. Primary outcomes included variations in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and postprandial plasma glucose (PPG). Body weight, lipid profile, and renal function were the secondary outcomes. Normality was assessed using the Shapiro-Wilk test; paired t-tests and Wilcoxon signed-rank tests were applied as appropriate. Multivariate linear regression was performed with change in HbA1c as the dependent variable and key covariates (baseline HbA1c, age, sex, T2DM duration, body weight, imeglimin dose, and number of concomitant oral anti-diabetic drugs) as independent variables. A two-tailed p<0.05 was considered statistically significant. Results The study comprised 100 patients (55% female; mean age: 57.69 ± 9.24 years; mean T2DM duration: 10.38 ± 5.69 years). HbA1c decreased significantly from 7.96 ± 1.56% to 7.35 ± 1.02% (mean change: -0.62 ± 1.05%; p<0.001; n=77) after three months of imeglimin therapy. FPG decreased from 156.63 ± 48.48 mg/dL to 124.45 ± 20.46 mg/dL (-32.18 ± 47.02 mg/dL; p<0.001), and PPG decreased from 217.85 ± 84.08 mg/dL to 173.22 ± 39.71 mg/dL (-44.63 ± 68.44 mg/dL; p<0.001). Body weight decreased significantly (-0.81 kg; p<0.001). Low-density lipoprotein cholesterol and triglyceride levels also showed significant reductions (p<0.001). The estimated glomerular filtration rate remained stable (p=0.135), and gastrointestinal side effects were reported in only 2% of the patients. Conclusion Imeglimin demonstrated meaningful improvements in glycemic control, with a favorable safety and tolerability profile in metformin-intolerant patients with T2DM. These findings support the use of imeglimin as an effective and well-tolerated alternative option for metformin in patients with T2DM.

Cognitive frailty (CF) is prevalent in older adults with type 2 diabetes mellitus (T2DM) and significantly increases risks of adverse outcomes. Early detection is essential for potential reversibility, requiring efficient bedside identification tools.

This study included 523 consecutive older adults (aged 65 years or older) diagnosed with T2DM at a tertiary care center in Sichuan, China. Within a health ecological framework, 35 candidate variables were collected. Multiple imputation was used for missing data. LASSO regression was applied to the full candidate set to select key features. Six algorithms (logistic regression, decision tree, random forest, support vector machine, XGBoost, and stacking) were trained to identify CF with a 70/30 split (training/test). Performance was evaluated on the test set using AUC, AP, accuracy, sensitivity, specificity, and calibration; SHAP was used to assess model interpretability.

Mean age was 74.3±6.4 years, and CF prevalence was 41.5%. LASSO identified eight indicators: age, cognitive activities, physical exercise, diabetes complications, nutritional status, depressive symptoms, perceived social support, and insomnia symptoms. On the test set, logistic regression achieved the best performance for identification (AUC 0.947, AP 0.936, accuracy 0.879, sensitivity 0.838, specificity 0.910), with good calibration. SHAP analysis revealed that older age, lower frequency of physical exercise, higher scores for depressive symptoms, lower social support, poorer nutritional status, a greater number of diabetes complications, lack of cognitive activities, and higher scores for insomnia symptoms were the major contributors to a higher likelihood of CF.

In this single-center hospital-based sample, a parsimonious model using eight readily obtainable features demonstrated strong internal validity for identifying CF in older inpatients with T2DM. This tool may facilitate early screening and clinical decision-making. Prospective studies are warranted to confirm its clinical utility.

Early myocardial stress may develop in subjects with prediabetes or newly diagnosed type 2 diabetes (T2D) even in the absence of overt heart failure. We aimed to evaluate circulating lncRNAs in prediabetes or newly diagnosed T2D subjects.

We conducted a cross-sectional study on 133 subjects with prediabetes or newly diagnosed T2D without a history of cardiovascular disease. All participants underwent clinical, biochemical and echocardiographic evaluations. Circulating lncRNAs MALAT1, NOS2P3, CCDC68, RNF145 and ARL4C were assessed. The study population was stratified into two groups according to the NT-proBNP value (Group 1, NT-proBNP < 75 pg/mL; Group 2, NT-proBNP ≥ 75 pg/mL).

Group 2 exhibited increased hs-CRP and epicardial adipose tissue (EAT) thickness, and lower E/A ratio (p for all < 0.05). The investigated lncRNAs were upregulated in the Group 2 and were associated with NT-proBNP levels (p for all < 0.05). LncRNAs ARL4C and NOS2P3 were associated with EAT thickness (p for all < 0.05). Multiple regression analysis showed that lncRNA ARL4C, NT-proBNP, age, male sex, and BMI were associated with EAT thickness (p for all < 0.05).

Prediabetes or newly diagnosed T2D subjects with higher NT-proBNP levels exhibited an increased expression of circulating lncRNAs; moreover, lncRNAs ARL4C and NOS2P3 were associated with EAT thickness. Our findings suggest that the evaluation of circulating lncRNAs in addition to NT-proBNP may be useful to identify dysmetabolic subjects with an early myocardial stress.

To improve diabetes outcomes in a primarily rural state, six federally qualified health centers (FQHCs) piloted Food is Medicine (FIM) initiatives after a structured pre-implementation planning process. This report details FIM implementation approaches, barriers, and problem-solving that can help inform the successful scaling of FIM programs in similar rural FQHC settings.

Continuous glucose monitoring (CGM) is an underused tool for diabetes management among patients from underserved communities. This report describes a training designed to increase CGM referrals among health care professionals treating patients with type 2 diabetes in primary care at a federally qualified health center in a rural region in California.

Diabetes and its complications are serious public health problems, disproportionately affecting rural Americans. Contributing to the literature, this systematic review examines intervention studies targeting people with diabetes (PWDs) receiving care in rural federally qualified health centers (FQHCs). The study (N=16) is informed by the Study Design, Data, Methods, Outcomes (SDMO) framework. Overall, findings revealed that rural FQHC interventions targeting PWDs were of serious or high risk of bias. Most studies (69%) used pre-experimental, pre-post intervention designs, often embedded within quality improvement initiatives or feasibility studies. Three studies (19%) employed quasi-experimental designs while only two studies (12%) employed randomized controlled trial designs. Most studies (63%) collected self-report (e.g., dietary intake, diabetes knowledge and behaviors) and objective (e.g., A1C, body mass index) data. Interventions largely focused on improving diabetes self-management or outcomes (56%), with fewer focused on hypertension management and food insecurity (44%). The intervention studies often reported improved A1C levels and other meaningful results. More rigorous research is needed to advance the science of rural FQHC interventions targeting PWDs.

Rural residents have higher rates of diabetes and diabetes-related mortality than urban residents, complicated by higher rates of uninsurance. We sought to understand the association between rurality and health insurance and diabetes-related complications and management. Electronic health record data (EHR) from safety-net clinics across four states from 2014-2019 were used. Adjusted generalized estimating equation-based logistic regression models were fit. Among 29,019 patients with diabetes, we found no association between rurality and diabetes-related complications. Patients in large rural communities had higher odds of uncontrolled blood pressure and lower odds of statin prescriptions versus urban patients. Odds of chronic and acute complications documented in the EHR were lower for uninsured than insured patients as were statin and insulin prescriptions. Rurality was not associated with acute or chronic diabetes-related complications but was associated with underlying factors. Safety-net clinics can help address differences given their role in the rural health care system.

To compare the frequency of postoperative complications, specifically staple-line bleeding and leakage, in patients undergoing laparoscopic sleeve gastrectomy (LSG) with and without staple-line reinforcement.

A descriptive, analytical study. Place and Duration of the Study: Department of General Surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from January 2014 to December 2024.

Patients aged 20 to 60 years, of either gender, who underwent LSG were retrospectively reviewed. A binary logistic regression was conducted to assess the association between staple-line reinforcement and postoperative bleeding, adjusting for age, gender, diabetes mellitus, hypertension, and smoking status. Results were presented as odds ratios (ORs) with 95% confidence intervals (CIs). A p-value of <0.05 was considered statistically significant. Model fit and multicollinearity were assessed before finalising the regression model.

Staple-line reinforcement was not found to have a significant association with the reduced postoperative bleeding (OR = 0.636, 95% CI: 0.206-1.964, p = 0.432). No post-operative leakage was noted in either group.

Staple-line reinforcement during LSG does not significantly reduce the incidence of postoperative bleeding or leakage. These findings suggest that the use of staple-line reinforcement material may not be essential when meticulous surgical technique is employed. Further large-scale prospective studies are recommended to confirm these results and refine surgical protocols.

Laparoscopic sleeve gastrectomy, Staple-line reinforcement, Bleeding, Leakage, Bariatric surgery.

Diabetic nephropathy (DN) is the most common complication of diabetes, with immune-mediated inflammation playing a significant role in its pathophysiology. The complement system, a key proinflammatory factor, is implicated in DN. This study was aimed at identifying diagnostic biomarkers related to the complement system in DN using bioinformatics methods. We analyzed three datasets (GSE96804, GSE104948, and GSE1009) from public databases, employing differential expression analysis and machine learning to identify complement system-related genes (CSRGs) as potential biomarkers. A diagnostic nomogram was constructed based on these genes, and immune microenvironment differences between the DN and control groups were explored. Gene interaction networks, enrichment analysis, and drug predictions were also conducted. Mendelian randomization (MR) was used to examine the causal links between identified biomarkers and DN. Our analysis identified five biomarkers (CKB, ANXA1, HSPA1L, CYP27B1, and XYLT1) associated with DN. A diagnostic nomogram based on these biomarkers showed high accuracy (model correction slope close to 1 and AUC close to 1). Immune infiltration analysis revealed significant differences in immune cell subsets between the DN and control groups. Gene set variation analysis (GSVA) indicated that the oxidative phosphorylation (OXPHOS) pathway was activated in CKB, HSPA1L, CYP27B1, and XYLT1 while inhibited in ANXA1. MR confirmed HSPA1L as a risk factor for DN (OR = 1.625, 95% CI: 1.272-2.076, p = 9.96e - 05). In conclusion, these five CSRGs may play significant roles in DN progression, providing a foundation for further research into DN pathogenesis and potential molecular markers for clinical diagnosis.

Heart failure (HF) is a complex chronic disease with multiple comorbidities, including diabetes. Patients with diabetes are at an increased risk of developing HF-a major adverse cardiovascular outcome-and the comorbidity of HF and diabetes is associated with worse outcomes than HF alone. Some HF studies show that diabetes contributed to increased risk for rehospitalizations, but there is limited evidence about risk factors for rehospitalization in home healthcare patients with both HF and diabetes. The purpose of this study was to identify risk factors for 60-day rehospitalization in home healthcare HF patients with diabetes. This study is a secondary data analysis of a retrospective cohort study conducted using the Outcome and Assessment Information Set (OASIS-C) version. In the final multivariable logistic regression model, the frequency of pain interfering with the patient's activity or movement and the patient's overall status were statistically significant. Patients with minimal pain interference (less often than daily) had about 60% lower odds of 60-day rehospitalization than those without pain interference (OR = 0.394), and patients facing temporary high health risk(s) had about 86% higher odds of rehospitalization than patients in stable conditions (OR = 1.861). Identifying risk factors for HF patients with diabetes in this study helps define their care needs in the home healthcare setting. However, future studies are warranted to use larger sample sizes to further assess which hidden factors drive rehospitalization among home healthcare HF patients with diabetes.