Global population aging is accelerating, and pain and depression frequently co-occur in middle-aged and older adults. Frailty, an age-related clinical syndrome, markedly elevates the risks of falls, disability, hospitalization, and mortality. This study investigated whether comorbid depression affects long-term frailty trajectories in patients with chronic pain, to help identify high-risk populations and guide comprehensive interventions.

Based on 8 years of follow-up (2011-2018) from the nationally representative multi-stage probability sample of the China Health and Retirement Longitudinal Study (CHARLS), 4,778 participants aged 45 years and older with chronic pain were enrolled. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10), with a total score ≥10 indicating depressive symptoms, and frailty was quantified by a 32-item Frailty Index (FI). Group-based trajectory modeling (GBTM) identified FI developmental trajectories, and multinomial logistic regression examined the association between depression and trajectory group membership.

Three frailty trajectories were identified: Low Frailty Group, Moderate Frailty Group, and High Frailty Group. Overall, 61.3% of participants had comorbid depressive symptoms. Depressive symptoms were associated with significantly higher odds of the moderate (OR = 2.82, 95% CI 2.42-3.29) and high trajectories (OR = 6.57, 95% CI 5.18-8.34). Each 1-point CES-D-10 increment increased the odds by 11% and 19%, respectively. These associations remained stable across subgroups.

In middle-aged and older adults with chronic pain, depression was associated with worsening frailty trajectories. Routine depression screening integrated with mental health care for chronic pain and frailty may help slow frailty progression and reduce disability burden.

This conceptual, implementation-oriented paper proposes a framework for precision prevention centred on physical activity promotion and early risk mitigation, aiming to support a shift from reactive disease management toward proactive prevention. The proposed framework focuses on the early identification of risk trajectories by integrating biological, environmental, and social determinants of health through systems thinking, multi-omics technologies, digital health, and behavioural science. It aims to inform tailored, context-sensitive interventions that will help to mitigate chronic non-communicable diseases (NCDs), while supporting lifelong resilience. Within this framework, physical activity is positioned as the central, modifiable anchor behaviour through which personalised prevention strategies may be operationalised. Building on the 2025 Hamburg Declaration and the Global Alliance for the Promotion of Physical Activity's (GA@PA) mission, this conceptual paper proposes a multidimensional model, combining personalised strategies for physical activity, nutrition, sleep, and mental health with contextual environmental adaptations. By bringing together stakeholders across multiple sectors, including healthcare, education, urban planning, sport organisations, industry, and community groups, GA@PA aims to strengthen global collaboration and to accelerate the implementation of evidence-based strategies for physical activity promotion. Emerging technologies, including digital twins, wearable biosensors and artificial intelligence (AI)-driven analytics, are discussed as potential enabling tools for real-time monitoring and for providing input for adaptive interventions, while mobile health platforms may extend access to underserved populations. Rather than providing prescriptive solutions, the paper outlines key implementation fundamentals. These include technological infrastructure with interoperable biosensors and AI aligned with prevailing ethical frameworks such as the AI Act and UNESCO recommendations; interdisciplinary research on resilience and outlier populations; policy and education reform, including routine assessment of physical activity as a vital sign within healthcare encounters; and cross-sector collaboration spanning urban design to sport-for-development initiatives such as the International Olympic Committee (IOC)'s Olympism365. Sports organisations may support broader participation through sport-for-all programmes. The framework emphasises equity, cultural adaptation, and community co-design as critical features for scalability across diverse global contexts, highlighting the role of sport, fitness, and public health partnerships in creating a context where healthy choices become accessible and sustainable. Overall, this conceptual paper outlines a practice-informed framework proposing precision prevention as an evolving and testable implementation framework for supporting sustainable and equitable prevention systems. By integrating science, technology and policy through a multisectoral lens, precision prevention is proposed as a testable pathway to reduce the NCD burden, to enhance the health span and to foster resilient societies.

The association between diabetes mellitus (DM) and the Decayed, Missing, Filled Teeth (DMFT) index is not yet settled. This study aimed to assess associations between DM and the DMFT index among adults in Central Sudan. A community-based cross-sectional study was conducted among adults (aged ≥ 18 years) in Central Sudan using a multistage stratified random sampling design. Dental morbidity was assessed using the DMFT index as a continuous dependent variable. Modified multivariate Poisson regression was used to calculate Adjusted Relative Risks (ARR) for associated factors. Seven hundred and seventy-three adults were enrolled. The median (interquartile range, IQR) DMFT index was 5 (2-10), and 14.6% of participants had DM. After adjustment, older age, lower education, and unemployment were significantly associated with the DMFT index. DM was associated with the DMFT index (ARR = 1.18, 95% CI = 1.10-1.26). Glycated (HbA1c) levels were also independently associated with increased DMFT index (ARR = 1.03, 95% CI = 1.02-1.04). DM is associated with DMFT index among adults in Central Sudan. There is a need to integrate oral and systemic health initiatives in Sudan.

Type 2 Diabetes Mellitus (T2DM) is a complex metabolic disorder characterized by insulin resistance and progressive β-cell dysfunction, although these mechanisms alone do not account for the considerable variability observed in disease presentation and clinical evolution. During the last decade, epidemiological and mechanistic studies have shown that metabolic dysfunction develops within a broader framework in which biological susceptibility is continuously shaped by environmental exposures, occupational conditions, lifestyle-related behaviors, psychosocial influences, and socioeconomic circumstances. Rather than acting independently, these factors appear to modify metabolic regulation through interconnected biological pathways that contribute to differences in disease susceptibility, progression, and long-term outcomes across populations. This perspective supports a more integrated interpretation of T2DM pathophysiology, in which biological, environmental, and socioeconomic influences jointly determine disease expression. Accordingly, this review critically evaluates current evidence regarding the contribution of these interacting determinants to the onset, progression, and clinical manifestations of T2DM.

This narrative review was based on publications retrieved from PubMed, Scopus, and Web of Science addressing biological, environmental, behavioral, occupational, and socioeconomic factors relevant to T2DM. Epidemiological, clinical, and experimental studies were selected to provide complementary evidence on the mechanisms through which these variables contribute to metabolic dysfunction, disease progression, and diabetes-related complications. Particular attention was given to investigations examining the interplay among these factors rather than considering them as isolated contributors to disease development.

The literature examined indicates that T2DM arises through the convergence of multiple pathogenic processes rather than from a single metabolic abnormality. Obesity, insulin resistance, sedentary lifestyles, and dietary imbalance remain central contributors to disease development, while increasing evidence also points to a relevant contribution from environmental exposures and socioeconomic conditions. Pollutants, adverse occupational settings, chronic psychosocial stress, and inequalities in healthcare access have all been associated with disturbances in metabolic regulation and less favorable clinical outcomes. Delayed diagnosis, limited preventive strategies, and insufficient diabetes education further compromise long-term disease management and may contribute to the persistence of chronic complications.

T2DM arises from metabolic alterations driven by environmental and socioeconomic factors that can modify disease susceptibility and clinical evolution. Differences in disease burden observed across populations are unlikely to result from isolated determinants; instead, they appear to reflect the cumulative influence of environmental exposures, social conditions, and biological vulnerability. Their combined effects may promote chronic inflammation, oxidative stress, and progressive impairment of glucose homeostasis, although the relative contribution of each determinant probably differs according to the characteristics of the population studied.

The persistent global increase in T2DM highlights the need for preventive and therapeutic strategies that extend beyond glycemic control alone. Addressing environmental exposures, socioeconomic inequalities, healthcare accessibility, and lifestyle-related factors alongside conventional metabolic management may improve long-term clinical outcomes and reduce the burden of diabetes-related complications. A broader understanding of how these determinants interact will also facilitate the development of more effective public health policies and individualized therapeutic approaches.

Hemoglobin A1c (HbA1c) assay validation is essential for establishing analytical reliability, evaluating discrimination between diabetic and non-diabetic (NDM) dogs, and establishing reference intervals.

Validate a canine HbA1c point-of-care analyzer (Vet Chroma™), evaluate its diagnostic performance, and establish a reference interval in healthy dogs.

Fifty-one diabetic, 44 NDM controls, and 42 healthy client-owned dogs.

Prospective validation of precision, linearity, interference, and storage stability. Method comparison used an immunoturbidimetric comparator assay (Olympus DxC 700 AU). Diagnostic performance was evaluated via receiver operating characteristic (ROC) analysis, likelihood ratios, and odds ratios.

Average intra- and inter-assay coefficients of variation were 3.92% and 8.47%. Linearity over the clinical range (0.86%-6.27% HbA1c%) was strong (R2 = 0.973) with minor constant bias. HbA1c remained stable for 5 days at 4 °C and up to 3 months at both -20 and -80 °C, but not reliably at 6 months. Lipemia and icterus exhibited variable interfering effects. Method comparison indicated non-interchangeability with the comparator assay. Diabetic dogs had significantly higher HbA1c than NDM (mean 5.10% vs 1.58%). ROC analysis yielded an AUC of 0.969, with a cutoff > 3.22% achieving 90.20% sensitivity and 100% specificity. The positive likelihood ratio was not estimable, and the odds ratio was 22.90 (95% CI, 3.60-146.90). Healthy young dogs' reference interval was 1.25% (90% CI, 1.19-1.59) to 2.75% (90% CI, 2.56-2.90).

The Vet Chroma™ provides reliable HbA1c measurements in canine whole blood and effectively discriminates diabetic from non-diabetic dogs. Results should be interpreted alongside clinical and clinicopathologic findings.

BACKGROUND Bullosis diabeticorum (BD) is a dermatologic, often acral, complication of diabetes, with a reported prevalence of approximately 0.16% to 0.5% among diabetic individuals in the United States. This case reports a man whose presentation was atypical in location and severity, progressing to ulceration. CASE REPORT A 41-year-old man with a history of poorly controlled type 2 diabetes mellitus (T2DM) complicated by stage II chronic kidney disease and chronic erectile dysfunction presented for ongoing management. His HbA1c values ranged from >14% to 7.8%, often influenced by social determinants. Two months later, he presented with blisters with a non-erythematous base (no surrounding erythema) that were non-painful, non-itchy, non-pruritic, and easily ruptured, forming scabs. The largest wound measured 7.2×3.6×0.1 cm, containing yellow slough, consistent with ulcerative BD. Labs showed elevated albumin-to-creatinine ratio and decreased estimated glomerular filtration rate, a measure of kidney function. Diabetes management included metformin and basal insulin titration, while erectile dysfunction treatment included phosphodiesterase-5 inhibitors. With no signs of infection, wound cultures were not obtained and antibiotic therapy was not initiated. Testing excluded neuropathy and venous-related ulcerations. However, as no biopsy or direct immunofluorescence testing was performed, the diagnosis was clinical, and based on a history of uncontrolled diabetes. Wound care transitioned the patient to twice daily quarter-strength Dakin's solution moist-to-dry dressings after initial non-adherence. One month later, the patient's wounds and fasting glucose showed improvement. CONCLUSIONS This case highlights the risks of uncontrolled T2DM with complications, particularly when compounded by social determinants.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have transformed the management of type 2 diabetes mellitus and obesity, but their expanding use has raised concerns about ocular safety. This narrative review aimed to evaluate associations between individual GLP-1 RAs and the risk of developing non-arteritic anterior ischemic optic neuropathy (NAION) or diabetic retinopathy (DR), with particular emphasis on whether pharmacokinetic exposure and formulation explain within-class heterogeneity. PubMed was searched through June 2026, without a lower date limit, for human clinical trials, observational studies, and meta-analyses reporting quantitative ocular outcomes; reference lists, regulatory prescribing information, and pharmacokinetic data were also reviewed. Reported hazard ratios ranged from 1.29 to 7.64 for NAION and from 0.42 to 1.76 for DR. The most consistent NAION signal involved high-exposure subcutaneous semaglutide, whereas findings for oral semaglutide, liraglutide, dulaglutide, exenatide, and tirzepatide were absent, inconsistent, or weaker. DR worsening was likewise most evident with high-bioavailability subcutaneous semaglutide, but appeared more closely related to rapid, large reductions in glycated hemoglobin (HbA1c), particularly reductions of at least 2%, than to a class-specific retinal effect. Observational exposure patterns supported a preliminary, hypothesis-generating NAION threshold at a steady-state concentration (Css) of approximately 30-55 nmol/L. Semaglutide 7.2 mg, with an estimated Css of approximately 230 nmol/L, and highly bioavailable oral orforglipron warrant formulation-specific postmarketing ocular surveillance, although direct evidence of NAION risk remains unavailable. Current evidence does not support class-wide prescribing restrictions. An individualized approach considering patient-specific ocular risk, agent, formulation, and dose is more appropriate, while prospective studies with standardized ophthalmic endpoints are needed to establish causality and validate pharmacokinetic and pharmacogenomic risk parameters.

Diabetes mellitus (DM) is a significant risk factor for fungal infections, particularly Candida and dermatophytes, and glycemic control may be associated not only with the presence of these fungi but also the pattern of these infections. This study aimed to evaluate the relationship between glycemic control (HbA1c) and the type of fungal infection among diabetic patients. A cross-sectional study was conducted on 113 diabetic patients with suspected fungal infections. Clinical samples were collected from different body sites and analyzed using phenotypic and molecular methods. Patients were stratified according to glycemic control into good (HbA1c <6.5%), poor (HbA1c 6.5-7.9%), and very poor (HbA1c ≥8.0%) groups. A significant association was observed between glycemic control and the type of fungal infection (P = 0.015). Dermatophyte infections were more common in patients with good glycemic control (64.1%), while Candida infections increased with poorer glycemic control, reaching their highest prevalence in the very poor control group (83.3%). Dermatophytes were distributed across multiple anatomical sites, whereas Candida was mainly associated with moist and occluded areas. Overall, the interdigital region was the most affected site (37.5%). Candida infections were more common in female patients (20/33, 60.6%), while dermatophyte infections were more common among male patients (28/47, 59.6%). Furthermore, diabetes duration differed significantly across glycemic control groups. These findings demonstrate a significant association between glycemic control and the pattern of superficial fungal infections in diabetic patients. Poor glycemic control was associated with increased Candida infections, whereas dermatophyte infections were more frequent in better-controlled patients, highlighting the role of glycemic status in the distribution of fungal infections.

Erythromelalgia is a rare acral clinical syndrome characterized by episodes of burning pain, erythema, and increased skin temperature in the extremities. Its occurrence in children is exceptional. It may occur as a primary form or secondary to an underlying organic disorder; type 1 diabetes mellitus is an uncommon cause. Diagnosis is clinical and is established after other etiologies have been excluded. Treatment is aimed at alleviating symptoms and managing the underlying condition. We present a pediatric case of erythromelalgia secondary to type 1 diabetes mellitus.

Skeletal muscle constitutes one of the largest tissue compartments in the human body and plays fundamental roles in locomotion, posture maintenance, and metabolic regulation. Muscle homeostasis requires a precise balance between protein synthesis and degradation pathways; disruption of this equilibrium leads to pathological conditions, including sarcopenia and muscle atrophy, which frequently coexist with metabolic disorders such as obesity, Type 2 diabetes mellitus, and metabolic syndrome. Recent advances have identified the gut microbiota as an important regulator of skeletal muscle health, positioning probiotics as potential therapeutic interventions. Among probiotic candidates, Lactobacillus species have been associated with improvements in muscle health through pleiotropic mechanisms, including attenuation of inflammatory signaling, enhancement of mitochondrial biogenesis, modulation of muscle protein turnover, and restoration of the intestinal microbial balance by enriching beneficial bacteria while suppressing pathogenic species. These multifaceted effects translate to improved exercise performance, amelioration of metabolic dysfunction, and prevention of muscle wasting. This review comprehensively evaluates the current evidence supporting Lactobacillus supplementation as a strategy to increase skeletal muscle health and function, examines the underlying molecular mechanisms, and identifies critical research priorities, including strain-specific characterization, well-controlled human clinical trials, and mechanistic investigations, to optimize probiotic-based interventions for muscle-related disorders.