Since the publication of the National Institute for Care and Health Excellence's TA943 guidance, the uptake of continuous glucose monitoring and hybrid closed loop systems in type 1 diabetes care is expanding rapidly. Community diabetes specialist nurses and general practice nurses are both integral to implementing these technologies outside of hospital settings.

To explore and understand the confidence levels, training and support available to community diabetes specialist nurses and general practice nurses in relation to continuous glucose monitoring and hybrid closed loop systems technologies, based on a national service evaluation.

A national survey was distributed to UK nurses and midwives in May 2025. Confidence was measured across five continuous glucose monitoring and hybrid closed loop systems domains, with qualitative feedback analysed thematically.

Community diabetes specialist nurses showed moderate to high confidence with continuous glucose monitoring and variable confidence with hybrid closed loop systems. General practice nurses reported low confidence across all domains, with minimal access to formal training. Differences in support structures and team composition contributed to capability gaps.

Tailored training, system-wide support and commissioning reform are needed to ensure equitable technology-enabled diabetes care across community and primary care settings.

Metabolic-associated steatotic liver disease (MASLD) represents a prevalent and multifaceted systemic condition, characterized by its intricate interplay of obesity, type 2 diabetes, and various metabolic perturbations. Given its complexity, MASLD necessitates a comprehensive multidisciplinary strategy for both prevention and management.

Each of the experts who contributed to this review has made an in-depth review of the literature within their field of knowledge using PubMed. This review covers nutrition, physical activity and exercise, type 2 diabetes mellitus, cardiovascular risk factors, psychological approach, and clinical care by hepatologists in MASLD patients.

Adherence to the Mediterranean diet and engagement in exercise have been shown to ameliorate and potentially reverse MASLD. The hepatologist plays a pivotal role in diagnosis, assessment of liver comorbidities, and disease staging, emphasizing lifestyle modification and tailored therapy. Nutritionists are vital in dietary interventions, while specialists in sports medicine are essential for overcoming sedentary lifestyles, requiring fitness evaluations to customize exercise prescriptions. Psychological support addresses social and adherence challenges, enhancing patient management. Additionally, metabolic medicine experts are crucial for managing associated comorbidities, including cardiovascular risk factors and type 2 diabetes.

Diabetes mellitus affects one in nine adults worldwide, with timely diagnosis and accurate classification being essential for patient management. C-peptide is an important biomarker in the diagnostic workup. As diabetes sub-typing and treatment options continue to evolve, this review will highlight the important aspects of C-peptide analysis and interpretation and additionally, evaluate its current and emerging clinical role.

Several sample types and testing strategies such as fasting, random and stimulated C-peptide are available which are reviewed here. Random nonfasting C-peptide is convenient to perform in clinic and performs well compared to gold standard testing for classification of severe insulin deficiency and insulin dependence. C-peptide measurement may also be useful for classifying type 2 diabetes subtypes and in predicting response to treatment. Despite ongoing efforts towards standardization of C-peptide, variation still exists between analytical methods.

This review summarizes recent literature relating to preanalytical, analytical and clinical aspects of C-peptide testing. Future research in this area may build on the role of C-peptide in predicting glycaemic control, clinical complications and response to pharmacotherapy.

Mounting evidence indicates that Type 2 diabetes mellitus (T2DM) is a public health challenge globally, and its occurrence is anticipated to surge in the forthcoming years. Dipeptidyl peptidase-4 (DPP-4) serves as a target for its treatment, with its inhibitors effectively preserving the levels of glucose-dependent insulinotropic peptide and glucagon-like peptide 1(GLP-1). This review presents an overview of the therapeutic possibilities of six frequently employed DPP-4 inhibitors (DPP-4is) (Sitagliptin, saxagliptin, vildagliptin, linagliptin, alogliptin and teneligliptin) in managing T2DM, focussing on their characteristics, mechanism of action, advantages and side effects in comparison with alternative oral antidiabetic drugs as well as the possibility of using in silico method in advancing its timely and cost-effective production.

A literature search was conducted using the major search engines such as PubMed/Medline, Scopus, and Google Scholar, etc. employing terms like 'Type 2 diabetes mellitus (T2DM), DPP-4 inhibitors, and Dipeptidyl peptidase-4', etc. to identify relevant studies.

Our findings indicate that DPP-4is stimulate secretion of insulin and suppress secretion of glucagon by elevating endogenous GLP-1 concentrations without an intrinsic hypoglycaemia risk. Although these agents share a common mechanism of action, their considerable structural heterogeneity may lead to distinct pharmacological characteristics. Literature shows that DPP-4is have a promising safety profile in comparison with other oral antidiabetic medications, however, certain safety aspects require additional exploration. Different DPP-4is have demonstrated comparable safety and tolerability, whether used alone or in combination with other antidiabetic medications. Besides, it has been shown that in silico method could be employed in development of DPP-4is. Further research is necessary to ascertain whether differences among DPP-4 inhibitors might influence the occurrence of specific adverse effects.

DPP-4 inhibitors remain effective and well-tolerated options for managing T2DM.

This study examined the association of rental assistance receipt with cost-related medication nonadherence (CRN) engagement in low-income adults with diabetes. Using National Health Interview Survey (NHIS) data from 2016 through 2019 and 2020 through 2022, we included low-income adults who were 1) diagnosed with diabetes, 2) prescribed medications, and 3) renters. Propensity score weighting approach created a sample in which receipt of rental assistance was independent of observed sociodemographic characteristics. Logistic regression examined the association of rental assistance receipt with CRN, respectively. Lack of receipt of rental assistance was significantly associated with higher odds of CRN engagement in NHIS 2016-2019 (Odds ratio=2.32; 95% confidence interval=(1.59, 3.37); p<.0001) and NHIS 2020-2022 (Odds ratio=1.74; 95% confidence interval=(1.04, 2.91); p=.03). Given the shortage of affordable housing in the United States, findings suggest that expansion of affordable housing could be critical for improving health outcomes in low-income adults with diabetes.

Early detection of cancer and prompt linkage to medical care in people experiencing homelessness (PEH) are crucial to improve the disparity in cancer incidence and mortality between PEH and their housed counterparts. A systematic review was conducted across 3 academic databases in April 2024 to identify interventions that aim to improve adherence to cancer care among PEH. Data from 16 eligible studies were extracted and organized around intervention type, and thematic analysis was conducted to extract key lessons learned. All studied cancer screening, taking part in mostly urban settings in the United States. The most common interventions were increasing cancer screening accessibility (n=7) and patient navigation (n=6). In one randomized trial, patient navigation was associated with 8.51 higher odds of lung cancer screening completion. Combining multiple interventions had the greatest impact on screening rates, but future interventions should also link PEH to diagnostic procedures, cancer treatment, and survivorship.

Arm lymphoedema after breast cancer treatment is preventable and can be reversible if caught early. Many risk factors are modifiable and lifestyle changes adopted by patients can reduce incidence substantially. Education in risk reduction is a central tenet of specialist lymphoedema prevention programmes, however, non-specialist healthcare professionals commonly get requests for instructions and advice by breast cancer patients. In general, healthcare professionals receive inadequate education and training on the lymphatic system and may feel ill-equipped to issue advice, despite being best placed to provide it. Low-risk patients are unlikely to require lifestyle modifications to prevent lymphoedema once the treatment phase is over, unless cording or adherent axillary scars persist, but high- and medium-risk patients need education in lifetime prevention and self-treatment strategies. This article discusses risk stratification and outlines self-management strategies for at-risk cohorts. By gaining knowledge about lymphoedema prevention, healthcare professionals can confidently guide their patients on how to prevent lymphoedema and its physical and psychological sequelae.

Gastrointestinal stromal tumors (GISTs) originate from mesenchymal precursor cells of the gastrointestinal wall and account for approximately 3% of all gastrointestinal malignancies. In adults, these tumors most commonly harbor mutually exclusive activating mutations in KIT, PDGFRA, BRAF, or SDH-family genes. KIT and PDGFRA mutations are well-established predictive biomarkers for response to tyrosine kinase inhibitors (TKIs). The advent of Next Generation Sequencing (NGS) has accelerated the identification of novel genetic alterations, improving disease characterization, providing prognostic and predictive information, and enabling detection of rare germline variants.

We conducted a retrospective analysis of 31 patients with GIST to evaluate the implementation of NGS testing and the interpretation of pathogenicity in real-life clinical practice. Identified mutations were compared with publicly available databases, and rare KIT exon 11 variants underwent computational modeling to assess their impact on protein conformation and imatinib interaction. Germline testing was performed when indicated.

In addition to common primary and secondary mutations in KIT and PDGFRA, three patients carried rare KIT exon 11 variants not previously classified in public databases: p.Gln556del (upstream of codons 557/559) and p.Asn566_Pro573del and p.Val569_Leu576_del (downstream), all located within the juxtamembrane (JM) domain. One patient harbored an SDHB c.287-1G⟩C alteration resulting in aberrant splicing, also detected in the germline. The structural modeling predicted that all rare KIT exon 11 variants affected protein conformation and influenced imatinib interaction. Clinically, all three variants were associated with response to imatinib and met ACMG-AMP criteria for pathogenicity as well as ASCO-CAP tier 1 classification.

Our findings highlight the clinical relevance of integrating NGS into routine GIST management, particularly for the identification and interpretation of rare genetic variants. The study underscores the importance of data sharing and collective variant annotation to support accurate molecular classification, prognostic assessment, and therapeutic decision-making for individual patients.

Emerging evidence suggests that circadian timing influences the efficacy of immune checkpoint inhibitors (ICI), with morning infusions associated with improved therapeutic outcomes across various malignancies. However, the impact of ICI infusion timing on extensive-stage small cell lung cancer (ES-SCLC), a disease with poor prognosis and limited therapeutic advancements, remains unexplored.

This retrospective study (LungTime-R02) analyzed 397 patients with ES-SCLC who received first-line anti-PD-L1 (atezolizumab or durvalumab) plus chemotherapy at our center between May 2019 and October 2023. The time of day of administration (ToDA) was calculated as the median infusion time for each patient's first four ICI treatment cycles. To assess its prognostic relevance, hazard ratios (HRs) of earlier progression or death were estimated across multiple ToDA thresholds (11:00-16:30). Propensity score matching (1:2) was applied to balance baseline characteristics.

Of the 397 patients, the optimal ToDA cutoff for maximizing progression-free survival (PFS) benefit was identified as 15:00, with the lowest HR for PFS observed at this threshold. Patients who received immunochemotherapy before 15:00 exhibited significantly longer PFS and overall survival compared to those treated later, with results consistent across pooled and propensity score matching cohorts. Multivariable analysis confirmed early ToDA as an independent prognostic factor for both PFS (adjusted HR, 0.483; 95% CI, 0.357-0.654) and overall survival (adjusted HR, 0.373; 95% CI, 0.265-0.526).

This study provides real-world evidence supporting the survival benefit of earlier immunochemotherapy administration in patients with ES-SCLC. These findings add to the growing body of knowledge on the clinical relevance of circadian timing in cancer treatment.

Not applicable.

Pancreatic cancer (PC) presents a significant challenge for prevention and treatment, posing a serious threat to the health and lives of patients. The five East Asian countries (China, Japan, North Korea, South Korea, and Mongolia) represent one of the most significant regions globally in terms of PC burden.

We retrieved data from the Global Burden of Disease (GBD) Study 2021 regarding the prevalence, incidence, mortality, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) associated with PC in these five East Asian countries from 1990 to 2021. We employed joinpoint, age-period-cohort (APC), and decomposition analysis methods to assess the epidemiological characteristics of PC. To project the future burden of PC through 2036, we applied two prediction models: Autoregressive Integrated Moving Average (ARIMA) and Bayesian age-period-cohort (BAPC) models.

China recorded the highest incidence, prevalence, mortality, YLLs, YLDs, and DALYs among the five East Asian countries in both 1990 and 2021. Japan exhibited the highest age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), age-standardized prevalence rate (ASPR), and age-standardized YLDs rate in both 1990 and 2021. Mongolia experienced significant increases in the number and rates of incidence, prevalence, death, YLLs, YLDs, and DALYs from 1990 to 2021. The age group with the highest prevalence, incidence, mortality, YLDs, YLLs, and DALYs rates across the five East Asian countries was consistently those aged 70 and older. The incidence rate across the five countries is influenced by aging populations, surpassing global averages. Projections for 2030 and 2036 suggest that Japan will have the highest ASPR (13.23 in 2030 and 13.85 in 2036), ASIR (12.14 in 2030 and 12.53 in 2036), and ASMR (10.97 in 2030 and 11.39 in 2036) among the countries.

The disease burden of PC in the five East Asian countries has steadily increased over the past three decades, particularly among older adults due to population aging.