Type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD) are two prevalent chronic conditions that interact bidirectionally, with their high comorbidity posing a serious global health challenge. Recent studies highlight the gut-brain axis, particularly the gut microbiota-astrocyte axis, as a key mechanism underlying this comorbidity. The review reveals a common gut dysbiosis pattern in both T2DM and MDD, marked by reduced short-chain fatty acids (SCFAs)-producing bacteria and elevated lipopolysaccharide (LPS)-associated pro-inflammatory bacteria. Nevertheless, the two diseases present opposing astrocytic states: overactivation in T2DM and inhibition in MDD. In the progression from T2DM to secondary MDD, microbiota dysbiosis induces astrocyte hyperactivation in the hippocampus and hypothalamus, which in turn reduces glutamine synthetase (GS) and brain-derived neurotrophic factor (BDNF), exacerbates neuroinflammation, promotes insulin resistance (IR) and hypothalamic-pituitary-adrenal (HPA) axis overactivation, and disrupts the glutamate-glutamine (Glu-Gln) cycle, ultimately culminating in MDD. Conversely, as MDD progresses to secondary T2DM, microbiota dysbiosis suppresses astrocyte activation in the hippocampus and prefrontal cortex, which similarly aggravates neuroinflammation, promotes IR, and disrupts the Glu-Gln cycle, thereby contributing to T2DM. Together, these results advance our knowledge of the bidirectional interplay between T2DM and MDD, while simultaneously identifying potential nodes for therapeutic modulation.

This study aimed to evaluate the retinal and ocular findings and identify factors associated with the timing of the first ophthalmology visit among diabetic patients in Hafar Al Batin, Saudi Arabia, where there is concern that patients are not having prompt ophthalmic evaluation after diabetes mellitus (DM) diagnosis.

This retrospective cohort study analyzed data from 357 diabetic patients who had no prior ocular examination after their DM diagnosis at King Khaled General Hospital during the second semester of 2021-2022. Data on demographics, clinical characteristics, and the duration between DM diagnosis and the first ophthalmology visit were collected from medical records and analyzed using multiple regression.

A significant delay was found between initial DM diagnosis and the first ophthalmology visit. The prevalence of diabetic retinopathy (DR) and macular edema was approximately 42% and 30%, respectively. Longer delays were significantly associated with older age ( P < 0.001), elevated HbA1C levels ( P = 0.022), coexisting hypertension ( P = 0.012), Type I DM ( P < 0.001), and lower education level ( P < 0.001). Patients ultimately diagnosed with DR had a significantly longer delay compared to those within normal limits ( P < 0.001).

A substantial delay exists between diabetes diagnosis and initial eye examination among patients in Hafar Al Batin, leading to a high prevalence of preventable, vision-threatening complications. These findings underscore the urgent need for proactive public health strategies focused on improving patient education and implementing timely screening protocols to mitigate the risk of vision loss from diabetes.

Gender variation exists in the clustering of cardiovascular (CV) risk factors. Hypertension (HTN), diabetes mellitus (DM), lipid abnormalities, obesity, cigarette smoking, and significant alcohol use are risk factors that typically influence one another and predispose to cardiovascular disease (CVD).

This study assessed gender-based variation in the prevalence of CV risk factors among young individuals with HTN.

This was a cross-sectional study involving 157 participants aged between 18 and 45 years with systemic HTN. Participants were recruited consecutively and categorized by gender. Sociodemographic and clinical information were collected using a pro forma. Lipoprotein (a), lipid profile, fasting blood glucose, uric acid, and creatinine were obtained from a fasting venous blood sample. Data were analyzed using STATA 17.

The median age of the study participants was 30 years (24-37). Females accounted for 48% of the participants. A higher prevalence rate of significant alcohol use (34.2% vs 5.3%, P < 0.001), and cigarette smoking (14.6% vs 1.3%, P < 0.001) was found in males. A higher prevalence of LP (a) (2.2% vs 13.3%, P = 0.036) was found in the females. Moderate and severe obesity were more common among females ( P = 0.036). There was no significant difference in the prevalence of hyperuricemia, DM, dyslipidemia, reduced estimated glomerular filtration rate, and blood pressure control rate between the male and female participants.

The study demonstrated some gender-based differences in the prevalence of some CV risk factors among young hypertensives. These findings are valuable for developing gender-specific strategies to reduce CV risk in this population.

Depression and long-term HbA_1c variability are associated with adverse outcomes in type-2 diabetes (T2D), which may be related to suboptimal self-management practices and health-related quality of life (HRQoL).

In the prospective Hong Kong Diabetes Register (2013-2019), we estimated the independent and joint associations of depression and HbA_1c variability with outcomes. Depression was measured using the Patient Health Questionnaire-9 (PHQ-9) with a validated Chinese cut-off score ≥ 7. The HbA_1c variability score (HVS) was expressed as the percentage of HbA_1c, which varied by 0.5% compared to the preceding value.

Amongst 5657 Chinese patients with T2D [58.7% male, age (mean ± SD): 58.47 ± 10.62 years, duration of diabetes: 10.63 ± 8.19 years and time-weighted HbA_1c: 7.44% ± 1.04%], 13.3% had depression. After full adjustment, depression was associated with increased risk of cardiovascular disease (CVD) [adjusted hazard ratio (aHR): 1.79 (95% CI: 1.15-2.79); p = 0.010], whereas high HVS (≥ median, 42.9%) was associated with increased risks of chronic kidney disease (CKD) [1.49 (1.21-1.82); p < 0.001] and severe hypoglycaemia (SH) [1.93 (1.22-3.07); p = 0.005]. The depression-high-HVS group had the highest aHR for CKD, which was attenuated from 1.90 (1.41-2.56) to 1.74 (1.25-2.44), and that for all-cause mortality from 2.00 (1.33-3.01) to 1.72 (1.06-2.78) after adjustment for self-management practices and HRQoL.

Depression and high HVS are independently and differentially associated with adverse events, with the depression-high-HVS group having the worst outcomes, which were modulated by self-management and HRQoL, calling for systematic screening of depression and holistic management aimed at avoiding fluctuating glycaemic control in T2D.

The Omnipod 5 Automated Insulin Delivery (AID) System is safe and effective for individuals managing Type 1 diabetes (T1D). Longer-term studies may provide additional evidence of sustained effectiveness and safety of AID system use in T1D.

This 12-month extension study was conducted following a multicenter randomized controlled trial (RCT) where participants used either AID (Omnipod 5) or standard therapy (current non-automated pump therapy) for 13 weeks. Participants in France (n = 76) could transition to or continue with AID for an additional 12 months. Glycemic, safety, and psychosocial outcomes during or at the end of the extension phase were compared with baseline or end of RCT, as appropriate.

Seventy-five participants enrolled in the extension phase. From RCT baseline to the end of the extension phase, time in range 70-180 mg/dL increased by 17.9% (p < 0.0001) or 4.3 h/day to 62.3%. Time above range > 180 mg/dL and mean sensor glucose decreased by 17.7% and 27.8 mg/dL (both p < 0.0001), respectively. HbA1c decreased from 8.33% to 7.18% (-1.14%; p < 0.0001). Glycemic improvements were maintained for those continuing with AID from the RCT intervention group and for those transitioning to AID from standard therapy. Diabetes Quality of Life-brief and Hypoglycemia Confidence Scale scores were maintained or improved at 6 and 12 months compared to RCT baseline. Adverse events were infrequent (12 per 100 person-years).

Findings support the RCT results, demonstrating safety and sustained improvements in glycemic and psychosocial outcomes with the Omnipod 5 System in adults in France with T1D over 12 months.

ClinicalTrials.gov NCT05409131.

In this paper, we propose a Bayesian multivariate network meta-regression model to compare multiple treatments used to treat cardiovascular and diabetes diseases, where the multivariate aggregate outcomes include low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. We assume a log-linear regression model for the standard deviation of the treatment random effects to overcome the difficulty that some treatments may present only in a single study. As the within-study sample covariance matrix $\boldsymbol {S}$ is partially observed or completely missing and the within-study sample correlations are not observed at all, we postulate a hierarchical structure on the unknown within-study covariance matrices. We further develop a Markov chain Monte Carlo sampling algorithm to sample from the posterior distribution and a Monte Carlo procedure to rank the treatment effects for the multivariate outcomes. DIC is used for model comparison. Two variations of DIC are further developed to quantify (i) the overall improvement in the fit and (ii) the gain in the fit of each outcome due to the multivariate model versus the univariate model alone. A detailed analysis of the aggregate data from real randomized controlled trials is carried out to further demonstrate the proposed methodology.

Background Type 2 diabetes mellitus (T2DM) and thyroid dysfunction are common endocrine disorders. Thyroid hormones play an important role in glucose metabolism, insulin secretion, and insulin sensitivity. Disturbances in thyroid function may worsen glycemic control and increase the risk of diabetic complications. This study aimed to determine the prevalence of thyroid dysfunction in patients with T2DM and evaluate its impact on glycemic control. Methods This cross-sectional study was conducted at Nawaz Sharif Medical College/Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan, from January to June 2025. A total of 260 patients with T2DM were enrolled through consecutive sampling. After exclusion of incomplete records, 252 patients were included in the final analysis. Demographic and clinical data were collected through interviews and medical records. Fasting blood glucose, glycated hemoglobin (HbA1c), thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were measured. Data were analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York). Results Among 252 participants, 68 (27.0%) had thyroid dysfunction while 184 (73.0%) were euthyroid. Subclinical hypothyroidism was the most common abnormality, affecting 15.1% of patients. Patients with thyroid dysfunction had significantly higher fasting blood glucose levels (189.7 ± 49.6 vs. 161.4 ± 42.8 mg/dL, p<0.001) and HbA1c levels (9.1 ± 1.7 vs. 7.8 ± 1.4%, p<0.001) compared to euthyroid patients. Poor glycemic control (HbA1c ≥7%) was more common in patients with thyroid dysfunction (83.8% vs. 58.7%, p<0.001). Multivariable logistic regression showed that thyroid dysfunction was independently associated with poor glycemic control (adjusted OR=2.74, 95% CI: 1.41-5.33, p=0.003). Conclusion Thyroid dysfunction is common among patients with T2DM and is associated with poor glycemic control. Routine thyroid screening may help identify high-risk patients and improve diabetes management.

Background and objective Musculoskeletal pain (MSKP) is a common but frequently underrecognized complication among patients with type 2 diabetes mellitus (T2DM). Chronic hyperglycemia, obesity, peripheral neuropathy, reduced physical activity, microvascular complications, and altered biomechanics have all been implicated in the development of musculoskeletal disorders affecting the spine, shoulder, knee, hand, and foot. The objective of this study is to determine the frequency, anatomical pattern, and severity of MSKP and to identify the clinical factors associated with MSKP among patients with T2DM. Methods A descriptive cross-sectional study was conducted among 230 consecutive adult patients with T2DM attending the outpatient diabetes clinic of Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan. Demographic characteristics, duration of diabetes, body mass index (BMI), glycemic control (HbA1c), diabetic complications, physical activity, and MSKP characteristics were recorded using a structured interviewer-administered questionnaire and review of medical records. Pain was assessed across eight anatomical regions using a structured body-region questionnaire, and pain severity was graded using the 11-point Numerical Rating Scale (NRS). Data were analyzed using descriptive statistics and the chi-square test, with a p-value <0.05 considered statistically significant. Results The prevalence of MSKP was 73.0% (168/230). The mean age of participants was 55.8 ± 10.6 years, and 129 (56.1%) were female. The lower back was the most frequently affected site (101, 43.9%), followed by the shoulder (83, 36.1%), knee (76, 33.0%), neck (58, 25.2%), hand/wrist (48, 20.9%), ankle/foot (42, 18.3%), hip (34, 14.8%), and elbow (20, 8.7%). Multiple-site pain was reported by 97 (57.7%) patients with MSKP, while moderate pain was the most common severity category (96, 41.7%). MSKP was significantly associated with female sex, longer duration of diabetes (>10 years), obesity, poor glycemic control (HbA1c ≥8%), peripheral neuropathy, and low physical activity (all p < 0.05). Conclusion MSKP is highly prevalent among patients with T2DM, with the lower back, shoulder, and knee being the most commonly affected anatomical sites. Female sex, longer diabetes duration, obesity, poor glycemic control, peripheral neuropathy, and low physical activity were significantly associated with MSKP. Routine musculoskeletal assessment should be integrated into comprehensive diabetes care to facilitate early identification, multidisciplinary management, and improved physical function and quality of life.

Diabetic foot ulcers (DFUs) are difficult to manage in resource-limited settings, where access to standard offloading devices is limited for healing of plantar diabetic foot ulcers. This is due to the cost, limited availability, and the need for specialised expertise. Toa Uzito is a low-cost offloading device developed to address this gap. We evaluated the effectiveness of a low-cost offloading device (Toa Uzito) in improving healing outcomes in patients with plantar ulcers. A matched case-control clinical study was conducted at a specialised diabetic foot centre in Dar es Salaam, Tanzania. Patients with a single plantar DFU were enrolled. Those treated with Toa Uzito were compared with matched controls who received standard care without offloading. Controls were matched based on age, body mass index, and diabetes duration. The primary outcome was time to complete ulcer healing. Healing were analysed using Kaplan Meier survival analysis and Cox regression. A total of 621 patients were included (128 intervention, 493 controls), with a mean follow-up of 133.8 days. Ulcer healing was significantly better in the intervention group: 44.9% healed (versus 34.9% in controls) by 12 weeks, and increasing to 85% (versus 75.2% in controls) by 24 weeks. All patients in the intervention group healed, with a shorter mean healing time (125.7 vs. 137.5 days). Toa Uzito also demonstrated significantly superior healing efficacy compared with standard care after stratification by SINBAD classification (χ² = 71.2, p < 0.01) . The low-cost Toa Uzito significantly improves healing rates and reduces time to healing. Its affordability and simplicity makes it an effective offloading strategy for promoting DFU healing in resource-limited settings.

Nephrotic-range proteinuria in patients with Type 2 diabetes mellitus (T2DM) may result from diabetic nephropathy or non-diabetic glomerular disease (NDGD). Kidney biopsy risks and limited accessibility complicate patient selection. We aimed to identify predictors of NDGD and develop a score to guide biopsy decisions.

We conducted a single-center retrospective study of T2DM patients undergoing native kidney biopsy for nephrotic-range proteinuria at a tertiary hospital in Thailand between 2014 and 2022. Biopsy findings were classified according to the presence or absence of NDGD. Independent predictors were identified using multivariable logistic regression, and a weighted clinical prediction score was derived. Discrimination was evaluated using the area under the receiver operating characteristic curve (AUROC).

Among 289 patients, 142 (49.1%) had NDGD with or without concomitant DN. The most frequent diagnosis was IgA nephropathy. Independent predictors of NDGD included older age, shorter duration of T2DM, absence of diabetic retinopathy, absence of prior hypertension, higher estimated glomerular filtration rate, and hematuria. Higher haemoglobin was retained in the prediction model despite its borderline statistical association. The prediction score demonstrated good discrimination (AUROC, 0.85; 95% confidence interval, 0.80-0.89). At a threshold of ≥ 3 points, the score had 96.5% sensitivity and 40.8% specificity, whereas a threshold of ≥ 7 points had 66.9% sensitivity and 84.4% specificity.

NDGD is common among T2DM patients with nephrotic-range proteinuria. The proposed clinical prediction score showed good discrimination in this cohort but requires external validation before it can be used to support biopsy decision-making in clinical practice.