Thiols, as a class of organic compounds containing sulfhydryl, play important roles in antioxidant, cytoprotective and signaling activities. This study aimed to investigate thiol/disulfide metabolite homeostasis in children with diabetic ketoacidosis (DKA) and their correlation with disease severity and renal impairment. Children with type 1 diabetes mellitus complicated with ketoacidosis from June 2022 to December 2024 were selected for this study. The metabolite levels of thiols and disulfides were measured by collecting blood samples from the children and testing them using a highly automated spectrophotometric assay. Clinical data, including blood glucose, blood ketones, blood gas analysis, and renal function indicators, were collected from the children to assess the severity of the disease and renal impairment. Seventy-two children with DKA (19 mild, 25 moderate, and 28 severe cases), were included. Native thiols were elevated with disease exacerbation, while total thiols and disulfides did not change significantly. Homeostatic index 1 and index 3 differed among the three groups. Reduced renal function was observed in 34 children with DKA, who also had decreased natural thiols, total thiol, and homeostatic index 3. Elevated native thiols were protective factors for disease exacerbation (OR 0.980, 95% CI 0.960-1.000) and renal function decline (OR 0.970, 95% CI 0.950-0.990) in children with DKA. Thiol/disulfide metabolite homeostasis in children with DKA is strongly associated with disease severity and renal impairment. Reduced native thiols are associated with more severe DKA and renal impairment.

Cerebral oedema is a rare and potentially lethal complication of diabetic ketoacidosis (DKA). While more commonly reported in the paediatric population, adult cerebral oedema in the setting of DKA remains poorly understood and under-recognised. We present the case of a woman in her late 20s who was brought to the emergency department with severe DKA and altered mental status. Her imaging demonstrated diffuse cerebral oedema with effacement of sulci and basal cisterns. Notably, the oedema was identified before significant metabolic correction had occurred, suggesting that cerebral oedema may have been a direct consequence of DKA rather than a complication of its treatment. The patient received fluid resuscitation, insulin infusion and hyperosmolar therapy, and recovered fully without neurosurgical intervention. This case highlights the importance of early recognition and intervention for cerebral oedema in adult DKA, especially in patients presenting with severe acidosis and neurologic changes.

Cervical disc arthroplasty (CDA) is an effective motion-sparing procedure for patients with cervical radiculopathy or myelopathy. Obese patients undergoing anterior cervical discectomy and fusion have higher complication rates, but the procedure remains effective in this population. The aim of this study was to determine the safety and efficacy of CDA in appropriately selected obese patients.

This single-institution retrospective cohort study included adult patients who underwent CDA from July 2015 to December 2020. Patients were included if they had baseline and at least 4-year postoperative patient-reported outcome measures (PROMs), including the Neck Disability Index (NDI), numeric rating scale (NRS) for neck pain and arm pain, EQ-5D, and North American Spine Society patient satisfaction questionnaire. Demographic, intraoperative, and postoperative characteristics were collected. Patients were divided into nonobesity (BMI < 30) and obesity (BMI ≥ 30) groups.

There were 83 patients included in this study, with 49 in the nonobesity group and 34 in the obesity group. Obese patients were more likely to have diabetes mellitus and a higher American Society of Anesthesiologists class. There were no significant differences in the operative duration, hospital length of stay, estimated blood loss, 90-day readmission rate, 90-day return to the operating room rate, or time to return to work. The mean follow-up duration was 5.6 years in the nonobesity group and 5.1 years in the obesity group. Both groups significantly improved across all PROMs postoperatively (p < 0.001). There were no significant differences in preoperative or postoperative NDI, NRS neck pain, NRS arm pain, or EQ-5D scores. There were no significant differences in patient satisfaction with surgery (89.8% satisfied in nonobesity group and 85.3% satisfied in obesity group; OR 1.52, 95% CI 0.40-5.71).

CDA is a safe and effective motion-sparing procedure for cervical radiculopathy and myelopathy in appropriately selected obese patients.

Type 2 diabetes mellitus is a chronic metabolic disorder characterized by insulin resistance and β-cell dysfunction, often coexisting with obesity. Obesity increases adipose tissue inflammation and oxidative stress, which may impair mitochondrial function and muscle metabolism. The aim of this study was to investigate the effects of obesity severity on oxidative stress biomarkers, exercise-related biomarkers, physical activity level, and sleep quality in individuals with type 2 diabetes mellitus.

This prospective observational study included 80 individuals aged 20-80 diagnosed with type 2 diabetes mellitus. Participants' body mass index, physical activity assessed by the International Physical Activity Questionnaire-Short Form, and sleep quality assessed by the Pittsburgh Sleep Quality Index were recorded. Serum samples were analyzed for oxidative stress biomarkers (total antioxidant status, total oxidant status, malondialdehyde, and superoxide dismutase) and exercise-related biomarkers (irisin, Fibronectin Type III Domain-Containing Protein 5, Adenosine Monophosphate-Activated Protein Kinase, and leptin) using enzyme-linked immunosorbent assay methods.

There were significant differences in irisin, Fibronectin Type III Domain-Containing Protein 5, Adenosine Monophosphate-Activated Protein Kinase, leptin, malondialdehyde, superoxide dismutase, total antioxidant status, and total oxidant status values according to body mass index levels (p<0.001). Overweight participants had higher irisin, Adenosine Monophosphate-Activated Protein Kinase, and Fibronectin Type III Domain-Containing Protein 5 levels, while leptin, malondialdehyde, and total oxidant status levels increased with obesity severity. Physical activity levels decreased as body mass index increased (p=0.016). No significant differences were observed in self-reported sleep quality parameters assessed by the Pittsburgh Sleep Quality Index across body mass index groups (p>0.05).

Increasing obesity severity in individuals with type 2 diabetes mellitus is associated with elevated oxidative stress and decreased antioxidant defense, along with lower levels of exercise-related metabolic biomarkers. These findings highlight the importance of promoting regular physical activity and interventions targeting the irisin/Adenosine Monophosphate-Activated Protein Kinase pathway to reduce oxidative stress and improve metabolic health in obese diabetic individuals.

The aim of this study was to evaluate the association between gestational diabetes mellitus and the severity and impact of lower urinary tract symptoms and urinary incontinence on quality of life in pregnant women.

This case-control study enrolled 500 pregnant women (251 with gestational diabetes mellitus; 249 healthy controls) between 30 and 38 weeks' gestation. Women completed the International Consultation on Incontinence Questionnaire-Short Form, Urogenital Distress Inventory-Short Form, Incontinence Impact Questionnaire-Short Form, and Incontinence Severity Index. Sociodemographic, obstetrics, and anthropometric data were also collected. Multivariable logistic regression analyses were performed to examine the independent association between gestational diabetes mellitus and lower urinary tract symptoms and urinary incontinence.

The gestational diabetes mellitus group exhibited a significantly higher mean age compared to the control group (p<0.001). Pre-pregnancy body mass index and body mass index during pregnancy were also significantly elevated in the gestational diabetes mellitus group (p<0.001). The median gestational weight gain was significantly greater in the gestational diabetes mellitus group (p=0.027). Women with gestational diabetes mellitus demonstrated significantly elevated scores in International Consultation on Incontinence Questionnaire-Short Form, Urogenital Distress Inventory-6, Incontinence Impact Questionnaire-7, and Incontinence Severity Index (p<0.001 for all). After adjusting for age, pre-pregnancy body mass index, body mass index during pregnancy, and gestational weight gain in multivariable logistic regression models, gestational diabetes mellitus remained independently associated with increased UI risk (adjusted OR 2.34, 95%CI 1.56-3.51, p<0.001).

Gestational diabetes mellitus is significantly associated with increased severity of lower urinary tract symptoms and urinary incontinence, as well as a greater negative impact on quality of life during pregnancy. Routine systematic screening for lower urinary tract symptoms and urinary incontinence may be considered for all pregnant women with gestational diabetes mellitus, with early implementation of preventive interventions including supervised pelvic floor muscle training programs.

The aim of this study was to evaluate the impact of sodium-glucose cotransporter-2 inhibitors on haematological parameters and other clinical markers in this patient population.

We retrospectively analyzed the medical records of 150 diabetic patients with chronic kidney disease who initiated sodium-glucose cotransporter-2 inhibitor therapy, comparing their baseline and 3-month post-treatment laboratory and clinical data.

Following 3 months of treatment with sodium-glucose cotransporter-2 inhibitors, mean haemoglobin and haematocrit levels significantly increased, even in patients with an estimated glomerular filtration rate below 60 mL/min/1.73 m2. This therapy also led to significant reductions in the spot urine albumin-to-creatinine ratio, as well as in both systolic and diastolic blood pressure.

Sodium-glucose cotransporter-2 inhibitor therapy was associated with significant increases in haemoglobin and haematocrit levels in diabetic patients with chronic kidney disease. These findings suggest that sodium-glucose cotransporter-2 inhibitors may represent a potential area requiring further investigation for the treatment of anaemia associated with diabetic chronic kidney disease.

Diabetic kidney disease (DKD) represents a significant microvascular complication associated with type 2 diabetes mellitus (T2DM), markedly elevating the risk of kidney failure, cardiovascular events, and premature mortality. Despite advancements in therapeutic management, such as renin-angiotensin-aldosterone system (RAAS) blockade and sodium-glucose cotransporter 2 (SGLT2) inhibitors, residual risk remains significant. Finerenone, a novel nonsteroidal and selective mineralocorticoid receptor antagonist (MRA), has demonstrated substantial cardiorenal benefits in clinical trials; however, real-world data, especially from Saudi Arabia, remain limited.

This single-center, retrospective cohort study. All adult patients (≥18 years) who received finerenone as part of routine clinical care were eligible if they met either of the following criteria: (1) documented diabetic kidney disease (DKD) based on KDIGO-aligned clinical criteria, including diabetes mellitus with chronic kidney disease manifested by albuminuria/proteinuria and/or reduced eGFR; (2) and/or a urine protein-to-creatinine ratio (uPCR) >0.3 mg/mg. Longitudinal changes in uPCR, eGFR, and serum potassium were analyzed using linear mixed-effects models adjusted for relevant clinical covariates.

A total of 75 patients prescribed finerenone were screened, of whom 67 met the inclusion criteria. The median age was 63 years, and 53.7% were female. Comorbidities were highly prevalent, including diabetes mellitus (89.6%), hypertension (97.0%), dyslipidemia (92.5%), heart failure (56.8%), and coronary artery disease (40.3%). A significant effect of time on uPCR was observed (F[3,193] = 3.457; P = 0.018), with a mean reduction of 0.464 mg/mg after six months (95% CI, -0.895 to -0.034; P = 0.027). The estimated eGFR slope after finerenone initiation was -1.08 mL/min/1.73 m² per month (95% CI -1.74 to -0.41; P = 0.002), corresponding to an annualized decline of approximately -12.9 mL/min/1.73 m² per year. Serum potassium increased modestly at early follow-up points (F[5,245] = 4.008; P = 0.002), rising by +0.209, + 0.256, and +0.286 mmol/L at the first three readings (P = 0.029, 0.005, and 0.006, respectively), then plateaued thereafter (P > 0.5).

Finerenone use among DKD patients in Saudi Arabia was associated with significant reductions in proteinuria, an early decline in eGFR that requires cautious interpretation, and an overall favorable safety profile. These real-world findings align with results from pivotal clinical trials and support the incorporation of finerenone into standard DKD management. Future multicenter prospective studies are warranted to confirm these outcomes and evaluate long-term cardiorenal benefits.

Race, ethnicity, and social determinants of health (SDOH) contribute to disparities in diabetes outcomes, particularly hemoglobin A1c (HbA1c). Although continuous glucose monitoring (CGM) improves glycemic management, it remains unclear whether associations persist between SDOH and CGM metrics, as prior research has focused solely on HbA1c.

To examine the associations of race, ethnicity, and SDOH with glycemic metrics among patients with type 1 or type 2 diabetes who use CGMs.

This retrospective cross-sectional study evaluated CGM profiles paired with demographic data from individuals receiving outpatient care at a single-center academic health system between October 1, 2017, and February 28, 2025. The cohort included pediatric (aged <18 years) and adult (aged ≥18 years) patients with type 1 or type 2 diabetes who met CGM data sufficiency criteria.

Race and ethnicity category, individual-level SDOH (eg, insurance type), and neighborhood-level socioeconomic status.

Glycemic outcomes included HbA1c, mean glucose, time in range, time above range, glycemic risk index, coefficient of variation, and extended hypoglycemic episodes. Inverse probability weighting and mixed-effects models were used to examine associations between exposures and outcomes.

The study included 1743 participants with 3296 CGM profiles (mean [SD] age, 38.8 [20.8] years; 926 female [53.1%]; 86 identifying as Black [4.9%], 56 as Hispanic [3.2%], 1508 as White [86.5%], and 93 as other [5.3%] race and ethnicity). Black race and public health insurance were associated with higher HbA1c (estimate, 0.55%; 95% CI, 0.27%-0.82%) and mean glucose (estimate, 17.88 mg/dL; 95% CI, 3.69-32.07 mg/dL). Public insurance was also associated with higher time in range (estimate, -3.56%; 95% CI, -5.45% to -1.66%), time above range (estimate, 3.49%; 95% CI, 1.53%-5.46%), and glycemic risk index (estimate, 4.50; 95% CI, 2.13-6.87). Socioeconomic disadvantage was associated with an increase in coefficient of variation (estimate, 3.26; 95% CI, 0.81-5.70). Associations were most pronounced among children experiencing more socioeconomic disadvantage and Black children across metrics. These associations persisted after adjusting for insulin pump use.

This cross-sectional study of adult and pediatric CGM users with type 1 or type 2 diabetes found that CGM and insulin pump use alone did not eliminate associations between SDOH and glycemic outcomes. These findings highlight the need for interventions beyond technology, such as diabetes education and behavioral support, to promote equity in diabetes care.

Obesity and type 2 diabetes are major global health concerns associated with substantial clinical and economic burdens. Bariatric metabolic surgery (BMS) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are effective interventions, but their long-term impact on health care utilization costs remains incompletely understood.

To compare short- and long-term health care utilization costs among patients with obesity and diabetes treated with GLP-1RAs vs those who underwent BMS.

This observational, retrospective cohort study used electronic medical records from Clalit Health Services, the largest health care organization in Israel. Adults (aged ≥24 years) with obesity (body mass index [BMI] ≥30) and diabetes who underwent their first BMS or initiated GLP-1RA therapy between January 1, 2010, and December 31, 2022, were identified. Propensity score matching yielded 2721 matched pairs, who were followed up for up to 12.5 years (mean [SD], 6.5 [3.5] years), through December 31, 2023. Data cleaning and analyses were conducted from June to October 2025.

Treatment with GLP-1RAs or BMS.

Health care utilization costs incurred by the health system, excluding costs of the index interventions. Attributable costs were estimated using a difference-in-differences approach and modeled with multivariable linear regression.

The matched cohort included 5442 adults (mean [SD] age, 51 [10] years; 3243 women [59.6%]; mean [SD] BMI, 40.5 [6.0]). Mean (SD) monthly follow-up costs were higher among patients treated with GLP-1RAs than those who underwent BMS ($415.3 [$746.7] vs $304.9 [$628.5]). The adjusted difference-in-differences method showed $109.0 higher monthly costs per patient for GLP-1RA treatment (SE = $17.0; P < .001), associated primarily with hospitalization costs ($43.9; SE = $13.3; P = .001) and non-GLP-1 medication costs ($52.5; SE = $4.4; P < .001). Most cost differences accrued within the first 4 years. BMS was associated with greater early reductions in BMI and hemoglobin A1c, whereas GLP-1RA treatment showed more modest but sustained effects.

This cohort study found that, among adults with obesity and diabetes, health care utilization costs were higher with GLP-1RA treatment than with BMS, excluding intervention costs, largely reflecting differences in early clinical trajectories. These findings suggest that, among patients eligible for both interventions, BMS may confer combined clinical and economic advantages over long-term follow-up.

To investigate associations between (human leukocyte antigen) HLA alleles and overall lupus nephritis (LN) susceptibility, biopsy-defined histologic classes and reduced renal function in Taiwanese patients with systemic lupus erythematosus (SLE). We conducted a retrospective case-control study using data from the Taiwan Precision Medicine Initiative. The matched cohort included 388 SLE patients with biopsy-confirmed LN and 381 SLE patients without LN. HLA alleles were imputed from single nucleotide polymorphism (SNP) array data using HIBAG. Multivariable logistic regression was employed to evaluate associations of candidate HLA alleles with LN overall, individual LN histologic classes and reduced renal function within LN, adjusting for age, gender, hypertension and diabetes mellitus. The study included 388 biopsy-confirmed LN cases and 381 matched SLE controls without LN. Four alleles were independently associated with overall LN susceptibility, including HLA-B*13:01 (adjusted OR 1.68, 95% CI 1.09-2.59), HLA-B*58:01 (1.69, 1.15-2.49), HLA-C*03:02 (1.75, 1.19-2.58) and HLA-DRB1*03:01 (1.51, 1.01-2.27). Class-specific analyses showed that HLA-B*13:01 was associated with Class I/II LN; HLA-B*58:01 and HLA-C*03:02 with Class III ± V LN; and HLA-B*13:01, HLA-B*58:01, and HLA-C*03:02 with Class IV ± V LN. No allele remained independently associated with Class V LN after full adjustment. Within the LN cohort, HLA-B*13:01 was the only allele associated with reduced renal function (eGFR < 60 mL/min/1.73 m²; adjusted OR 2.24, 95% CI 1.30-3.85). Overall, the strongest associations were observed for HLA class I alleles, particularly HLA-B*13:01 in this study. In Taiwanese patients with SLE, a narrower set of predominantly HLA class I alleles is associated with LN susceptibility and proliferative LN phenotypes. HLA-B*13:01 showed the most consistent association across overall LN susceptibility, histologic severity and reduced renal function.