Traditional risk models for macrovascular complications in type 2 diabetes (T2DM) rely on physiological and biochemical indicators, which may lack long-term follow-up data and thus potentially overlook key variables.

A retrospective cohort study was conducted on 4,186 T2DM patients from the Diabetes Health Management Platform in Hotan, Xinjiang, covering the period from 2015 to 2023. Eight machine learning (ML) algorithms were used, with an 8:2 random split into training (n=3,348) and validation (n=838) sets. Performance was evaluated using the area under the receiver operating characteristic curve (AUC), and feature contributions were analyzed using SHAP values. The clinical applicability was verified through decision curve analysis.

The T2DM with macrovascular complications group had significantly higher waist circumference, oropharyngeal abnormalities, and absent lung crackles (P < 0.05). The T2DM with macrovascular complications group also had significantly higher BMI, body temperature, and ALT (P < 0.05), but lower fasting blood glucose, with borderline abnormalities in blood urea and AST. The T2DM with macrovascular complications group had higher smoking, alcohol consumption, and exercise frequency (P < 0.05), but a reverse trend in self-reported "poor" health status (P < 0.05). Among all machine learning models (training AUC 0.68-0.85), XGBoost performed best (training AUC = 0.830, validation AUC = 0.850), with superior clinical net benefit compared to traditional strategies. SHAP analysis revealed that BMI (contribution +0.1116), body temperature (+0.0923), and LDL-C (+0.0821) were key predictive factors, with elevated body temperature potentially indicating subclinical inflammation activation.

Among patients with vascular complications, the disconnect between health behavior risks and subjective health perception is more pronounced. Elevated body temperature, high blood pressure, triglycerides, and fasting glucose indicate inflammation, increasing cardiovascular risk; moderate regular exercise provides protection.

Advanced liver fibrosis is a major determinant of liver-related morbidity and mortality and occurs more frequently in individuals with type 2 diabetes mellitus (T2DM). While metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among patients with T2DM, data on the risk of advanced liver fibrosis in this population in the United Arab Emirates (UAE) remain limited. Non-invasive fibrosis scores offer a pragmatic approach for risk stratification in routine clinical practice.

To determine the prevalence of high risk for advanced liver fibrosis and its clinical associations among patients with T2DM in the UAE using validated non-invasive fibrosis scores.

A retrospective cross-sectional study was conducted between October to December 2023, enrolling T2DM patients who attended at the Diabetic Care Centre in Dubai, UAE. Data was extracted from the Dubai Health electronic medical records, Epic (Salama). Liver fibrosis risk was assessed using the fibrosis-4 (FIB-4) score and Nonalcoholic Fatty Liver Disease (NAFLD) fibrosis score, with chi-square tests determining the statistical difference across liver fibrosis risk groups. Analyses were performed at a 5% significance level.

Among 373 patients, there was a slight female predominance (53%). Overall, 2.7% were at high risk of advanced liver fibrosis, while 56% had suspected hepatitis steatosis (MASLD), which aligns with global MASLD estimates in T2DM. Higher BMI was significantly associated with greater liver fibrosis risk (p=.002).

A small but clinically relevant proportion of patients with T2DM in the UAE are at high risk for advanced liver fibrosis. Incorporating non-invasive fibrosis risk assessment into routine diabetes care may facilitate early detection and specialist referral.

Type 2 diabetes mellitus (T2DM) represents a systemic disease that extends beyond metabolic dysfunction to include accelerated neurocognitive decline driven by oxidative stress, inflammation, and insulin resistance. Emerging evidence suggests that essential micronutrients may interact synergistically or antagonistically with biguanides, particularly metformin, to influence neurocognitive function. This systematic review synthesized preclinical and clinical evidence on the interactions between essential micronutrients and biguanides (notably metformin) in modulating neurocognitive outcomes in T2DM.

Following PRISMA 2020 guidelines, we systematically searched PubMed, Web of Science, and Scopus for studies published between 2010 and 2025. After screening 226 records in Rayyan, 40 studies met the inclusion criteria. Both preclinical and clinical studies were analyzed descriptively to identify patterns of mechanistic and functional outcomes. Extracted data covered intervention types, doses, duration, biomarkers, and cognitive outcomes.

Of the 40 studies, 27 (67.5%) were preclinical and 13 (32.5%) were clinical, spanning 14 countries. Most interventions involved vitamin D, zinc, magnesium, vitamin E, or polyphenols, either alone or combined with metformin. Synergistic effects were observed in 77.5% of studies, with significant improvements in fasting plasma glucose, HbA1c, insulin sensitivity, and oxidative balance. Key molecular pathways involved AMPK, PI3K/Akt, GSK3β, and Nrf2-CREB, which mediated enhanced glucose utilization, mitochondrial function, and synaptic plasticity. Antagonistic effects (10%) were mainly linked to metformin-induced vitamin B12 depletion, which impaired neurotrophic signaling and elevated homocysteine levels. Across studies, neuroprotective benefits correlated with increased BDNF, PSD-95, and SIRT1 expression, and reduced IL-6, TNF-α, and MDA levels.

Most (75%) of the studies showed a synergistic interaction between biguanides (metformin) and micronutrients save a few that showed antagonistic interaction. Integrating micronutrient supplementation particularly vitamin D, zinc, and antioxidant compounds into T2DM management enhances both metabolic control and cognitive function. These findings support a paradigm shift toward combined nutraceutical-pharmacologic therapy within clinical and public health frameworks. Future research should focus on dose optimization, mechanistic validation, and long-term clinical evaluation to develop evidence-based, nutrition-sensitive diabetes care models.

Pulmonary embolism is a cardiovascular disease associated with significant morbidity and mortality. There is a paucity of literature regarding this condition from the Ghanaian perspective. This study aimed at evaluating the clinical profile and admission outcomes of patients with acute pulmonary embolism at the Methodist Hospital, Wenchi, Ghana.

A retrospective pilot study was conducted by analyzing medical records of patients diagnosed with acute pulmonary embolism from September 2023 to March 2025. Data on demographics, clinical manifestations, risk factors, investigations, treatment, and outcomes of admission were collected.

Out of 17 patients enrolled in the study, 11 (64.7%) were females. The mean age was 58.8 ± 13.0 years. The commonest risk factors were age > 65 years (n = 6), immobilization (n = 5), obesity (n = 4), and recent surgery (n = 3). Hypertension and diabetes mellitus were the predominant comorbidities. Dyspnea (76.5%, n = 13) and chest pain (n = 5) were the most frequent presenting symptoms while tachypnea (70.6%, n = 12), tachycardia (70.6%, n = 12), and hypoxia (52.9%, n = 9) were the commonest clinical signs. Three patients had hemodynamic instability. Pretest probability assessment was infrequently performed (n = 7). Sinus tachycardia (76.5%, n = 13) was the predominant electrocardiographic abnormality. The majority (58.8%, n = 10) had intermediate-risk pulmonary embolism whereas 3 patients were classified as having high-risk pulmonary embolism. Two in-hospital mortalities were recorded.

Clinical features and predisposing factors were largely similar to those described in the literature. Also, pretest probability assessment was underutilized. In-hospital mortality rate (11.8%) was relatively high. Large-scale, multicenter prospective studies are recommended to assess long-term complications of acute pulmonary embolism such as recurrence and chronic thromboembolic pulmonary hypertension.

Pediatric Type 2 Diabetes is a growing global concern, driven by rising childhood obesity and lifestyle factors. The study aimed to analyze global publication trends, key contributors, and collaborative networks in Pediatric Type 2 Diabetes research. A bibliometric analysis of 1,555 Scopus-indexed publications was conducted. Study types, citation metrics, and collaboration networks were evaluated. There was 20.02% annual growth (5 papers in 1998 to 99 in 2023). The USA (42%) led globally, followed by the UK, Canada, and Germany; Finland had the highest citation impact. Original research (70.6%) dominated, mainly on clinical and epidemiological themes. P. Zeitler was the most prolific author, while G. Imperatore's works were the most cited. Strong collaborations existed between the USA and the UK, with the University of Colorado Anschutz Medical Campus as the leading institution. Pediatric Type 2 Diabetes research shows rapid expansion but limited contributions from India and South Asia, highlighting a need for region-specific studies.

To examine the independent and combined effects of diabetes mellitus (DM) and hypertension (HTN) on acute kidney injury (AKI) and 90-day mortality in critically ill patients.

We retrospectively analyzed 3,282 adult intensive care unit (ICU) admissions to King Abdullah University Hospital, Jordan (2012-2022). Patients were stratified by DM and HTN status. Logistic regression identified predictors of AKI, and Cox proportional hazards models assessed 90-day mortality.

AKI occurred in 44.7% of DM patients versus 40.8% without DM (p = 0.0423). Patients with both DM and HTN had the highest AKI incidence (48.6%) and the highest 90-day mortality (37.8%). In addition, the HTN × DM interaction was a significant predictor of AKI in multivariable analysis (OR = 1.18, 95% CI: 1.07-1.36, p = 0.0059) and increased the mortality hazard independently (HR = 1.43, 95% CI: 1.04-1.97, p = 0.0286).

DM is associated with increased AKI and mortality in critically ill patients, and concurrent HTN further amplifies these risks. These findings support integrated cardiometabolic risk assessment in ICU settings.

This article synthesizes current preclinical and clinical literature regarding glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in rheumatoid arthritis (RA), highlights mechanistic hypotheses and explores potential clinical roles and limitations of their use.

GLP-1 RAs are established therapies for type 2 diabetes mellitus and obesity, with demonstrated benefits on glycemic control and cardiovascular risk reduction. Emerging evidence suggests that GLP-1 RAs may exert anti-inflammatory and immunomodulatory effects relevant to RA.

Present evidence is insufficient to recommend GLP-1 RAs as standard RA therapy. Well designed randomized controlled trials are needed to establish their efficacy and optimal role.

Data on the familial occurrence of type 1 diabetes mellitus (T1DM) in Korean pediatric populations are limited. This study evaluated the clinical characteristics of children with T1DM according to family history and estimated the T1DM prevalence among relatives.

We conducted a multicenter retrospective cohort study including patients aged ≤18 years newly diagnosed with T1DM at 18 university-affiliated hospitals in Korea between 2010 and 2024. The index child was defined as the first sibling diagnosed with T1DM and categorized according to the presence of affected parents or siblings. Familial T1DM prevalence was calculated for siblings, first-degree relatives, and twin pairs.

Among 936 index children, 32 (3.4%) exhibited a T1DM family history. Compared with index children, subsequent-affected children presented with lower plasma glucose (300.0 mg/dL vs. 412.0 mg/dL, P=0.009) and glycosylated hemoglobin levels (10.4% vs. 12.6%, P<0.001), and a lower frequency of diabetic ketoacidosis (13.8% vs. 49.7%, P<0.001). Venous pH and serum bicarbonate levels were higher (7.4 vs. 7.3, P=0.005; 22.0 mmol/L vs. 17.0 mmol/L, P=0.004, respectively), whereas urine ketone levels were significantly lower (P<0.001). Sibling, first-degree relative, and twin-pair prevalence rates were 3.0% (23/779), 1.3% (34/2,651), and 42.9% (3/7), respectively.

In this multicenter Korean cohort, familial T1DM accounted for 3.4% of pediatric cases, which was lower than in Western populations. Subsequent-affected children exhibited milder metabolic decompensation at diagnosis than did index children, likely reflecting earlier recognition through family awareness and screening. These findings underscore the importance of early education and monitoring of at-risk relatives within affected families.

Insulin errors in inpatients with diabetes occur frequently during surgical admissions. Older adults have higher risks. There is a need for service user involvement in developing complex interventions to improve insulin safety in hospitals.

To develop a logic model for a system-based safety intervention to support safer insulin use for older adults with diabetes undergoing surgical hospital admission.

A co-design approach combining systems thinking and design thinking methods was employed. Purposive sampling was employed. Older adults with diabetes and multiprofessional staff working across perioperative care were involved as co-designers and decision makers throughout the iterative process of intervention development. An initial exploratory phase included semi-structured interviews with service users (n = 10), hospital staff (n = 23) and non-participatory observations (n = 3) which informed subsequent collaboration. Initial findings validated in separate service user and staff workshops and engagement activities. The resulting data were presented at joint stakeholder workshops (n = 3) to confirm the final intervention components needed to develop the model. In total, n = 10 older adults and n = 11 healthcare professionals working across the perioperative pathway participated in the co-design process between October and December 2024.

Co-designers were engaged and collaborative. Multiple interacting components at patient, staff and context level identified. Through an iterative process, a co-designed logic model known as the SHINE (safe-hospital-insulin-use) wheel was constructed, addressing two prioritised areas: transitions of care and right insulin, time and way. The model also identifies eight actions and twelve separate outputs as components. Solution-related themes centred around: it is all so connected; right insulin, right time, right way; safer transitions of care; empowerment; organisation and provision of care; developing and supporting the workforce. Two prototypes of tools for patient and staff education to support empowerment and increase patient preparedness for hospital admission were developed.

Multiple interacting components influence hospital insulin safety. System-based, non-linear safety approaches are required. This co-design study identified priorities of older adults with diabetes and healthcare professionals to be addressed in system-wide insulin safety interventions for surgical admissions. Tools developed provide tangible outputs for application in clinical practice.

People with diabetes with recent lived experience of surgical hospital admission were integrally involved as co-designers and decision makers in this study. They contributed towards interpretation and analysis of findings through discussion, feedback and validation in workshops and through means accessible to them. They were decision makers in the identification of priorities for intervention development and in identifying and validating the content of the toolkit developed.

Aim: To investigate the data sources available in Mexico for real-world research. Materials & methods: A systematic literature review on PubMed, EMBASE and VHL using a combination of controlled vocabulary and keywords for the concepts of electronic health records, epidemiologic studies and Mexico was performed. Results: A total of 331 articles and 89 conference abstracts reporting real-world studies were identified. These included 320 data sources: 142 unique named databases, 172 unnamed databases from specified providers, and 26 electronic medical record datasets. The main data sources came from healthcare institutions (35%), followed by government agencies (26%). The most frequent database design corresponded to surveys (34%) and disease registries (20%). Most databases included cohort studies (43%), population-based (25%) and cross-sectional studies (18%). Specific diagnostic tests (28%), access (22%) and pharmacological treatment (21%) were the most common issues analyzed in databases at patient-level data. Neoplasms, cardiac disorders and infections/infestations were the most common therapeutic areas analyzed in databases. Conclusion: In Mexico, the use of databases has increased, driven by governmental and nongovernmental organisations and companies. However, further efforts are still needed to improve the quality and knowledge of real-world evidence.