There has been an increase in the occurrence of Type 1 diabetes and Type 2 diabetes occurring below 25 years of age. In this report, we outline the trends, clinical characteristics, and complications in Type 1 diabetes and Type 2 diabetes diagnosed ≤ 25 years of age, as observed at a tertiary care diabetes centre in India. We conducted a retrospective study involving 10,449 individuals diagnosed with diabetes at age ≤ 25 years who were registered from 2010 to 2023 at a network of diabetes centre in India. Type 1 diabetes was identified by a history of ketoacidosis, low C-peptide levels, and the necessity of insulin from the time of diagnosis. Type 2 diabetes was diagnosed based on the absence of ketosis, preserved C-peptide levels and a response to oral hypoglycemic agents for at least two years. Among 10,449 individuals with diabetes, 45.5
Diabetes mellitus (DM) is a major contributor to global morbidity and mortality, particularly in developing regions. Effective identification of high-risk individuals is crucial for targeted prevention and resource allocation. This population-based study aimed to compare the association and discriminatory performance of novel visceral adiposity indices—Lipid Accumulation Product (LAP), Visceral Adiposity Index (VAI), and Waist-triglyceride Index (WTI)—and Waist Circumference (WC) with Body Mass Index (BMI) in detecting prevalent diabetes. Data from 17,945 participants in the Iran 2021 WHO STEPwise approach to Noncommunicable Disease Risk Factor Surveillance (STEPS) survey were analyzed. Associations with diabetes were examined via multivariable logistic regression models. Comparisons of discriminatory performance were carried out using receiver operating characteristic curves and Somers’ D. Stratified analyses were performed by sex, age group, and place of residence. All indices were significantly associated with diabetes. Addition of LAP and WTI to the base predictive model yielded a significantly higher discriminatory ability (AUC = 0.816, 95
Reversion from impaired fasting glucose (IFG) to normoglycemia is associated with a more favorable metabolic prognosis. Although the creatinine-to-body weight ratio (Cre/BW) has been linked to glycemic transitions, the contribution of lipid-related metabolic characteristics remains unclear. We examined the association between Cre/BW and reversion to normoglycemia and explored mediation by the triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C), atherogenic index of plasma (AIP), and triglyceride-glucose (TyG) index. This secondary analysis included 15,442 adults with IFG from a longitudinal health examination cohort in China. Cox proportional hazards models evaluated the association between the Cre/BW ratio (×100) and reversion to normoglycemia. Missing covariates were handled using multiple imputation with 50 imputed datasets. Restricted cubic splines assessed nonlinearity, and exploratory mediation analyses evaluated TG/HDL-C, AIP, and TyG. During approximately 3 years of follow-up, 7,230 participants (46.8
Inflammation contributes to obesity-related metabolic dysfunction in type 2 diabetes (T2DM), yet evidence from sub-Saharan Africa remains limited, particularly from studies adjusting for medication use and endemic infections. This study investigated associations between high-sensitivity C-reactive protein (hs-CRP), tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and obesity in Nigerian adults with T2DM, adjusting for medication use and asymptomatic malaria. This cross-sectional study included 151 adults with T2DM and 100 age- and sex-frequency-matched healthy controls from Southwest Nigeria. Plasma inflammatory markers were measured by enzyme-linked immunosorbent assay. Multivariable logistic regression examined associations with obesity (body mass index ≥ 30 kg/m²), adjusting for age, sex, metformin use, statin use, and asymptomatic malaria rapid diagnostic test status. All models were restricted to participants with T2DM; near-universal metformin use (98
Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are increasingly prescribed in adults with type 2 diabetes (T2D) presenting for elective surgery, yet procedure-specific perioperative safety data for thyroidectomy remain limited. We evaluated whether preoperative GLP-1 RA continuation is associated with aspiration, thyroidectomy-specific complications, or metabolic events. Using the TriNetX US Collaborative Network (2017 to 2025), we emulated three active-comparator target trials in adults with T2D undergoing thyroidectomy, comparing preoperative GLP-1 RA with DPP-4 inhibitors (DPP-4i), SGLT2 inhibitors (SGLT2i), or usual care. Cohorts were 1:1 propensity score matched; Cox models estimated hazard ratios (HRs). The primary outcome was 24-month all-cause mortality; secondary outcomes included diabetic ketoacidosis (DKA), readmission, hypocalcemia, recurrent laryngeal nerve injury, and class-relevant safety events. Aspiration-related events and a broader postoperative respiratory composite were prespecified and analysed over three postoperative windows. Negative-control outcomes probed residual confounding. Matched cohorts comprised 722, 736, and 611 patients per arm. Aspiration-specific events were below the minimum reportable cell size in all comparisons and windows; a broader postoperative respiratory composite showed no excess. No excess recurrent laryngeal nerve injury was observed. Hypocalcemia was more frequent with GLP-1 RA than with SGLT2i in the primary analysis without reaching significance (HR 1.43, 95
The Aral Sea region of Uzbekistan represents an environmentally vulnerable setting where historically reported iodine deficiency in the region, thyroid dysfunction and metabolic disorders may coexist. Urinary iodine was not directly measured in this study; references to iodine deficiency reflect regional contextual documentation only. Biochemical data linking thyroid status, aminotransferase elevation and dysglycaemia in this population remain scarce. A cross-sectional study enrolled 98 adults from Muinak, Kanlykul, and Takhtakupir, Karakalpakstan (2024–2025). Anthropometry, fasting and 2-h postprandial glucose, HbA1c, thyroid hormones, aminotransferases and fasting lipid profile were assessed. Fasting triglycerides (TG) were available for 64/98 participants (65.3
Testosterone deficiency is common in men with type 2 diabetes mellitus (T2DM) and has been associated with a procoagulant thromboelastography (TEG) profile. Whether the estradiol-to-testosterone ratio (E2/T) provides information beyond testosterone alone is uncertain. We performed an exploratory secondary cross-sectional analysis of 92 hospitalized men with T2DM from a previously published single-center cohort. E2/T was calculated as estradiol (pmol/L) divided by total testosterone (nmol/L). TEG data were available for 84 participants. Routine TEG testing used a TCA-6000 analyzer with kaolin activation and citrated whole blood. E2/T was examined continuously after natural-log transformation and descriptively by tertiles. Spearman correlations and multivariable linear regression adjusted for age, body mass index, glycated hemoglobin, and fasting glucose were used. Sensitivity analyses used heteroscedasticity-consistent (HC3) standard errors, false-discovery-rate correction, alternative hormone models, exclusion of the maximum E2/T value, winsorization, Cook’s-distance screening, and leave-one-out refitting. Median E2/T was 10.92 (interquartile range 5.97–17.23). Across increasing tertiles, median TEG maximum amplitude (MA) increased from 59.4 to 62.4 and 65.9 mm (P = 0.002). In the adjusted model, log E2/T was associated with MA (B = 2.85 mm, 95
The COVID-19 pandemic profoundly disrupted chronic disease management, including diabetes care. While early studies described short-term changes in access to care and laboratory monitoring, the long-term evolution of diabetes care delivery remains poorly understood. This study evaluates four-year longitudinal shifts in healthcare utilization, telemedicine adoption, preventive screening, pharmacologic treatment, and metabolic outcomes before and during the pandemic. We conducted a retrospective cohort study of adults with diabetes or prediabetes receiving care at a single health system from March 2018 to February 2022. Outcomes included primary care engagement, telemedicine use, adherence to ophthalmology and podiatry screening, medication prescribing patterns, HbA1c, BMI, urinary albumin–creatinine ratio (uACR), and mortality. A COVID-19–positive subgroup was analyzed separately. A sensitivity analysis was conducted restricting the cohort to patients with confirmed diabetes mellitus only (HbA1c ≥ 6.5
Metformin is the first-line pharmacological therapy for type 2 diabetes mellitus (T2DM). However, long-term use has been associated with reduced serum vitamin B12 levels, which may contribute to peripheral neuropathy — a common and debilitating complication of diabetes. To systematically evaluate the association between long-term metformin use, vitamin B12 deficiency, and peripheral neuropathy in adults with T2DM. A PRISMA 2020-compliant systematic review and meta-analysis was prospectively registered in PROSPERO (CRD420261363992). PubMed, Google Scholar, Europe PMC, and Cochrane CENTRAL were searched from January 2009 to April 2026. Two reviewers independently screened records (Cohen’s κ = 0.82). Quality was assessed using the Newcastle-Ottawa Scale and GRADE framework. Results: Twenty studies (n ≈ 292,000; 15 countries) were included. Three pre-specified meta-analyses using random-effects models (DerSimonian–Laird) were conducted. Metformin use was significantly associated with increased peripheral neuropathy risk in cross-sectional pooling (k = 6; pooled OR = 1.84, 95
Excessive cortisol secretion is responsible for metabolic complications, increasing morbidity and mortality. Normalizing cortisol levels with surgery or medical treatments are the most effective ways to limit these complications, but few studies have compared these two strategies specifically on metabolic complications. This observational, retrospective, monocentric study included 62 patients with confirmed endogenous ACTH-independent hypercortisolism followed in our department between January 2019 and January 2024. Patients were included in three groups: surgery (n = 42), medication (n = 13), and observation (n = 7). Metabolic complications were assessed at baseline, 6 months and 12 months. We compared the evolution of complications depending on the therapeutic strategy and according to the underlying etiology of hypercortisolism. After 6 months, patients in both surgery and medication group showed improvements in cortisol levels, weight, blood pressure, lipid profile, diabetes, and liver parameters. Weight loss was higher in the medication group (-1.61 VS + 0,25 kg/m² in surgery group) while there was no difference for the other parameters. This difference was persistentat 12 months. Patients with primary bilateral macronodular adrenocortical hyperplasia (PBMAH) who received medication showed a higher reduction in BMI (-1,98 VS + 0,68 kg/m²), systolic and diastolic blood pressure (-11,6 VS + 3 and − 4,5 VS + 5 mmHg respectively) than operated patients. No significant differences were observed for other etiologies. Our study suggests that medical treatment is more effective than surgery to improve weight in ACTH-independent hypercortisolism, especially in patients with PBMAH. Treatment modality does not appear to have any impact on other short-term metabolic complications.
Vitamin D has been proposed to support immune regulation and improve insulin sensitivity in type 1 diabetes (T1D), but the extent of its added clinical benefit remains unclear. This review summarizes randomized evidence regarding its influence on insulin use, metabolic outcomes, and β-cell function. Searches across five major databases through October 14, 2025, identified randomized controlled trials evaluating vitamin D supplementation in T1D. Total daily insulin dose (TDD) served as the primary endpoint, while glycated hemoglobin (HbA1c) and C-peptide measurements were assessed as secondary outcomes. Pooled mean differences (MD) with 95
Federally Qualified Health Centers (FQHCs) serve as the primary care setting for millions of medically underserved individuals in the United States, including a substantial population living with insulin-requiring diabetes. Despite the established benefits of diabetes technology and the importance of glycemic control in preventing complications, comprehensive characterization of demographic composition, socioeconomic context, glycemic burden, and technology utilization among insulin-requiring patients in FQHCs remains limited. We aimed to provide a comprehensive contemporary characterization of this population across a geographically diverse FQHC network. We conducted a cross-sectional analysis of electronic health record data from 40 FQHCs across 17 states during 2024. The study included adults aged 18 to 75 years with type 1 diabetes (T1D) or type 2 diabetes treated with insulin (T2D). We examined demographic and socioeconomic characteristics, weighted mean HbA1c, the proportion of patients with HbA1c above 9.0
Nivolumab-associated hypophysitis is a rare endocrine immune-related adverse event with incompletely defined clinical characteristics and management. This study aimed to synthesize patient-level evidence to clarify its presentation, treatment, and clinical outcomes, thereby facilitating earlier recognition and evidence-based management. We conducted a retrospective, case-based synthesis of nivolumab-induced hypophysitis. PubMed, EMBASE, Web of Science, WanFang Data, and CNKI were systematically searched for reports published up to Jan 31, 2026, using a combination of MeSH terms: (“nivolumab” OR “PD-1 inhibitor” OR “programmed death-1 inhibitor” OR “immune checkpoint inhibitor” OR “ICI”) AND (“hypophysitis” OR “pituitary inflammation” OR “hypopituitarism”) AND (“immune-related adverse event” OR “irAE” OR “endocrinopathy”). Among 2,264 records screened, 38 case reports and case series comprising 40 patients were included in the final analysis. Median age was 62 years (range 26–84), and 72.5
Insulin resistance (IR) is increasingly recognized as a potential correlate of knee osteoarthritis (KOA); however, prospective evidence supporting this association remains limited. This study aimed to investigate the association between various surrogate markers of IR and the risk of incident KOA in a large prospective cohort. This prospective cohort study used CHARLS data from 2011 with follow-up in 2013, 2015, 2018, and 2020. Six surrogate IR indices—estimated glucose disposal rate (eGDR), Chinese visceral adiposity index (CVAI), triglyceride-glucose index (TyG), TyG-body mass index (TyG-BMI), metabolic score for insulin resistance (METS-IR), and atherogenic index of plasma (AIP)—were evaluated in relation to incident self-reported symptomatic KOA using multivariable Cox regression and restricted cubic splines. Sensitivity analyses addressed early incident cases, multiple testing, BMI overlap in adiposity-based indices, and potential selection bias. A total of 5871 participants free of KOA at baseline were included. During follow-up, 2143 participants (36.5
Diabetic neuropathy is a common chronic complication of diabetes, and damage to corneal small nerve fibers represents an early manifestation of small fiber neuropathy within the visual system. However, whether corneal nerve injury differs across diabetes subtypes remains unclear. This study aimed to investigate subtype-specific variations in corneal nerve morphology based on the Ahlqvist classification in a Chinese diabetic population and to explore their associations with microvascular complications. This multicenter cross-sectional study enrolled 516 patients with diabetes aged 18–80 years. Diabetes subtypes were classified using a modified Ahlqvist-based hierarchical clustering approach, with additional sensitivity analysis using six-variable k-means clustering. Corneal nerve parameters were quantified using in vivo confocal microscopy, and their associations with neuropathic signs, median nerve motor conduction velocity, and microvascular complications were analyzed. Statistical analyses included analysis of variance or Kruskal–Wallis tests, Spearman correlation analyses, and multivariable logistic regression, as appropriate. CNFD showed an overall between-subtype difference, with numerically lower values in the SAID subgroup and higher values in the MOD subgroup. However, corrected post hoc comparisons did not confirm significant pairwise differences. Associations between CCM parameters and median motor nerve conduction velocity showed an unexpected inverse direction and were therefore interpreted cautiously. No significant associations were observed between NDS and CCM parameters. In the overall cohort, lower standardized CCM parameters were consistently associated with higher odds of DR, and these associations remained significant in sensitivity models with additional adjustment for diabetes duration, HbA1c, and BMI. In contrast, no significant associations were observed between CCM parameters and DKD. Subtype-specific regression findings were considered exploratory because of limited event numbers in some subgroups. CCM parameters showed subtype-related heterogeneity among patients classified using a modified Ahlqvist-based framework. Lower CCM parameters were more consistently associated with DR than with DKD, suggesting a potential relationship between corneal small-fiber imaging markers and retinal microvascular involvement. Associations with median motor nerve conduction velocity showed an unexpected inverse direction and require further validation. Longitudinal studies with comprehensive NCS-based DSPN definitions are needed to confirm these exploratory findings. This observational study was retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR2500100007 https://www.chictr.org.cn/) on April 1, 2025.
Hyperinsulinemia is an early metabolic abnormality commonly associated with insulin resistance, but its relationship with cardiovascular injury in real-world populations remains incompletely understood. We examined whether fasting insulin is related to arterial stiffening and early myocardial biomarker abnormalities in a large health-examination population. This real-world retrospective analysis enrolled 30,343 adults who received routine health examinations from January 2017 to November 2021. For individuals with multiple visits, the earliest examination was used as the baseline record. Fasting insulin was evaluated in quartile categories, a log-transformed continuous exposure, and a hyperinsulinemia indicator based on the cohort-specific 75th percentile. The binary arterial-stiffness endpoint was defined using a mean baPWV (brachial-ankle pulse wave velocity) threshold of 1400 cm/s or higher. Myocardial injury was evaluated by cardiac troponin I or T. Logistic regression models were fitted to quantify the relationships of fasting insulin and HOMA-IR (homeostatic model assessment of insulin resistance) with baPWV-related outcomes and myocardial injury markers. Dose-response patterns were explored using restricted cubic spline modeling. Subgroup analysis and sensitivity analysis were performed. Python (3.13.0) was used for statistical analysis. Higher insulin categories were accompanied by greater adiposity, blood pressure, glucose, HOMA-IR, triglycerides, baPWV, and arterial-stiffness. Hyperinsulinemia was correlated with arterial stiffness in the unadjusted model and adjusted model (OR, 1.31; 95
Postprandial walking attenuates glucose excursions in type 2 diabetes mellitus (T2DM), but it is not known whether specific wearable hip-exoskeleton modes add benefit beyond non-assisted walking. In a randomized, partially counterbalanced crossover proof-of-concept study, 14 adults with T2DM completed three 30-minute overground walking conditions: non-assisted walking (Non-BF), Bot-Fit Aqua mode (BF-Aqua), and Bot-Fit Boost mode (BF-Boost). Walking speed was individualized to 40
Osteoporosis is increasingly recognized as an important comorbidity among patients with type 2 diabetes mellitus (T2DM). However, data regarding its prevalence and associated factors in older Iranian diabetic patients remain limited. The current study was designed to assess the prevalence of osteoporosis and associated factors in T2DM patients over 55 Years of age. In this cross-sectional study, 102 patients with T2DM aged over 54 years were recruited from endocrinology clinics and wards of Imam Reza and Sina Hospitals in Tabriz, Iran. Demographic, clinical, laboratory, and medication-related data were collected. Bone mineral density was assessed using dual-energy X-ray absorptiometry and osteoporosis was defined based on lumbar spine and/or femoral neck T-scores ≤ -2.5. In cases of degenerative changes affecting lumbar spine measurements, values from the femoral neck were prioritized. Logistic regression analyses were performed to identify factors associated with osteoporosis. The prevalence of osteoporosis was 32.4
Cardiovascular-kidney-metabolic (CKM) assessment may not capture heterogeneity in vulnerability to cardiometabolic multimorbidity (CMM). We evaluated whether objective functional reserve could provide a complementary phenotyping layer. We analysed CHARLS as the development cohort, HRS VBS as the primary supportive replication cohort, ELSA as a simplified transportability cohort, and SHARE W6 DBS as a grip-only robustness cohort. Equal-weight cohort-specific CKM domain counts were crossed with age- and sex-standardized objective functional reserve. Incident CMM was defined as the first follow-up observation with at least two reported cardiometabolic conditions. Cox models were supplemented by discrete-time, common-domain, common-threshold three-domain, grip-only, interaction, CMM-or-death, selection-weighted, landmark, subgroup, and five-year risk-stratification analyses; Fine–Gray and cause-specific models were used where mortality timing was adequate. In the five-year CMM analyses, deaths before CMM were counted separately rather than classified as controls; 1,000 bootstrap resamples were used. Descriptive samples comprised 3,238 CHARLS, 1,627 HRS VBS, 1,927 ELSA, and 12,641 SHARE participants, with 284, 117, 73, and 701 incident CMM events. High CKM burden plus low reserve was associated with incident CMM in CHARLS (hazard ratio [HR] 3.52, 95
Metabolic dysfunction–associated steatotic liver disease is the most common chronic liver disease worldwide, affecting approximately 25–30
