Hemoglobin (Hb) concentration has been associated with metabolic abnormalities, but its relationship with metabolic syndrome (MetS) remains incompletely characterized. We examined these associations in a Japanese health checkup population. This cross-sectional study included 17,567 adults (10,175 men and 7392 women) examined between 2007 and 2024. MetS was defined according to the Japanese criteria. MetS analyses included 10,169 men and 7389 women after excluding nine participants with missing medication data. Sex-stratified regression, sensitivity, restricted cubic spline, and exploratory receiver operating characteristic analyses were performed. MetS was present in 1973 men (19.4%) and 310 women (4.2%). Higher Hb quartiles were generally accompanied by less favorable metabolic profiles. In adjusted linear models, Hb was positively associated with homeostasis model assessment of insulin resistance (HOMA-IR), triglycerides, fasting plasma glucose, waist circumference, and body mass index in both sexes; the largest standardized association was with HOMA-IR (men, β = 0.264; women, β = 0.150). In the principal confounder-adjusted logistic model, the odds ratios for MetS per 1 g/dL higher Hb were 1.441 in men and 1.668 in women. Associations remained significant in all sensitivity analyses. Restricted cubic splines indicated significant nonlinearity in both sexes. The areas under the curve for Hb alone were 0.579 in men and 0.676 in women. Higher Hb levels were associated with prevalent MetS and adverse metabolic parameters in both sexes. Hb may provide ancillary metabolic information but is insufficient for standalone MetS screening. The cross-sectional design precludes causal inference.
BACKGROUND AND AIMS: Telephone-based motivational interviewing (MI) may be a low-cost, scalable intervention to support behavior change and improve outcomes for people with metabolic syndrome. However, robust trials are required to enable service providers to make informed choices about investment in these programs. In preparation for such a trial, feasibility and cost-effectiveness of potential interventions need to be established. Therefore, this study aimed to determine the feasibility of a multicomponent intervention incorporating physiotherapist-delivered, telephone-based MI for adults with metabolic syndrome and to estimate effects on cardiometabolic risk factors, behavior change, quality of life, and cost-effectiveness. METHODS: Single-group, mixed-methods feasibility study. Adults with metabolic syndrome received brief guideline-based education plus telephone MI (8 weekly sessions and two boosters). Feasibility according to Bowen's framework was assessed via demand (recruitment), acceptability (qualitative), implementation (session completion, intervention fidelity [MITI-4]), and practicality (intervention costs and adverse events). Secondary outcomes (efficacy) were measured at baseline and 6 months and analyzed using within-participant change. Costs and exploratory cost-effectiveness were described. RESULTS: Twenty-seven out of 58 eligible participants were recruited (47%). Twenty-four commenced and 23 completed all 10 MI sessions (98% attendance). MITI-4 coding indicated competent MI delivery. One fall without injury and one withdrawal were reported. At 6 months, steps/day increased (MD 974; 95% CI 102-1847) and waist circumference decreased (-2.2 cm; 95% CI -4.3 to -0.1); quality of life and diet adherence also improved. Mean intervention cost was AUD515/participant; cost-effectiveness outcomes were uncertain due to variability. CONCLUSIONS: Telephone MI for adults with metabolic syndrome was feasible and implemented with fidelity, with promising behavioral and cardiometabolic improvements observed. A randomized trial with longer follow-up and robust economic evaluation is warranted.
Background: The widespread adoption of automated insulin delivery systems has created new opportunities for remote monitoring and data-driven redesign of diabetes care. However, real-world evidence on telemonitoring-supported care redesign remains limited.Methods: We conducted a real-world before-after study in 109 individuals with type 1 diabetes treated with the MiniMed (TM) 780G automated insulin delivery system. Routine care was redesigned from multiple annual outpatient visits to a default annual combined physician-diabetes specialist nurse visit supported by structured remote monitoring through CareLink (TM) Premium. Outcomes were assessed over two consecutive 12-month periods before and after implementation.Results: Telemonitoring-supported care redesign reduced outpatient utilization from 4.92 to 2.49 visits per patient-year, representing an approximate 50% reduction. Glycemic outcomes remained stable, with no clinically meaningful change in HbA1c (56.3 +/- 1.0 vs. 56.2 +/- 1.0 mmol/mol) and preserved Time in Range (74.6 +/- 0.7 vs. 72.4 +/- 1.0%). No safety signal was identified, with one diabetic ketoacidosis event observed during each study period and no increase in severe adverse events. Treatment satisfaction improved (median DTSQc score 11.5), while satisfaction with telemonitoring-supported care and digital messaging was high.Conclusions: Telemonitoring-supported care redesign enabled substantial reductions in outpatient utilization while maintaining glycemic control and participant satisfaction, with no safety signal identified. These findings support telemonitoring not merely as a clinical intervention but as an enabling infrastructure for organizational redesign of diabetes care.
Background: The hypertriglyceridemic waist phenotype, combining abdominal obesity and elevated serum triglycerides, is associated with adverse cardiovascular prognosis. The combination of dietary and exercise programs has the potential to improve outcomes with regard to adverse cardiac remodeling and dysfunction associated with poor metabolic health. We tested the hypothesis that the combination of a Mediterranean Diet (MedDiet) and exercise interventions improves cardiac structure and function more than the sum of each individual intervention.Methods: We performed a randomized 2 & times; 2 factorial design trial that included adults with the hypertriglyceridemic waist phenotype (triglycerides >= 1.50 mmol/L, waist circumference >= 80 cm in women or >= 94 cm in men). Participants were randomly assigned to one of four 16-week interventions: (1) MedDiet alone, (2) exercise alone, (3) MedDiet + exercise, or (4) control group. The MedDiet groups received education, counseling, and key food items from the MedDiet. The exercise groups participated in a structured exercise program designed to achieve 150 min of moderate-intensity aerobic exercise per week. Data were collected during the screening, baseline, and post-intervention visits. In mixed-effects models, we compared the post-intervention echocardiographic measurements of left ventricular (LV) structure and function per intervention group after adjusting for age, sex, and baseline values. We calculated an interaction ratio between MedDiet and exercise to assess their combined effect.Results: Of the 200 recruited, 185 participants (76% women) had available echocardiographic data. LV measurements were within normal range for most participants. After the intervention, the posterior wall thickness (LV structure) was higher in the MedDiet groups (0.04 [95% CI: 0.01-0.07] cm), and the septal mitral annular tissue Doppler e' velocity (diastolic function) was higher in the exercise groups (0.4 [95% CI: 0.0-0.8] cm/s). No significant interactions between interventions were identified with respect to LV measurements.Conclusion: No interaction between the MedDiet and exercise interventions on LV structure and function was observed among adults with the hypertriglyceridemic waist phenotype. Further research is needed to ascertain whether the combination of these interventions can prevent the development of adverse LV remodeling over the long term or in participants with more advanced cardiac alterations.
Background: Overweight, obesity, and type 2 diabetes (T2DM) increase the risk of vascular complications, including retinal vascular alterations. Artificial intelligence (AI)-based retinal screening enables early detection of microvascular damage, potentially contributing to appropriate cardiometabolic prevention strategies. We performed a realworld evidence observational study to assess cardiometabolic parameters as well as retinal vascular alterations using novel AI-based retinal imaging. Methods: Between September and December 2025, we recruited 301 consecutive adults with overweight,obesity, or T2DM; cardiometabolic assessment was performed, and all participants also underwent retinal screening with the Aireen AI system, distinguishing those who resulted positive (n = 42), negative (n = 204), or undetermined (n = 55) at the screening. Results: All patients who resulted positive at the screening were confirmed with a diagnosis of retinal alterations by the ophthalmologists. The presence of positive retinal screening (RS+) progressively increased with worsening fasting glycemia, glycated hemoglobin (HbA1c) levels, carotid intima-media thickness, and endothelial function (P < 0.001 for all). Multivariate logistic regression analysis revealed independent associations of RS+ with HbA1c [odds ratio (OR) 2.29, P < 0.001], carotid stenosis (OR 1.06, P < 0.001), fasting glucose (OR 1.02, P < 0.001), and the triglyceride/high-density lipoprotein cholesterol ratio (OR 2.19, P = 0.010). Conclusions: These findings suggest that AIbased retinal screening with advanced tools can effectively identify early microvascular damage in individuals with overweight, obesity, or T2DM, with RS+ prevalence reflecting glycemic burden and vascular dysfunction. Therefore, integrating AI retinal assessment into cardiometabolic prevention programs may enable timely interventions to prevent progression to vision-threatening complications and support comprehensive cardiovascular risk management.
