Background: Individuals with diabetes have an increased risk of infection-related hospitalization; however, whether type 1 diabetes (T1D) and type 2 diabetes (T2D) differentially influence outcomes following hospitalization remains unclear. We compared mortality, metabolic complications, and hospital outcomes among adults with T1D, T2D, or no documented diabetes admitted with urinary tract infection (UTI) or pneumonia. Methods: We performed a retrospective cohort study using electronic health records from a tertiary 1500-bed medical center (2018–2026). Eligible adult hospital admissions for UTI or pneumonia were classified according to documented T1D, T2D, or no diabetes. The study included 22,475 UTI admissions (211 with T1D, 9230 with T2D, and 13,034 without diabetes) and 32,703 pneumonia admissions (208 with T1D, 15,112 with T2D, and 17,383 without diabetes). Multivariable logistic regression was used to evaluate the association between diabetes status and 30-day mortality, with adjustment for age, sex, BMI, CCI, and MEWS. Because individuals could contribute multiple eligible admissions, the primary mortality models used patient-level cluster-robust standard errors to account for within-patient correlation. Results: T1D admissions involved substantially younger individuals than T2D or non-diabetes admissions but were associated with the greatest metabolic instability during hospitalization. Hypoglycemia occurred in 41.2% of T1D admissions for UTI and 19.7% for pneumonia, compared with 19.6% and 4.1% in T2D, respectively (both p < 0.001). Hyperglycemia was also markedly more frequent in T1D, affecting 88.6% of UTI and 72.6% of pneumonia admissions. ICU transfer was nearly threefold higher in T1D than T2D during UTI hospitalization (10.0% vs. 3.5%, p < 0.001). After adjustment, T1D was not independently associated with 30-day mortality, whereas T2D was associated with modestly lower adjusted odds of 30-day mortality compared with patients without documented diabetes. No significant mortality differences were observed between T1D and T2D. Conclusions: Diabetes type was not independently associated with higher short-term mortality following hospitalization for UTI or pneumonia after adjustment for measured confounders. However, T1D was associated with substantially greater glycemic instability and increased intensive care utilization, suggesting that diabetes type may influence the metabolic complexity and intensity of inpatient management more than short-term survival.
Several decades of intensive research into antidiabetic therapeutics have yielded an expansive, mechanism-driven pharmacopeia. Yet, the clinical endpoint for these diverse agents remains singular and superficial: the reduction in glycated hemoglobin (HbA1c). By focusing primarily on downstream glucose lowering, current therapeutic paradigms treat the symptom rather than the etiology. This approach persists despite definitive consensus that the foundational pathology of type 2 diabetes is much more complex which paves the way to insulin resistance, not merely the spillover of glucose into the bloodstream. This systemic misalignment raises a critical question for the scientific community: are we collectively “agreeing to disagree” on a biological fact or a clinical myth? The Myth is that ‘Persistent hyperglycemia’ is the disease itself, but the fact is: hyperglycemia is a late-stage biomarker of systemic insulin resistance. By managing the biomarker rather than the root cause, clinical medicine has normalized an incomplete treatment model. This review aims to deliberately provoke a shift in rational thinking. We challenge the comfortable status quo of accepting hyperglycemia as the primary definition of diabetes. True therapeutic innovation requires moving past this consensus of convenience. We must reorient basic and clinical science toward reversing the cellular mechanisms of insulin resistance itself, rather than settling for the cosmetic management of blood glucose levels. Rather than merely recounting established therapeutic mechanisms, this review systematically bridges classical antidiabetic pharmacology with the specific pharmacogenomic determinants likely driving hyperglycemia and phenotypic insulin resistance. Mechanisms of action and pharmacogenomic perspectives of α-glucosidase inhibitors, Sulfonylureas, SGLT2 inhibitors, GLP-1 agonists, Meglitinides, Insulins, Metformin, Thiazolidinediones, and DPP4 inhibitors are discussed in this review. In conclusion, mapping the pharmacogenetic landscape of antidiabetic therapies reveals how distinct genetic variations likely dictate drug metabolism and insulin receptor kinetics. Decoding these patient-specific mechanisms is essential to reverse tissue-specific insulin resistance and transition from empirical prescribing to precise, genotype-directed diabetes management.
Background/Objectives: Antiphospholipid antibodies (aPL) comprise anticardiolipin antibodies (aCL), antibodies against β2 glycoprotein I (anti-β2GPI) and lupus anticoagulant (LA). LA is an established risk factor for thrombosis and pregnancy morbidity in the general population. In people with type 1 diabetes (T1D), aPL have been proposed as potential predictors of microvascular and macrovascular diabetes-related complications. The aim of the present prospective, observational study was to investigate the prevalence of aPL in a well-defined cohort of adults presenting with uncomplicated T1D compared with healthy controls. In addition, we prospectively examined whether aPL titers or positivity were potentially associated with the subsequent development of diabetes-related complications. Methods: Two hundred (200) adults with T1D and without microvascular or macrovascular complications participated (mean age, 37.9 ± 10.6 years; mean diabetes duration, 21.00 ± 9.20 years). We also included 200 age- and sex-matched healthy controls (mean age, 37.7 ± 10.1 years) without diabetes mellitus or other autoimmune diseases. The aPL panel, including aCL ΙgG/IgM, anti- β2GPI IgG/IgM, and LA, was assessed using standardized laboratory methods. Participants with T1D were re-evaluated after a mean follow-up of 7.6 years. Results: Titers of aCL IgG/IgM and anti-β2GPI IgG, as well as positivity of aCL-IgG and aCL-IgM, were higher in participants with T1D compared with healthy controls, whereas LA positivity was very low in both groups. In the T1D group, aCL-IgG titers significantly correlated with age and diabetes duration. Neither aCL-IgG titers nor positivity was associated with the development of microvascular or macrovascular complications or with all-cause mortality during follow-up. Conclusions: In adults with long-standing, uncomplicated T1D, most aPL titers and positivity rates were higher than those observed in healthy controls. However, aCL-IgG titers and positivity were not associated with the subsequent development of diabetes-related complications. Larger prospective studies are required to determine whether aPL have predictive value for diabetes-related complications and to identify subgroups of people with T1D who may benefit from aPL testing.
Background/Objectives: Telerehabilitation for physiotherapy programs (TelePhysio) has been shown to improve knee extension force (KEF) in older patients with type 2 diabetes mellitus (T2DM), but factors associated with responsiveness remain unclear. This exploratory secondary analysis investigated whether baseline eating behaviors modified the effectiveness of TelePhysio in KEF. Methods: This secondary analysis included 74 older patients with T2DM enrolled in a randomized controlled trial. The participants were assigned to the TelePhysio (n = 39) or non-intervention group (n = 35). Baseline eating behaviors were assessed using an Eating Behavior Questionnaire. Multiple regression analysis was performed using 6-month KEF as the dependent variable, adjusting for baseline KEF, age, sex, body mass index, diabetic polyneuropathy, intervention group, baseline eating behavior score, and their interactions. The original trial was prospectively registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; UMIN000024416; registered on 15 October 2016). Results: A significant interaction was found between the intervention group and baseline eating behavior score (B = −0.0064, p = 0.0352). Estimated TelePhysio effects on eating behavior scores corresponding to mean − 1 standard deviation (SD), mean, and mean + 1 SD were +0.36, +0.12, and −0.12 Nm/kg, respectively. None of the seven domain-specific group-by-domain interactions reached statistical significance. Sensitivity analyses using KEF changes showed a similar directional trend but were not statistically significant (p = 0.2913). Conclusions: Baseline eating behaviors may be associated with differential responsiveness to TelePhysio in older adults with T2DM. The estimated effect of TelePhysio on KEF was smaller at higher baseline Eating Behavior Questionnaire scores. These findings should be cautiously interpreted because the interaction was not confirmed using sensitivity analysis regarding changes in the KEF.
Background/Objectives: The ankle–brachial index (ABI) is a low-cost, non-invasive screening tool for peripheral artery disease (PAD) and an independent predictor of cardiovascular events, which makes it suitable for primary care. Peripheral haemodynamic data across body mass index (BMI) gradients remain scarce, and BMI and diabetes are seldom modelled together despite their frequent co-occurrence. We investigated their associations with peripheral haemodynamic parameters. Methods: We performed a cross-sectional study in 147 primary care users, twenty-seven of whom had a self-reported diagnosis of diabetes mellitus (DM). Systolic pressure was obtained by auscultation, with Doppler being unavailable. The ABI was calculated per leg from unrounded pressure, and the lower index was adopted and classified according to American Heart Association thresholds (abnormal: ≤0.90; borderline: 0.91–0.99; normal: 1.00–1.40; elevated: >1.40). Nested linear models with robust standard errors estimated the adjusted association of DM with each outcome. Results: The DM group was older (62 vs. 44 years; p < 0.001), with greater rates of excess weight (77.8% vs. 54.2%), hypertension (59.3% vs. 25.8%), dyslipidaemia (48.1% vs. 11.7%), and smoking (30.8% vs. 10.1%). Crude upper-limb systolic pressure was 10.1 mmHg higher in the DM group (95% confidence interval [CI]: −0.5 to 20.6) but fell to 1.3 mmHg upon adjustment for age (p = 0.82 fully adjusted). The ABI did not differ between the groups (mean difference of 0.02, 95%CI: −0.06 to 0.11; p = 0.59) and showed no gradient across BMI. An abnormal ABI was present in 14.4% of participants and a borderline ABI in 18.5%, so that 32.9% had an ABI below 1.00. Conclusions: The crude blood pressure difference was attenuated after adjustment, chiefly for age, and DM was not independently associated with any outcome; residual confounding cannot be excluded. No ABI difference was detected, but power reached 80% only for a difference of about 0.12 units. The fact that one-third of participants had an ABI below 1.00 warrants further investigation of risk-based vascular peripheral assessment in primary care.
Background: Diabetic foot ulcer (DFU) recurrence remains a primary challenge in diabetes care. Although wound closure is the conventional therapeutic endpoint, it does not equate to risk resolution. Despite the implementation of evidence-based preventive strategies, a significant proportion of patients experience recurrent ulceration, highlighting an efficacy gap in current management. Objectives: This narrative review aims to quantify the residual recurrence risk and to provide a clinical framework for risk stratification in patients in remission. Methods: A structured narrative review of PubMed and Google Scholar (up to May 2026) was conducted to evaluate the residual burden associated with standard preventive interventions. Only English-language publications were considered. Results: Our analysis reveals that even with optimal adherence to established preventive protocols, a substantial residual risk persists, ranging from 16.7% to 41.4%. Clinical data indicate that the frequency of podiatric follow-up is a critical determinant of outcomes, with a 4-week screening interval limiting residual risk to 18.4%, significantly outperforming less frequent assessments. Conclusions: The persistence of residual risk mandates a paradigm shift in diabetic foot management: from a “healing-centered” approach to a “remission-focused” model. We propose an integrated, multidisciplinary strategy—anchored by 4-week podiatric surveillance—to mitigate the multifactorial drivers of recurrence and narrow the efficacy gap in clinical practice.
Background/Objectives: Prediabetes is a highly prevalent metabolic condition associated with an increased risk of progression to type 2 diabetes mellitus (T2DM) and related cardiometabolic complications. Although lifestyle modification remains the cornerstone of diabetes prevention, long-term adherence is often challenging in routine clinical practice. This systematic review and meta-analysis aimed to evaluate the effect of metformin therapy on progression from prediabetes to T2DM and its impact on glycemic and metabolic outcomes. Methods: A systematic literature search was conducted in PubMed, MEDLINE, and Web of Science in accordance with the PRISMA 2020 guidelines. Studies involving adults with prediabetes that evaluated metformin therapy and reported diabetes-related outcomes were eligible for inclusion. Risk of bias was assessed using the RoB 2 tool and the NOS. Where appropriate, quantitative meta-analysis was performed using a random-effects model. Results: Forty-one publications were included in the systematic review, with eligible subsets contributing to the quantitative analyses. Overall, the available evidence suggested that metformin was associated with a reduced risk of progression from prediabetes to T2DM compared with placebo, usual care, or lifestyle intervention alone. Long-term follow-up studies demonstrated sustained preventive effects extending beyond 10 years. Meta-analysis demonstrated a significant reduction in BMI among metformin-treated participants (MD = −2.06, 95% CI −2.53 to −1.60; I2 = 0%; p < 0.001). Findings for glycated hemoglobin and fasting plasma glucose were variable across studies and did not consistently reach statistical significance. Some studies reported additional improvements in insulin sensitivity and other cardiometabolic outcomes, although these findings were not consistently reported across the evidence base. Conclusions: The available evidence supports metformin as an effective adjunctive pharmacological strategy for reducing progression from prediabetes to T2DM, particularly among selected high-risk adults. When used alongside lifestyle modification, metformin may provide additional benefits in body weight and metabolic health. However, lifestyle intervention should remain the first-line preventive strategy. Further high-quality studies are needed to optimize patient selection, dose, treatment duration, and long-term clinical outcomes.
Background: The most appropriate management of glucose-lowering therapies in patients exposed to iodinated contrast media (ICM) is still debated. The recent development of antidiabetic drugs that improve cardiovascular and renal outcomes leads to questions regarding their impact on the risk of contrast-associated acute kidney injury (CA-AKI). The present study aimed to assess the effect of different glucose-lowering therapies on the rate of CA-AKI among patients undergoing coronary angiography and/or angioplasty. Methods: Diabetic patients exposed to ICM for coronary procedures were retrospectively identified and divided according to the strategy for the management of diabetes mellitus. The use of a new antidiabetic drug (NAD) was defined for patients treated with SGLT2-I, DDP4-I or GLP-1 receptor agonists on admission. The primary endpoint was the occurrence of CA-AKI within 72 h after contrast medium exposure. Results: We included 462 patients with diabetes mellitus, 51.5% treated with insulin, 44.4% treated with metformin and 50.9% receiving NAD. Among them, 48 (10.4%) experienced CA-AKI. Patients experiencing acute renal injury were more often treated with calcium channel blockers (p = 0.04) and diuretics (p = 0.004), and less often P2Y12 inhibitors (p = 0.04), and presented lower levels of hemoglobin (p = 0.02). Patients receiving NADs displayed a significantly lower occurrence of CA-AKI (33.3% vs. 53.6%, p = 0.009), mainly for those treated with SGLT2-I. On the contrary, patients treated with sulfonylureas and meglitinides displayed a significant increase in the rate of CA-AKI (10.4% vs. 3.9%, p = 0.05). The results were confirmed via multivariable analysis, with NADs and diuretics emerging as the only independent predictors of CA-AKI (NAD: adjusted OR = 0.42 [0.21–0.81], p = 0.01; diuretics: adjusted OR = 2.22 [1.14–4.35], p = 0.02). The independent predictors of CA-AKI were the use of NADs (adjusted OR = 0.45 [0.24–0.86], p = 0.02) and diuretics (adjusted OR = 2.57 [1.33–4.97], p = 0.005). Conclusions: Among patients with diabetes mellitus undergoing coronary angiographic procedures, the use of diuretics, sulfonylureas and meglitinides is associated with an increased occurrence of CA-AKI, whereas the rate of events was significantly lower among users of new antidiabetic drugs and especially SGLT2-I.
Metabolic diseases, including obesity and type 2 diabetes mellitus, represent a major global health burden and are closely linked to the composition and function of the gut microbiota. Advances in molecular methods have enabled detailed characterization of microbial communities and their interactions with diet, medications, and host physiology, positioning the microbiome as an active metabolic organ. However, the field faces persistent challenges in distinguishing causal relationships from associations, largely owing to substantial biological, exposure-related, and methodological heterogeneity. This review systematizes the principal lines of evidence connecting the gut microbiome to metabolic disorders and critically examines the sources of variability that limit reproducibility and cross-cohort transferability of these findings. We discuss the taxonomic, functional, and metabolite-based levels of microbiome analysis, evaluate the strengths and limitations of cross-sectional, case–control, cohort, and interventional study designs, and consider approaches for establishing causality, including fecal microbiota transplantation, Mendelian randomization, mediation analysis, causal diagrams, and triangulation of evidence. We conclude that only a comprehensive, standardized, and causally informed approach will allow reliable discrimination between true microbiota-driven effects and methodological artifacts, thereby advancing the integration of microbiome science into the management of metabolic diseases and diabetes.
Objective: This study aimed to evaluate how using personal health records (PHRs; Health2Sync®) impacts long-term glycemic management and body weight in people with type 2 diabetes (T2DM) and to identify factors associated with glycated hemoglobin (HbA1c) changes. Methods: This single-center, retrospective observational study included 154 patients with T2DM (76 PHR users and 78 non-users [control]; mean age: 57.9 and 65.0 years, respectively) between April 2022 and June 2024. Clinical parameters (HbA1c, body weight; BW), nutritional support, and antidiabetic medications were collected at the index date and at 3, 6, and 12 months. The between-group difference in HbA1c change (ΔHbA1c) from the index date to 12 months was the primary outcome, and the between-group difference in body weight change (ΔBW) was the secondary outcome. Factors associated with ΔHbA1c were explored using multivariate analysis in the PHR group. Results: In the PHR group, ΔHbA1c from the index date showed a significant reduction as early as 3 months, and this decrease was sustained at 6 and 12 months (p < 0.001). Furthermore, a similar trend was observed for ΔBW (p < 0.001). Moreover, multivariable regression analysis revealed an independent association between nutritional support and improvement in HbA1c. Conclusions: PHR use was associated with improved glycemic control and weight reduction in people with T2DM, and together with nutritional support, it may further enhance self-management and clinical outcomes.
Background: Type 2 Diabetes Mellitus (T2DM) is associated with cognitive decline, potentially mediated by neuroinflammatory processes and altered neuroplasticity. This study investigated cerebrospinal fluid (CSF) biomarkers of neuroinflammation and neuroplasticity in T2DM individuals versus controls, and their relationship with cognitive performance. Methods: This cross-sectional study included 56 T2DM individuals and 26 controls (aged 37–70 years; 48% male). CSF concentrations of leptin, IL-6, VEGF, BDNF, TNF-α, IGF-1, and IL-1β were measured using ELISA. Cognitive function was assessed using MMSE, the Stroop test, SDMT, RCFT, and TAAV. Group comparisons used Mann–Whitney U or t-tests; Spearman correlations examined variable relationships. Results: No statistically significant differences in CSF biomarkers were observed between groups. However, T2DM patients showed lower word recall (4.66 ± 1.48 vs. 5.81 ± 1.52; p = 0.002), reduced Symbol–Digit performance (17.82 ± 12.16 vs. 24.92 ± 12.10; p = 0.016), and higher Complex Figure Test scores (19.94 ± 9.32 vs. 15.94 ± 5.02; p = 0.009). IL-6 was negatively correlated with MMSE (r = −0.33, p = 0.005). Significant correlations emerged between MMSE and Symbol–Digit scores (r = 0.40, p < 0.001) and among biomarkers. Conclusions: “No statistically significant differences in CSF biomarkers were observed between groups and unadjusted CSF biomarker concentrations did not differ significantly between groups; however, after adjustment for age and BMI, IL-6 was significantly elevated in T2DM patients, indicating that covariate-adjusted analyses may be more sensitive for detecting subtle neuroinflammatory differences in this population.
Background: Contemporary antidiabetic therapy has evolved from a glucose-centered approach toward integrated cardiometabolic risk reduction. However, real-world evidence regarding treatment patterns and their association with glycemic and cardiovascular–renal profiles remain limited. Methods: This retrospective observational study included 250 adults with type 2 diabetes mellitus receiving non-insulin glucose-lowering therapy in routine specialist clinical practice. Demographic, clinical, biochemical, and pharmacological data were extracted from medical records. Glycemic control was assessed using HbA1c levels and HbA1c variation, while cardiovascular–renal parameters included estimated glomerular filtration rate (eGFR), C-reactive protein (CRP), lipid profile, blood pressure, and heart failure prevalence. Comparative analyses and multivariate logistic regression were performed. Results: The cohort had a mean age of 61.8 ± 11.3 years, and all patients had type 2 diabetes mellitus (100.0%). Obesity, metabolic syndrome, hypertension, ischemic heart disease, and chronic kidney disease were highly prevalent. Metformin was the most frequently prescribed therapy (58.8%), followed by GLP-1 receptor agonists (28.8%) and SGLT-2 inhibitors (27.6%). Patients receiving GLP-1 receptor agonists or SGLT-2 inhibitors showed numerically lower HbA1c values and greater HbA1c reductions compared with conventional therapies. However, differences in HbA1c, CRP, and eGFR were not statistically significant after correction for multiple comparisons. Longer diabetes duration independently predicted poor glycemic control, whereas increasing age was associated with a lower probability of HbA1c > 7%. Conclusions: Contemporary antidiabetic therapies were associated with favorable numerical cardiometabolic trends, although these associations did not remain statistically significant after multiple-comparison correction. The findings should therefore be considered exploratory and hypothesis-generating.
Background/Objectives: The prevalence of obesity is increasing among Japanese patients with type 2 diabetes (T2D); however, the impact of obesity history and severity on microvascular complications remains poorly understood. This study aimed to investigate the association of lifetime maximum body mass index (BMI) and BMI at the first clinical visit with the development and progression of diabetic nephropathy and retinopathy. Methods: This retrospective cohort study included T2D patients who first visited the clinic of the Institute for Medical Sciences, Asahi Life Foundation between 2005 and 2022. Patients were categorized into five groups based on both lifetime maximum and first-visit BMI: underweight, normal weight, class I obesity, class II obesity, and severe obesity. The primary endpoints were renal events (sustained increase in proteinuria or ≥40% decline in eGFR) and retinal events (worsening of diabetic retinopathy by ≥1 stage). Results: A history of severe obesity, based on the lifetime maximum BMI, was an independent risk factor for proteinuria progression. While a history of severe obesity was associated with all endpoints in unadjusted analyses, these associations with eGFR decline and retinopathy were not significant after adjusting for covariates. In contrast, the BMI at the first visit was significantly associated with retinal events but not with renal events. Conclusions: A history of maximum lifetime obesity is a critical predictor of the proteinuria progression. A history of obesity, a simple clinical metric, is a valuable tool for identifying high-risk patients and may contribute to more effective preventative strategies.
Background: Type 2 diabetes mellitus (T2DM) is associated with impaired skeletal muscle mass and function; however, respiratory muscle involvement has not been fully investigated, particularly in Japanese patients. This study aimed to evaluate respiratory muscle strength and identify its associated factors in Japanese patients with T2DM. Methods: This cross-sectional study included 55 patients with T2DM without respiratory disease. Maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax) were measured and expressed as percentages of the predicted values (PImax %pred and PEmax %pred). Clinical variables, including age, sex, body mass index (BMI), diabetic polyneuropathy (DPN), skeletal muscle index (SMI), handgrip strength, and 6-min walk distance (6MWD), were assessed. Correlation and multiple regression analyses were performed to identify factors associated with PImax %pred. Results: PImax %pred was significantly lower than the predicted value (69.5% [95% CI: 63.1–75.9], p < 0.001), whereas PEmax %pred did not differ significantly from the predicted value (95.6% [95% CI: 86.8–104.3]). PImax %pred was significantly associated with age, BMI, SMI, handgrip strength, and 6MWD. In multiple regression analysis, age, sex, BMI, and handgrip strength were independently associated with PImax %pred, whereas DPN was not. These findings remained unchanged after adjusting for smoking habits. Conclusions: Inspiratory muscle strength was selectively reduced in Japanese patients with T2DM and was independently associated with general physical characteristics and overall muscle strength. Inspiratory muscle weakness may reflect generalized skeletal muscle dysfunction rather than solely a neuropathic impairment. This assessment of respiratory muscle strength may provide additional insights into the physical function of patients with T2DM.
Background/Objectives: Uncontrolled diabetes and associated comorbidities disproportionately affect African American (AA) adults. Medication adherence is key to diabetes control yet is often suboptimal, particularly among AA adults. This study examined associations between patient characteristics and adherence among AA adults with uncontrolled diabetes and compared two medication adherence instruments for predicting diabetes control. Methods: This cross-sectional analysis used baseline data from the Management of Diabetes in Everyday Life (MODEL) study, a clinical trial to improve diabetes self-care among AA adults with uncontrolled diabetes. Internal consistency of the 12-item Adherence to Medication Refills and Medications Scale for diabetes medications (ARMS-D) was evaluated by comparing its Cronbach alpha to the standardized Cronbach alpha calculated from MODEL data. Associations with variables were examined using correlations, t-tests, or ANOVA, as appropriate. Stepwise multiple regression identified predictors of diabetes control assessed by hemoglobin A1c (HbA1c). Results: Among 665 participants (mean age = 54 years, HbA1c = 10.24%; 67% female; 73% high health literacy), 75% reported perfect adherence on the Summary of Diabetes Self-Care Activities Medications Subscale (SDSCA-MS) versus 7.3% on ARMS-D. ARMS-D showed strong internal consistency (alpha = 0.81). Lower adherence by ARMS-D was associated with younger age, higher social complexity, and depression (all p <= 0.001). ARMS-D score, age, depression, and insulin, dipeptidyl peptidase 4 inhibitor, and sodium-glucose co-transporter 2 inhibitor use predicted baseline HbA1c. Conclusions: This study demonstrates that younger age, depression, and high social complexity are associated with lower medication adherence measured using the ARMS-D. Adherence gaps identified by ARMS-D may validly predict diabetes control and help guide interventions to improve diabetes care in AA adults with uncontrolled diabetes.
Diabetic kidney disease (DKD) remains a primary driver of end-stage kidney disease and cardiovascular morbidity despite the optimized use of renin–angiotensin system (RAS) inhibitors and sodium-glucose cotransporter-2 (SGLT2) inhibitors. Recent evidence identifies the overactivation of the mineralocorticoid receptor (MR) as a critical, independent pathway leading to persistent renal inflammation and fibrosis. In the diabetic milieu, MR overactivation—driven by both aldosterone and ligand-independent factors such as Rac1 GTPase and oxidative stress—triggers pro-inflammatory and pro-fibrotic gene networks. Unlike traditional steroidal mineralocorticoid receptor antagonists (MRAs), the novel non-steroidal MRA finerenone exhibits a distinct binding mode that more effectively blocks the recruitment of transcriptional co-activators, thereby silencing detrimental downstream signaling in podocytes, fibroblasts, and myeloid cells. Preclinical models have demonstrated that MR blockade significantly reduces albuminuria and preserves podocyte integrity independent of systemic blood pressure. These findings translated into landmark clinical trials; the FIDELIO-DKD and FIGARO-DKD trials established that finerenone significantly reduces the risk of kidney disease progression and cardiovascular events across a broad spectrum of chronic kidney disease stages in type 2 diabetes. Furthermore, recent data from the FINEARTS-HF and CONFIDENCE trials suggest a synergetic benefit when combined with SGLT2 inhibitors, offering more robust cardiorenal protection with a manageable risk of hyperkalemia. This review synthesizes the current understanding of MR pathophysiology and clinical evidence, providing a comprehensive framework for the integration of MRAs into the evolving standard of care for patients with diabetic kidney disease.
Background: Kidney transplant recipients (KTRs) with diabetes mellitus (DM) are at high cardiovascular risk, and heart failure (HF) is a major concern. Dapagliflozin has proven benefits in HF, but data in KTRs are scarce. Methods: Retrospective analysis of adult KTRs with DM and HF who received dapagliflozin. Data were collected at baseline, defined as dapagliflozin initiation, and at the most recent follow-up (April 2024). Outcomes included changes in LVEF, renal function, metabolic and hemodynamic parameters, hospitalizations, and adverse events. Results: In 32 KTRs (median age 60.5 years, 66% male), after a median follow-up of 2.2 years, left ventricular ejection fraction (LVEF) did not change significantly (60% to 58%, p = 0.28). Systolic BP decreased by 5 mmHg (p < 0.001) and diastolic BP by 3 mmHg (p = 0.034). HbA1c decreased from 7.3 [6.6-8.1] to 6.8 [6.3-7.7]% (p = 0.034), while LDL-c and triglycerides decreased (p = 0.013 and p < 0.001). Body weight and BMI also decreased (both p < 0.001). Renal function, as assessed by eGFR, remained stable (p = 0.633), with no major renal safety signals. No deaths, severe hypoglycemia, or ketoacidosis occurred; urinary tract infections in 12%. Conclusions: In this exploratory cohort, dapagliflozin use was followed by stable graft function and changes in metabolic and hemodynamic parameters. No significant change in LVEF was observed. Given the observational design, small sample size, limited echocardiographic data, and absence of a control group, causal inference is not possible. These hypothesis-generating findings require confirmation in prospective controlled trials of KTRs with diabetes and heart failure.
This review aims to present an updated, comprehensive analysis of data on the diversity and challenges of current approaches to the screening and monitoring of subjects at risk of T1D, as the earliest interventions during the course of the disease. Previously, screening for T1D was justified only for research purposes. A major turning point occurred when teplizumab, an immunomodulatory drug that delays the onset of overt T1D, was approved. Nowadays, there is a growing number of screening initiatives, and this trend is spreading fast across the world. In this context, novel recommendations emphasize the need for the wider identification of subjects at risk of T1D, suggesting that screening should not include only first-degree relatives of persons with T1D. Furthermore, current experts’ opinions have shifted the detection of T1D risk in the direction of ultimate goal-screening in the general population. Also, subjects at risk should be monitored, undergo metabolic testing, be informed about their risk, and be educated about the disease. Currently, there is a diversity in approaches to the screening and monitoring of subjects at risk of T1D, predominantly in the pediatric population. Several knowledge gaps persist in this area of investigation, especially in recommendations and potential benefits for the adult population. However, the scientific community is focusing on developing and adapting screening and monitoring strategies to suit particular countries, aiming to make them more universal while refining the definition of individual risk for T1D. Nevertheless, the screening and monitoring of subjects at risk should be the earliest interventions focused on delaying T1D.
Background/Objectives: Contemporary diabetes guidelines increasingly emphasize broader cardiometabolic risk stratification beyond glycemic control, but the national proportion of Peruvian adults with diagnosed diabetes who show obesity or hypertension is unknown. We estimated the prevalence of overweight/obesity, obesity, and hypertension; quantified the proportion meeting at least one cardiometabolic-profile criterion; and described recent acquisition of diabetes medications. Methods: We performed a cross-sectional analysis of the Peruvian Demographic and Family Health Survey (ENDES) 2022-2024. Adults aged >= 30 years with a prior medical diagnosis of diabetes were included (n = 2599; weighted population estimate = 1.51 million) from 49,363 eligible adults (weighted population estimate = 19.91 million). Survey-weighted prevalences of overweight (body mass index [BMI] >= 25 kg/m2), obesity (BMI >= 30 kg/m2), hypertension (primary definition: systolic blood pressure [SBP] >= 140 mmHg or diastolic blood pressure [DBP] >= 90 mmHg), and diabetes medication purchase in the previous 12 months were estimated. Results: Mean age was 60.0 years (95% confidence interval [CI]: 59.2-60.8), and 55.9% were women. Overall, 81.5% (95% CI: 79.2-83.7) had overweight/obesity, 41.1% (95% CI: 38.0-44.3) had obesity, and 31.8% (95% CI: 28.7-34.9) had hypertension by the primary survey definition. Among participants with complete data for obesity and hypertension (n = 2534; weighted population estimate = 1.45 million), 58.5% (95% CI: 55.4-61.6) met at least one cardiometabolic-profile criterion. Independently, 78.9% (95% CI: 76.4-81.3) reported purchasing diabetes medications, with lower proportions in rural populations and among uninsured adults. Conclusions: Nearly six in ten Peruvian adults with diagnosed diabetes had obesity or hypertension, a population-level profile consistent with substantial cardiometabolic complexity and the potential need for broader risk-oriented management beyond glucose alone. Persistent gaps in medication acquisition suggest that therapeutic modernization and equitable continuity of basic pharmacologic treatment should be addressed simultaneously.
Background: Diabetes is the eighth-leading cause of death in the U.S. and poor blood glucose (BG) management is associated with serious long-term complications. While educational interventions have been shown to improve health outcomes among individuals with diabetes, evidence regarding the effectiveness of gamification remains inconsistent. The purpose of this study is to evaluate existing systematic reviews on the effectiveness of gamification interventions for blood glucose management among individuals with diabetes. Method: A systematic literature search was conducted using electronic databases including Medline, Embase, Cochrane library, APA PsycInfo, Web of Science, and Campbell systematic reviews. Studies published in English with gamification as the primary intervention and BG or HbA1c as primary outcomes were included in the review. Studies were excluded if they involved gestational diabetes, used gamification alongside other interventions, or were classified as gray literature. The quality of each review was assessed using a modified AMSTAR 2 tool. Results: Of 382 articles screened, eight systematic reviews were included in the final review. In the quality assessment, four reviews fulfilled 11 out of 13 (84.6%) of the critical appraisal items. All (100%) of the reviews demonstrated reduction in HbA1c; however, the reduction was statistically significant in only one review. Conclusions: Gamification shows potential in assisting with glycemic control, with reviews finding a decrease in HbA1c among patients with diabetes. More rigorous, large-scale studies need to be done to understand gamification as a method of diabetes management and long-term outcomes.
