ABSTRACT Aims Diabetes distress is common among adults with Type 1 diabetes (T1D) and is associated with poorer psychological and medical outcomes. While diabetes distress occurs across the lifespan, less is known about how its sources differ by age and how patient input can inform intervention development. Methods Using a user‐centred design (UCD) approach, we conducted six virtual group sessions with adults with T1D to inform the development of a cognitive‐behavioural intervention targeting diabetes distress. Participants included young adults aged 18–34 recruited from an academic medical centre and adults aged 35–64 recruited from a national patient advisory council. Sessions were audio‐recorded, transcribed and analysed using a modified inductive qualitative approach. Results Nineteen adults with T1D participated. Across age groups, participants identified shared domains of diabetes distress, including competing daily priorities, financial and insurance‐related barriers, interpersonal relationships and healthcare system challenges. However, important age‐related differences emerged. Young adults emphasized immediate disruptions to daily life, identity, competing priorities and technology‐related burden, whereas adults aged 35–64 highlighted cumulative fatigue, fear of complications, caregiving responsibilities and long‐term concerns related to healthcare access and financial sustainability. Conclusions Diabetes distress is a pervasive but age‐contextualized experience among adults with T1D. Incorporating stakeholder perspectives revealed both shared and age‐specific drivers of distress, supporting the need for life stage‐responsive psychosocial interventions to address diabetes distress in adults with T1D.
ABSTRACT Background Prediabetes is a critical window for preventing progression to type 2 diabetes mellitus (T2DM). Both vitamin D deficiency and physical inactivity are associated with impaired glucose metabolism. This study compared the effects of Traditional Chinese Exercise (TCE) and Kuanle Equipment Exercise (KEE) on glycaemic measures, lipid profiles, body composition and serum 25‐hydroxyvitamin D3 [25(OH)D3] in middle‐aged and elderly adults with prediabetes. Methods We conducted a 12‐week, single‐centre, randomised controlled trial involving 62 participants with prediabetes (mean age 55.2 ± 8.4 years; 88.7% female). Participants were randomly assigned to control (usual care, n = 21), TCE (n = 20), or KEE (n = 21). Primary outcomes included fasting plasma glucose (FPG), 2‐h OGTT glucose, glycated haemoglobin (HbA1c) and serum 25(OH)D3. Secondary outcomes comprised triglycerides, total cholesterol, LDL‐C, HDL‐C and body composition. Results At baseline, mean serum 25(OH)D3 was 21.53 ± 3.90 nmol/L. At 12 weeks, both TCE and KEE improved FPG, 2‐h OGTT glucose, HbA1c and 25(OH)D3 versus control (all p ≤ 0.001). Relative changes in FPG were −9.4% (TCE) and −15.2% (KEE) versus −1.5% (control); corresponding changes were −14.6% and −21.2% for 2‐h OGTT glucose, −6.7% and −12.9% for HbA1c, and +60.6% and +81.9% for 25(OH)D3. Direct TCE–KEE comparisons were not significant (all p > 0.05). In an exploratory analysis, change in 25(OH)D3 was inversely associated with change in 2‐h OGTT glucose (partial r = −0.358, p = 0.006), but not with FPG, HbA1c, or triglycerides. Conclusions Both TCE and KEE improved glycaemic outcomes and increased serum 25(OH)D3 compared with usual care in middle‐aged and elderly adults with prediabetes. Although KEE produced numerically larger estimates, direct between‐group comparisons were not significant, and the superiority of KEE over TCE was not established. These vitamin D findings require confirmation in trials that quantify sunlight exposure and dietary vitamin D intake.
ABSTRACT Background and Aim This network meta‐analysis addresses the limited dose‐specific comparative evidence by evaluating different doses of tirzepatide (TZP) versus dulaglutide (DULA) for glycemic control, weight loss, and safety in type 2 diabetes mellitus (T2DM). Methods Following PRISMA and Cochrane guidance, we searched major databases for RCTs comparing TZP and DULA in adults with T2DM. Efficacy outcomes included body weight change (Weeks 12 and 16) and mean HbA1c change (Weeks 12 and 24). Safety outcomes included mortality, cardiovascular events, and adverse events (AEs). SUCRA ranking was used and analysis performed in RStudio (v4.5.1). Results Four RCTs comprising 14,348 participants contributed to a seven‐node network. However, Nicholls et al. 2025 had the majority of sample size (n = 13,165). TZP 15 mg achieved the greatest reduction in body weight at Week 16 (mean difference [MD] vs. TZP 5 mg: −2.68 kg; 95% CI −4.98 to −0.38), while TZP 1 mg (MD: 4.39 kg; 95% CI 1.28 to 7.51) and DULA 0.75 mg (MD: 3.10 kg; 95% CI 0.25 to 5.96) were associated with smaller reductions relative to TZP 5 mg. TZP 15 mg also produced the largest HbA1c reduction at Week 24 (MD vs. TZP 5 mg: −0.40%; 95% CI −0.62 to −0.19), compared with TZP 10 mg (MD: −0.23%; 95% CI −0.44 to −0.02) and DULA 1.5 mg (MD: 0.67%; 95% CI 0.25 to 1.09). No significant differences were observed between treatments for all‐cause mortality or major cardiovascular events. Gastrointestinal AEs were more frequent with higher TZP doses, especially TZP 15 mg vs. TZP 5 mg for nausea, while serious AEs and severe hypoglycemia were similar across doses. Conclusion Higher TZP doses potentially improve efficacy, while lower TZP/DULA doses enhance tolerability, supporting individualized T2DM care. However, these findings should be interpreted cautiously because several comparisons are indirect, many participants had not reached their maintenance dose, several safety outcomes were based on limited event counts, and significant inconsistency was observed for early body‐weight outcomes.
ABSTRACT Introduction This study aims to develop a machine‐learning‐based risk prediction model for a long‐term visual prognosis in patients with proliferative diabetic retinopathy (PDR) following pars plana vitrectomy (PPV). Methods We analysed 609 PDR patients (609 eyes) who underwent PPV at Shanxi Eye Hospital from January 1, 2022, to January 1, 2025. The dataset was randomly split into training and validation sets at an 8:2 ratio. Candidate risk factors were identified using LASSO regression, followed by multivariate logistic regression to determine independent predictors. Machine learning algorithms were then trained to construct the prediction model, with performance evaluated by AUC‐ROC, accuracy, precision, recall, and F1 score. Calibration was assessed via calibration curves, and clinical utility by decision curve analysis (DCA). Results LASSO regression and multivariate logistic regression indicated that several factors influenced postoperative long‐term visual prognosis. These included Renal Insufficiency (OR = 6.932, 95% CI: 3.394–14.158), Preoperative iris neovascularization (OR = 7.674, 95% CI: 3.699–15.920), Silicone oil tamponade (OR = 2.799, 95% CI: 1.641–4.707), Indirect bilirubin (IBIL) (OR = 0.902, 95% CI: 0.829–0.981) (p < 0.05). LightGBM was found to be the best for predicting postoperative long‐term visual prognosis risk in PDR patients. The LightGBM model demonstrated good calibration in both training and validation sets. DCA of the validation set showed clinical net benefit at low‐to‐moderate risk thresholds, outperforming both ‘treat‐all’ and ‘treat‐none’ strategies. Conclusions In conclusion, this study developed a machine learning‐based prognostic model for long‐term visual prognosis in PDR patients after PPV, visualized as a proof‐of‐concept web calculator to assist clinical staff in early risk identification and support personalised treatment planning, pending external validation and prospective evaluation.
ABSTRACT Purpose To explore the clinical value of adrenal venous sampling (AVS) and CXCR4‐directed 68Ga‐pentixafor PET/CT in the subtype diagnosis of primary aldosteronism (PA), with postsurgical blood pressure control and biochemical cure as primary endpoints, and to compare the accuracy and practicability of the two methods. Methods A retrospective cohort study was conducted in PA patients undergoing unilateral adrenalectomy at West China Hospital between February 2023 and June 2025. Patients were divided into the AVS and CXCR4 imaging groups. The primary outcome was the clinical and biochemical success rate according to the Primary Aldosteronism Surgical Outcome (PASO) criteria. In the subgroup with both procedures, AVS was considered the reference standard to assess the diagnostic efficacy of CXCR4. Results A total of 160 patients completed the trial. According to the PASO criteria, the total biochemical success rate was 93.1%, among which the complete biochemical success rate in the AVS group was 84.1%, and in the CXCR4 group it was 93.1% (p = 0.091); the total clinical success rate was 82.5%, with a complete clinical success rate of 40.9% in the AVS group and 30.3% in the CXCR4 group (p = 0.412). There were no statistically significant differences between the two groups. In 16 patients with both examinations, CXCR4 showed a sensitivity of 70.0%, specificity of 83.3%, accuracy of 75.0%, and moderate agreement with AVS. Conclusion CXCR4 showed no statistical difference from AVS in diagnostic and prognostic outcomes in this study. However, discordance in multinodular disease indicates that molecular imaging cannot fully reflect the heterogeneity of aldosterone secretion. This finding requires verification in a larger cohort.
