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™ 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™ 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 × 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.
Background: The triglyceride-glucose (TyG) index has been associated with atherosclerotic cardiovascular disease (ASCVD) risk. However, the associations of TyG-related indices combined with obesity measures, including body mass index, waist circumference (WC), waist-to-height ratio, and body roundness index, with 10-year ASCVD risk across different populations remain unclear. Methods: Data from the China Health and Retirement Longitudinal Study (CHARLS; n = 8224) and the National Health and Nutrition Examination Survey (NHANES; n = 13,527) were analyzed. Weighted multivariable logistic regression, restricted cubic spline (RCS) analyses, and subgroup analyses were performed to evaluate the associations between TyG-related indices and 10-year ASCVD risk. Results: TyG and TyG-related indices were significantly associated with higher 10-year ASCVD risk in both cohorts. Nonlinear associations were observed between several TyG-related indices and ASCVD risk. Compared with the U.S. population, obesity-related TyG composite indices showed relatively stronger associations with ASCVD risk among Chinese adults. Subgroup analyses demonstrated more pronounced associations among females in the CHARLS cohort, whereas in NHANES, significant sex differences were observed only for the TyG index. Among the evaluated indices, TyG–WC showed relatively stronger associations with ASCVD risk across both datasets. Conclusion: TyG-related indices were significantly associated with 10-year ASCVD risk across Chinese and U.S. populations, although the strength of these associations varied between populations. TyG–WC may provide additional value for ASCVD risk assessment. Further longitudinal studies are warranted to validate these findings and clarify the underlying mechanisms.
Background: Metabolic dysfunction–associated steatotic liver disease (MASLD) is a growing public health challenge, highlighting the need for accessible markers of metabolic liver disease risk. Serum uric acid (SUA) has been linked to metabolic dysfunction, but its association with MASLD across the full clinical spectrum, including conventionally normal SUA ranges, and its prognostic relevance remain incompletely characterized. We evaluated the association between SUA and MASLD, including the dose–response relationship, and examined whether baseline SUA was associated with all-cause mortality among adults with MASLD. Methods: We performed a two-stage study using National Health and Nutrition Examination Survey data from 1999 to 2020. Stage 1 assessed the cross-sectional association between SUA and MASLD prevalence among 28,199 adults using survey-weighted logistic regression with quadratic and restricted cubic spline modeling. MASLD was defined according to 2023 multi-society consensus criteria as hepatic steatosis plus at least one metabolic abnormality. Stage 2 prospectively followed 6623 adults with MASLD for all-cause mortality using survey-weighted Cox proportional hazards models. Results: SUA demonstrated a significant nonlinear association with MASLD prevalence. In the primary adjusted model, each 1 mg/dL increase above the population-weighted mean SUA of 5.38 mg/dL was associated with 26% higher odds of MASLD (OR: 1.26, 95% CI: 1.22–1.31), with attenuation at higher concentrations. The highest estimated odds occurred around 8.5 mg/dL (OR: 1.40, 95% CI: 1.23–1.59). Among adults with MASLD, higher baseline SUA was associated with increased all-cause mortality (HR: 1.11 per 1 mg/dL, 95% CI: 1.01–1.23), with evidence of nonlinearity at higher concentrations (quadratic HR: 1.03, p < 0.001; C-index 0.84). Conclusion: In this nationally representative two-stage study, SUA was independently associated with MASLD prevalence and all-cause mortality among adults with MASLD. SUA may represent an accessible adjunctive marker of metabolic risk and prognosis in MASLD, although further longitudinal and mechanistic studies are needed to clarify causality and clinical utility. Prospectively Registered Protocol: https://osf.io/khe3u .
