Aims To explore how families facilitate psychological and behavioural adaptation among older children and adolescents with T1D from the perspective of parents, children and families.Methods A qualitative descriptive study was conducted using maximum variance sampling method. Seventeen families in China, including 16 parents and 10 older children/adolescents with T1D, participated in semi-structured online interviews via phone or social software. Conventional content analysis was employed for data analysis.Results Three interrelated themes emerged: (1) emotional adjustment through support and compensation; (2) positive belief formation through transcendence and identity; and (3) enhanced self-management through cooperation and development. Emotional exchange, verbal support, companionship and practical compensation were identified from parents or children for regulating children's emotions. Parents fostered positive self-identity and set role models to encourage children's resilience and optimism. Shared responsibility, cognitive-behavioural adjustments, expansion of supportive environments and avoiding unhealthy behaviors were shown to be effective strategies for improving children's diabetes management.Conclusions Perspectives on psychological and behavioural adaptation differed among parents, children and families, underscoring the need for family-centred approaches that address diverse emotional needs and align behavioural goals. Interventions should strengthen emotional connections, foster positive beliefs and enhance collaborative self-management within families to support children's adaptation to diabetes.

Purpose:To explore how adults with type 2 diabetes perceived and sustained self-management 12 months after completing a Self-Efficacy-Focused Structured Education Program (SSEP). Methods:A descriptive qualitative design was employed. Seventeen participants from a multicenter randomized controlled trial in China completed in-depth, semi-structured interviews. Data were analyzed using Braun and Clarke's reflexive thematic analysis with NVivo 11. Results:Five researcher-constructed themes were identified: (1) restructuring of diabetes cognition, (2) enhancement of self-efficacy, (3) reshaping of mindset through learning, (4) reconstruction and internalization of behaviors, and (5) factors influencing behavioral persistence. Participants experienced a cognitive-behavioral transformation in which reflective learning facilitated sustained behavioral change. Conclusion:The findings reveal a dual-process mechanism: reflective System 2 learning evolved into automatic System 1 habits supported by heuristic tools. Integrating contextual cues, visual prompts, and mobile-based nudges into future SSEP delivery may enhance habit formation and long-term adherence. Combining reflective training with ongoing family and community support could further strengthen diabetes self-management behaviors sustainability.

Background Deep cervical lymphovenous anastomosis (LVA) has been proposed as a novel surgical approach for Alzheimer's disease (AD). However, its therapeutic efficacy remains uncertain and controversial. Family caregivers who observe patients most closely and continuously play a vital role in recognizing subtle symptom changes. Their perceptions may provide important clues to perioperative symptom and caregiving-burden changes that remain poorly understood. Aims To explore family caregivers' perceptions of patients' symptom and caregiving burden changes before and after LVA in individuals with AD. Methods A descriptive qualitative study was conducted with 20 family caregivers of 20 distinct patients who had undergone LVA at a tertiary hospital in Henan Province, China. Semi-structured telephone interviews were analyzed thematically using Braun and Clarke's framework with NVivo 15. Results Three themes emerged, namely a spectrum of perceived postoperative symptom change trajectories; shifts in caregiving burden without added postoperative strain; sustaining hope through continued effort. Conclusion Caregivers reported modest postoperative changes mixed with persistent uncertainty. Future research may integrate quantitative assessments with caregiver reports to better characterize postoperative symptom changes in AD patients following LVA.

AIMS:Behavioural changes in one lifestyle domain may lead to improvements in others, known as spillover effects. This study examined whether a nudge-based dietary intervention could generate short-term (3 and 6 months) and long-term (24 months) spillover effects on physical activity and sleep among adults with type 2 diabetes. MATERIALS AND METHODS:A 2 × 2 factorial cluster-randomised controlled trial was conducted in 12 primary healthcare centres in Beijing, China. Adults aged 18-59 years with type 2 diabetes were randomised to a 1-month nudge-based dietary intervention (n = 204) or a control group (n = 73). Physical activity was assessed using the International Physical Activity Questionnaire-Short Form and step-tracking mobile applications. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index. Generalised linear mixed-effects models tested group, time, and interaction effects with covariate adjustment. The mediating effect of diabetes management self-efficacy was assessed for behaviour change. RESULTS:A significant short-term spillover effect was observed for daily step counts at 3 months (+1105 steps; p = 0.02), which was not sustained at 6 or 24 months. Exploratory mediation analyses indicated that diabetes management self-efficacy at 3 months did not statistically mediate the association between the dietary intervention and daily step counts at the same time point. Total physical activity and sleep quality showed modest but nonsignificant short-term improvements. CONCLUSIONS:The nudge-based dietary intervention produced observable but short-lived spillover effects on daily physical activity among adults with type 2 diabetes. These findings contribute empirical evidence on cross-behavioural spillover in diabetes management and underscore the need for future research to better elucidate the mechanisms and sustainability of such spillover effects.

Obesity management is challenged by high rates of recurrent weight gain following initial loss. We systematically reviewed 29 randomized controlled trials comparing long-term outcomes of lifestyle interventions, semaglutide, and metabolic and bariatric surgery (MBS). Databases were searched to March 2025, and data were synthesized using pairwise and network meta-analysis. Lifestyle interventions ranked highest in preventing recurrent weight gain, while semaglutide may support sustained weight reduction during ongoing therapy but is followed by rebound after discontinuation. MBS demonstrated relatively sustained weight loss (> 10

Adolescents with diabetes face challenges in self-management and glycemic control, with traditional care offering limited support. To evaluate the effects of digital interventions on adolescents with diabetes and their feature preferences. Six English-language databases (PubMed, Web of Science, Embase, Cochrane Library, CINAHL, and PsycINFO), two Chinese-language databases (China National Knowledge Infrastructure and Wanfang), and other relevant sources were searched from inception to June 20, 2023. Randomized controlled trials involving adolescents with diabetes that evaluated digital interventions and reported at least one clinical outcome were included. Key intervention features, including parental involvement and individualization, were summarized. Nineteen studies with 1726 adolescents were analyzed. The duration and functions of digital interventions varied. Only four studies incorporated parental involvement, and none provided individualized interventions. Adolescents preferred smartphone-based interventions due to their convenience. Analysis of HbA1c at baseline, 3, 6, and 12 months showed no significant differences (Z = 1.11, P = 0.27; Z = 1.48, P = 0.14; Z = 1.41, P = 0.16; Z = 0.68, P = 0.49) with digital interventions. However, smartphone applications demonstrated a significant improvement in HbA1c level (0.46 [95

BackgroundKinesiophobia is a common psychological barrier among patients undergoing coronary artery bypass grafting (CABG), yet its heterogeneity remains unclear. Identifying distinct fear-of-movement patterns may support targeted rehabilitation.MethodsA cross-sectional study was conducted among patients scheduled for CABG (N = 296; 78.7% male; mean age=59.97 years, SD = 10.0). Latent profile analysis (LPA) was performed using the four domains of the Tampa Scale for Kinesiophobia Heart to identify subgroups. Model fit indices, entropy, and class interpretability guided the selection of the optimal model.ResultsThree distinct latent profiles emerged, representing the best statistical fit and interpretability. The majority of participants exhibited moderate kinesiophobia (75.3%), followed by a low kinesiophobia group (22.3%). A small high kinesiophobia group (2.4%) demonstrated substantially elevated scores across all domains, especially in perceived danger and exercise avoidance.ConclusionThree distinct latent profiles of kinesiophobia were identified among patients undergoing CABG, highlighting notable heterogeneity in fear-of-movement responses. These findings provide a basis for developing personalized rehabilitation strategies, and future studies should investigate the psychological and clinical factors underlying this heterogeneity and its implications for postoperative outcomes.

[This corrects the article DOI: 10.3389/fendo.2025.1558692.].

BACKGROUND:Adolescents with type 1 diabetes (T1D) often experience heightened levels of diabetes distress and struggle with maintaining effective self-management behavior. Resilience-both at the family and individual levels-is a crucial psychological capacity for coping with challenges. However, limited research has explored how diabetes distress, family resilience, self-resilience, and self-management behavior are interrelated in adolescents with T1D. OBJECTIVES:The purpose of this study was to examine whether family resilience and self-resilience mediate the association between diabetes distress and self-management behavior in adolescents with T1D. METHODS:A cross-sectional study was conducted in a children's hospital in China, involving 143 adolescents with T1D (mean age=13.05 years) and their caregivers. Participants completed the Diabetes Behavior Rating Scale, Problem Areas in Diabetes Scale, Diabetes Strengths and Resilience measure for adolescents, and Family Resilience Assessment Scale. Structural equation modeling was employed for data analysis. RESULTS:Diabetes distress was negatively associated with family resilience, self-resilience, and self-management behavior. Family resilience, self-resilience, and self-management behavior were positively correlated. Both family resilience and self-resilience significantly and partially mediated the association between diabetes distress and self-management behavior. DISCUSSION:These findings highlight that family and individual resilience partly buffer the adverse effects of diabetes distress on self-management. Interventions should support families in recognizing and leveraging their strengths, while incorporating resilience-enhancing strategies to promote both psychological well-being and self-management in adolescents with T1D.

Background:Sustaining self-management is critical for optimizing clinical outcomes in individuals with type 2 diabetes mellitus (T2DM). Although digital health interventions (DHIs) have shown benefits for glycemic control and self-care, much of this evidence has focused on efficacy, and the behavioral mechanisms through which DHIs produce sustained effects remain insufficiently understood. Clarifying these mechanisms could inform the development of theory-driven interventions. Objective:This study examined the longitudinal behavioral pathways through which Artificial Intelligence-based Health Education Accurately Linking System, a WeChat (Tencent)-based digital health program, influences T2DM self-management, using the Extended Multi-Theory Model (MTM) of health behavior change. Methods:An explanatory sequential mixed methods prospective longitudinal cohort study was conducted among adults with T2DM (aged ≥18 y and proficient in WeChat use), recruited from 45 primary health care institutions in Beijing, China, between July 2023 and July 2024. Self-management behavior was assessed as the primary outcome using the Summary of Diabetes Self-Care Activities, and psychosocial determinants using the Extended MTM Scale and the Diabetes-related Skills Scale. Exploratory and confirmatory factor analyses assessed the construct validity of the Extended MTM Scale. Structural equation modeling examined longitudinal pathways among Artificial Intelligence-based Health Education Accurately Linking System users across baseline and 3, 6, and 12 months. For the qualitative phase, a purposive subsample was selected through maximum variation sampling based on baseline glycated hemoglobin; interviews were analyzed thematically until thematic saturation, and integrated with quantitative findings using a joint display. Results:Of the 406 enrolled participants, 391 completed baseline assessments. The Extended MTM Scale demonstrated a 6-factor, 22-item structure with excellent internal consistency (Cronbach α=0.928) and satisfactory construct validity. The structural equation modeling showed satisfactory fit (CFI=0.984, RMSEA=0.036). Changes in the social environment (β=0.23, 95% CI 0.07-0.38; P=.003) and physical environment (β=0.25, 95% CI 0.10-0.40; P=.001) at baseline, and diabetes-related skills at month 6 (β=0.16, 95% CI 0.03-0.29; P=.01), were directly associated with self-management behavior at month 12, whereas behavioral confidence and emotional transformation showed no significant direct effects. Social environment changes were indirectly associated with behavioral confidence through participatory dialogue at month 3 (β=0.20, 95% CI 0.04-0.36; P=.01; β=0.66, 95% CI 0.57-0.74; P<.001). Thematic analysis of 17 interviews identified 3 domains: environmental context, cognitive processes, and attitudes and skills. Environmental factors converged across both data strands, while qualitative data expanded on the cognitive and attitudinal processes underlying sustained self-management. Conclusions:This study is among the first to apply the Extended MTM framework to DHI-supported T2DM self-management, with environmental factors emerging as key drivers alongside selected cognitive, attitudinal, and skills-related processes. Complementing efficacy-focused research, it illuminates the psychosocial pathways underlying sustained self-management and refines the Extended MTM in digital health contexts. These insights can inform the design of theory-driven DHIs in primary care.

Purpose:In Acute Care for Elders (ACE) units, Comprehensive Geriatric Assessment (CGA) relies heavily on cumulative comorbidity metrics like Charlson Comorbidity Index (CCI). However, it fails to reflect the dynamic nature of acute illness, limiting its ability to predict short-term functional recovery. Therefore, we aimed to evaluate whether the principal diagnosis, representing acute physiological stress, offers superior predictive value compared to the CCI for functional outcomes in hospitalized older adults. Patients and Methods:This retrospective cohort study included 213 patients (≥65 years) admitted to the Acute Care for Elders (ACE) unit between January 2023 and December 2024. The primary outcome was short-term functional recovery, measured as the change in the Barthel Index (BI) from admission to discharge (ΔBI). Hierarchical multiple linear regression was used to create three models: a base model (demographic/clinical covariates), a CCI model, and a principal diagnosis model. Model performance was compared using Adjusted R2, Area Under the Curve (AUC) from ROC analysis, Net Reclassification Improvement (NRI), and information criteria (AIC/BIC). Results:The principal diagnosis model demonstrated significantly higher explanatory power (Adjusted R2 = 0.85) compared to the CCI model (Adjusted R2 = 0.78) and the base model (Adjusted R2 = 0.75). The inclusion of principal diagnosis resulted in a significant continuous Net Reclassification Improvement (NRI=0.37, 95% CI 0.11-0.65, p = 0.006). After adjustment for covariates, specific diagnoses such as Endocrine and Respiratory diseases were strong predictors of recovery, whereas CCI was not statistically significant. Conclusion:The principal diagnosis outperforms cumulative comorbidity as a predictor of short-term functional recovery in the ACE unit. Integrating principal diagnosis into the CGA serves as a valuable and practical complement to refine early functional prognostication.

Background The Guidelines on Prescriptive Authority for Nurses released by the International Council of Nurses indicate that 44 countries or territories worldwide have enacted legislation granting prescriptive authority to nurses. In the US, 27 states, two territories, and Washington, D.C. have authorized certified nurse practitioners full practice authority, including prescriptive authority, and momentum is building. Currently, in mainland China, there is no national legal mandate for nurse practitioners to prescribe, although a few institutions have initiated pilot training programs for nurse practitioners. However, little is known about the factors influencing their prescribing. Research on the value of such pilot programs from the perspectives of nurse practitioners and stakeholders is required.AimThe purpose of this study is to identify, assess and synthesize the perceptions of nurse practitioners and stakeholders in two pilot training programs on the barriers and facilitators to the potential development and implementation of nurse prescribing in mainland China. Design A descriptive qualitative research design. Settings The study was conducted at two nurse practitioner pilot institutions in mainland China. Participants Five nurse practitioners, three collaborators, three policymakers and three trainers of nurse practitioners from two pilot institutions. Methods Data were collected via semi-structured interviews. The Consolidated Framework for Implementation Research (CFIR) was used as a framework to orient the data analysis. Results Within the five Consolidated Framework for Implementation Research domains, we identified 31 barriers and 50 facilitators influencing the potential implementation of nurse practitioner prescribing. Barriers mainly included insufficient urgency for change, lack of policy and legal support, inadequate education and training on prescribing, and low public awareness. Facilitators encompassed nurses' practical prescribing experience, their competence and confidence in role expansion, effective teamwork, and a strong demand orientation within healthcare settings. Conclusion Our findings suggest that China possesses significant potential to successfully carry out nurse practitioner prescribing initiatives. It is crucial to explore factors hindering or promoting the development of nurse practitioners to effectively support their implementation within healthcare systems while strategizing for future advancements in this area. In the case that the national policy has not yet been promulgated, the outcomes derived from our pilot work will carry substantial influence over national policies.

This meta-analysis aimed to evaluate the benefits of prenatal exercise on neonatal outcomes in women with gestational diabetes mellitus (GDM). Systematic searches were conducted in PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus from their inception to September 9, 2023. ClinicalTrials.gov was also searched to ensure comprehensive coverage. We included studies that investigated the association between prenatal exercise and at least one adverse neonatal outcome of interest. A total of 4,268 publications were retrieved, and 3,060 records remained after removing duplicates. After screening abstracts, 107 studies were selected for full-text assessment, and ultimately, 17 articles (including 4 identified through manual searching) were included for data extraction. Extracted information included the first author, publication year, study design, geographical location, sample size, participants’ demographic characteristics, intervention characteristics, and relevant outcome variables.Pooled results from random-effects models showed that prenatal exercise significantly reduced the risk of adverse neonatal outcomes, including: Cesarean delivery (OR = 0.91, 95% CI: 0.88–0.94), Premature birth (OR = 0.49, 95% CI: 0.27–0.90), Macrosomia (OR = 0.58, 95% CI: 0.40–0.83), Fetal growth restriction (OR = 0.21, 95% CI: 0.08–0.52), and Birth trauma (OR = 0.26, 95% CI: 0.13–0.54). Subgroup analyses indicated that single-component exercise programs were more effective than multi-component programs in reducing the risk of macrosomia (P = 0.06). In conclusion, prenatal exercise substantially reduces the risk of multiple adverse neonatal outcomes in women with GDM, including macrosomia, preterm birth, cesarean delivery, fetal growth restriction, and birth trauma. These findings highlight the outstanding benefits of antenatal exercise for fetal health, supporting its inclusion as a key component of prenatal care for women with GDM. This meta-analysis is registered with PROSPERO (Registration Number: CRD42023485375).

BackgroundGestational diabetes mellitus (GDM) affects pregnancy outcomes and increases the risk of type 2 diabetes mellitus (T2DM) postpartum. Traditional health education interventions have shown positive effects, but adherence to lifestyle management and motivation for continued postpartum care still require improvement. This study aimed to develop a comprehensive structured program for Chinese women with GDM to improve adherence to lifestyle management and motivation for postpartum care, thereby reducing future T2DM risk.MethodsThe development of this program was divided into five steps: (1) Analysis: a summary of evidence and the analysis of needs, population characteristics, teaching content, and teaching environment; (2) Design: the design of learning objectives, teaching logic, and teaching strategies; (3) Development: the creation and development of teaching materials; (4) Implementation: the evaluation of scientific validity and rationality through an expert meeting and trial sessions; (5) Evaluation: formative and summative assessments. Finally, a pilot test was conducted to evaluate its feasibility and acceptability.ResultsLearning objectives were set in the cognitive, affective, and psychomotor domains, with a total of 189 items. The program consisted of five sessions, including: understanding GDM, nutrition and physical activity guidelines, expecting moms—are you ready, postpartum weight management, and reinforcing healthy behaviors. In addition, there was a session specifically for women starting insulin treatment, with the theme: timely insulin injection. Teaching materials included lesson plans, teaching posters, food cards, and a mother’s handbook, etc., totaling 11 items. The pilot study included eight women with GDM, all of whom expressed a positive acceptance of the program.ConclusionsThe feasibility and acceptability of the program were confirmed, and a final version was developed. It features clear objectives, detailed teaching content, engaging teaching materials, and standardized implementation processes, all of which are of significant importance for both short- and long-term management of GDM.

Nurse practitioners play a vital role in contributing to the UN’s Sustainable Development Goals, and Universal Health Coverage, especially the management of chronic noncommunicable diseases. Artificial intelligence tools such as ChatGPT are becoming promising resources for healthcare professionals. This study aimed to explore the capability of ChatGPT as a nurse practitioner by validating the performance of ChatGPT-3.5 and GPT-4 in the American Association of Nurse Practitioners (AANP) practice examinations. Questions from exams for five nurse practitioner disciplines were used to evaluate the accuracy and consistency of the responses in two phases. In the first phase, the accuracy rates and concordance of answers between the two versions with the five exam sets, totaling 535 questions were analyzed. In the second phase, the consistency of ChatGPT-4 performance in six retests, each involving five random questions from each set. ChatGPT-3.5 achieved an overall accuracy rate of 80.6%, while ChatGPT-4 achieved 90.7%. ChatGPT-3.5 and ChatGPT-4 showed strong consistency within all sets, while ChatGPT-4 performed better than ChatGPT-3.5. In the retests, ChatGPT-4 provided exactly the same answers as generated initially, including the incorrect ones. In conclusion, ChatGPT demonstrated excellent performance in AANP practice exams, with high levels of accuracy and consistency. This suggests that ChatGPT may support nurse practitioners in making clinical decisions and improving efficiency. Further studies could explore ways to integrate artificial intelligence tools with nurse practitioner practice to enhance the advanced practice nursing workforce.

Background/Objectives: Traditional diet management for type 2 diabetes (T2DM) is often complex and effortful to sustain. Nudging offers low-effort and automatic approaches to dietary behaviour change yet remains underexplored in T2DM. This study evaluated the independent and combined 6-month effects of nudging education (NE) and nudging tableware (NT) on HbA1c, along with other secondary health outcomes, among adults with T2DM and overweight/obesity, compared to their non-nudge counterparts (control education, CE; control tableware, CT). Methods: A 2 × 2 factorial cluster RCT was conducted in 12 primary healthcare settings in China (pre-registered as ChiCtr2100044471). Participants were randomly assigned to the nudging education group (NE + CT), the nudging tableware group (CE + NT), the combined group (NE + NT) or the full-control group (CE + CT) for 1 month. The primary outcome was HbA1c. Secondary outcomes included dietary behaviours, metabolic indicators, and psychological health. Generalized linear mixed models were used for analysis. Results: A total of 284 participants (mean age, 52.28 years; 54.3% male) were randomly assigned and included in the analysis. After 6 months, NE and NT independently led to HbA1c reductions (−0.76%, p < 0.001; −0.33%, p = 0.042, vs. controls), with an additive but non-interactive effect when combined, resulting in a 1.04% reduction (p < 0.001) in the combined group. They also improved total calorie, macronutrient, and vegetable intake, FBG, plasma lipids, and BMI. NE additionally reduced diabetes distress and enhanced self-efficacy. Conclusions: Both NE and NT improved dietary and metabolic outcomes without increasing the psychological burden. The combined group showed the greatest benefits. Findings highlighted the importance of considering automatic processes in diabetes management.

INTRODUCTION:This study determined whether tableware-based intervention promotes healthy eating behavior and address cardiometabolic risk factors. METHODS:PubMed, Web of Science, Scopus, Embase, ClinicalTrials.gov, and ICTRP were searched from the earliest date available to July 2024. Data were pooled to calculate mean differences and 95% confidence intervals using a random or fixed effect model. This study was registered with PROSPERO (CRD42024573343). RESULTS:Twenty-seven publications with 5319 participants were included in this review. The effectiveness of tableware was mostly evaluated through plate models, followed by lunchboxes, forks, spoons, placemats, and take-out containers. Tableware significantly reduced bite rate (d = -1.04 bites per minute), protein intake (d = -14.13 g), and starch intake (d = -26.27 g), body weight (d = -1.24 kg), body mass index (d = -0.41 kg/m2), waist circumference (d = -1.24 cm), HbA1c (d = -0.41%), 2-hour postprandial glucose (d = -2.47 mmol/L), and high-density lipoprotein cholesterol (d = -1.61 mg/dL). Tableware significantly increased the proportion of vegetables taken (d = 5%), with a positive trend for increasing meal duration and fruit intakes. Tableware had no significant effect on blood pressure, total cholesterol, triglycerides, low-density lipoprotein, and fasting blood glucose (unless 12 months duration). CONCLUSIONS:Tableware might be a practical tool to promote healthy food choices and weight loss, address fast eating, and improve cardiometabolic health across populations of various age groups.

Although the health benefits of physical activity for individuals with type 2 diabetes are well-established, physical inactivity remains widespread, and existing interventions often demonstrate limited long-term effectiveness. This review aimed to explore the barriers and facilitators to physical activity adherence in individuals with type 2 diabetes. PubMed, Web of Science, EMBASE, CENTRAL, and PsycINFO were systematically searched for relevant studies published up to 27 July 2025. Eligible studies included qualitative, quantitative, and mixed methods studies. Study quality was assessed using the Mixed Methods Appraisal Tool. The COM-B model and Theoretical Domains Framework were used to identify potential barriers and facilitators, while behavior change techniques were employed to identify potential intervention strategies. The registration number of this study is CRD42024622295. A total of 43 studies were included, including 17 randomized controlled trials, 11 qualitative studies, 6 mixed methods studies, 5 non-randomized studies, and 4 quantitative descriptive studies. The analysis identified 46 barriers and facilitators influencing adherence. Additionally, 26 potentially effective behavior change techniques were extracted and categorized into six key implementation strategies: flexible and personalized physical activity programs, multidimensional social support, participant education, enhancing self-efficacy and motivation, monitoring and feedback, and managing emotional experiences. This review systematically synthesizes the behavioral determinants of physical activity adherence in individuals with type 2 diabetes and proposes corresponding implementation strategies for intervention design. Future research should refine, evaluate, and validate these strategies while exploring the dynamic interactions between COM-B components to enhance intervention effectiveness.

This study assessed the risk of cardiovascular diseases (CVD) at various stages in women with gestational diabetes mellitus (GDM) and aimed to identify critical time points when the risk increases. Fifteen cohort studies including a total of 7,515,168 pregnant women were analyzed, among whom 429,564 had GDM and 13,773 developed CVD. Participants were grouped based on follow-up periods of approximately 5, 10, 15, and 25 years. Using random effects models, pooled hazard ratios (HR) with 95% confidence intervals (CI) were calculated. Within five years of diagnosis, women with GDM had a 19% higher risk of CVD (HR 1.19, 95% CI 1.11-1.27) compared to those without GDM, rising to 78% by the tenth year (HR 1.78, 95% CI 1.67-1.89). Long-term follow-up showed risk increases of 31% at 15 years (HR 1.31, 95% CI 1.28-1.35) and 26% at 25 years (HR 1.26, 95% CI 1.16-1.38). Overall, women with GDM had a 35% higher risk of developing CVD than those without (HR 1.35, 95% CI 1.32-1.38). These findings highlight that GDM significantly elevates the risk of cardiovascular diseases, particularly within ten years after diagnosis, emphasizing the need for timely intervention and ongoing monitoring to reduce cardiovascular risk in affected women.

Objective: Inflammation and nutrition are interrelated, and both are related to depression. This study explored the association between the C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index, a novel immunonutrition scoring system, and depression in patients with type 2 diabetes mellitus (T2DM). Methods: We included 3517 patients with T2DM from the National Health and Nutrition Examination Survey 2005-2010 and 2015-2018. The Patient Health Questionnaire-9 was used to evaluate depression. The CALLY index was based on a comprehensive assessment of serum CRP, serum albumin, and the lymphocyte counts from whole blood. Weighted multivariate logistic regression models were used to examine the relationship between the CALLY index and depression. The restricted cubic spline was applied to explore the nonlinear relationship. Results: Compared with the non-depressed group, CALLY index and albumin in the depressed group were significantly reduced, while CRP and lymphocytes were significantly increased (P < 0.05). After adjusting for covariates, only the CALLY index significantly decreased (the highest quartile vs the lowest quartile, odds ratio = 0.58, 95 % confidence interval: 0.38-0.89, P = 0.014). The non-linear association between the CALLY index and depression was not significant (P for nonlinear=0.69). The results of subgroup analysis were basically consistent (P for interaction > 0.05). Conclusion: The CALLY index was significantly negatively correlated with depression in American patients with diabetes and served as a potential marker for early identification.