Background and aims Contemporary guidelines, including 2025 ESC/EAS focused update, recommend lower LDL-cholesterol (LDL-C) goals for selected high-risk patients, renewing safety concerns about achieving very low LDL-C, particularly when reached pharmacologically later in life rather than through lifelong genetic exposure. We aimed to synthesize high-level evidence addressing common concerns and misconceptions related to very low and ultra-low achieved LDL-C levels. Methods Narrative review of evidence addressing common concerns related to intensive LDL-C lowering. Epidemiological studies, Mendelian randomization analyses, randomized controlled trials (RCTs), and meta-analyses were reviewed to evaluate associations between achieved LDL-C levels and outcomes including cognitive decline, cancer, hemorrhagic stroke, diabetes, cataracts, hormonal effects, and muscle symptoms. Results Across diverse populations, RCTs and meta-analyses do not support increased risks of cognitive impairment, cancer, cataracts, intracerebral hemorrhage, or clinically relevant hormonal dysfunction with intensive LDL-C lowering, including at very low achieved levels. Two safety considerations warrant attention: statin-associated dysglycaemia/new-onset diabetes and muscle-related symptoms. Dysglycaemia/new-onset diabetes is modest in absolute terms, occurs more frequently in individuals with higher baseline glycaemic risk, whereas muscle symptoms may occur across patient groups. Both should be weighed against larger absolute reduction in major atherosclerotic cardiovascular disease (ASCVD) events. For Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9)-targeted therapies, randomized outcome trials have not demonstrated clinically meaningful excess diabetes or muscle toxicity, even at ultra-low LDL-C levels, despite genetic signals suggesting potential metabolic effects. Conclusions In selected patients at elevated ASCVD risk, achieving very low LDL-C levels is supported by evidence of cardiovascular benefit without consistent evidence of major harm. Clear LDL-C definitions (thresholds/goals), transparent communication of absolute risks and benefits, and shared decision-making are essential to counter misinformation, reduce therapeutic inertia, and improve adherence to guideline-directed lipid management.

Diabetic neuropathy is a frequent and disabling complication of type 2 diabetes (T2D) that may develop early after diagnosis. Sudomotor dysfunction, an early manifestation of autonomic nerve injury, can be objectively assessed using electrochemical skin conductance (ESC). However, its longitudinal progression and clinical determinants remain poorly characterized. Research Design and Methods We conducted a longitudinal cohort study of adults aged 18–70 years with T2D duration < 5 years enrolled in the Center of Comprehensive Care for the Patient with Diabetes (CAIPaDi) in Mexico City. Sudomotor function was assessed using Sudoscan. Incident deterioration was defined as a decrease in foot ESC > 7.5 µS accompanied by crossing the abnormality threshold (≤ 60 µS). Time to deterioration was evaluated using Kaplan–Meier curves, log-rank tests, and multivariable Cox proportional hazards models. Results Among 1,821 participants, 56.7% were women. Median age was 52 years (IQR 45–59), and median diabetes duration was 1 year (IQR 0–3). Nearly half of incident deterioration events were detected at the first annual evaluation. In multivariable analysis, female sex (HR 1.50, 95% CI 1.07–2.18) and higher systolic blood pressure (HR 1.24 per 10-mmHg increase, 95% CI 1.11–1.37) were independently associated with earlier sudomotor deterioration. Event-free survival was lower among women and participants with systolic blood pressure ≥ 130 mmHg. Conclusions In adults with recently diagnosed T2D, female sex and higher systolic blood pressure were associated with earlier sudomotor deterioration, suggesting that vascular and biological susceptibility contribute to early autonomic nerve dysfunction.

Cardiometabolic multiple long-term conditions (MLTC), defined as the coexistence of two or more cardiometabolic diseases such as diabetes, cardiovascular disease, and chronic kidney disease, are increasingly prevalent and represent a growing challenge for health systems worldwide. Despite rising interest, progress in understanding cardiometabolic MLTC has been limited by substantial heterogeneity in definitions, measurements, and analytical approaches, restricting comparability across studies and limiting translation into clinical and public health practice. Reported prevalence estimates vary across populations, largely reflecting differences in study design and conditions included. The prevalence of cardiometabolic MLTC increases with age but is not confined to older populations, with these conditions often emerging in early adulthood, particularly among socioeconomically disadvantaged and minority ethnic populations, for whom these conditions also progress more rapidly. Longitudinal studies demonstrate disease accumulation and accelerating transitions following development of a cardiometabolic condition leading to premature mortality. These trajectories are shaped by interacting genetic, metabolic, behavioural, and psychosocial factors, while deprivation and structural inequities substantially amplify risk and earlier onset. Advancing research and improving care will require harmonised definitions, greater use of longitudinal data, and scalable analytical approaches that explicitly capture disease sequencing and transitions. To improve consistency and comparability, the definition of cardiometabolic MLTC should be standardised.

ABSTRACT Background People with long‐term type 1 diabetes have reduced cardiorespiratory fitness (CRF). We aimed to assess the influence of body composition, energy substrate use, and blood glucose control on cardiopulmonary exercise test performance in subjects with uncomplicated, long‐term type 1 diabetes. Methods Observational, cross‐sectional study. Subjects with and without type 1 diabetes, paired by sex and age, underwent treadmill cardiopulmonary exercise test, bioelectrical impedance analysis, indirect calorimetry at rest and during exercise. We used the t‐pair test; multivariate linear regression models and mediation analysis were used to evaluate determinants of CRF. Results 54 cases and 54 controls (52% female) were evaluated. The age was 39 (28–46) years, duration of disease 21 ± 10 years. HbA1c 7.9 (7.3–8.7). The baseline physical activity, resting energy expenditure, respiratory quotient and body composition were similar between groups. VO2max was 32 ± 9.2 versus 39 ± 7.9 mL/kg/min (p < 0.01) for cases and controls. Maximum carbohydrate oxidation was 809 (614–1174) versus 1082 (863–1454) (p < 0.01), respectively. In women 73% and 25% of the effect of diabetes status on VO2max were mediated by carbohydrate oxidation and heart rate reserve, respectively. In men 78% and 57% of the effect of diabetes status on VO2max were mediated by carbohydrate oxidation and phase angle, respectively. Conclusions Type 1 diabetes group had an altered CRF with lower carbohydrate oxidation. This suggests altered metabolic flexibility due to low substrate availability that could explain the earlier fatigue during intense exercise. There were different determinants of VO2max in persons with diabetes according to sex.

BACKGROUND AND OBJECTIVE:Approximately 20% of the global population has a Lp(a) concentrations above 50 mg/dL (> 125nmol/L), yet many remain unaware of the associated cardiovascular risks. In Mexico, routine measurement of Lp(a) is uncommon. This study aimed to investigate the frequency of Lp(a) testing, and the clinical actions taken by physicians upon detecting elevated Lp(a) concentrations in patients at a tertiary medical institution. METHODS:Using an algorithm-based screening system, we reviewed the clinical and biochemical data of patients with Lp(a) measurements from 2019 to 2024. Data were retrieved from the laboratory information system and electronic health records. Complementary assessment data were obtained from the radiology and cardiology departments. RESULTS:Of the 150,083 individuals evaluated at the institution, only 830 (0.5%) underwent Lp(a) testing, with testing rates increasing from 0.037% in 2019 to 0.24% in 2023. Elevated Lp(a) concentrations (> 50 mg/dL) were found in 21% of patients, and 2.2% had concentrations > 180 mg/dL. Patients with elevated Lp(a) had significantly higher rates of atherosclerotic cardiovascular disease (ASCVD) (p < 0.001) and familial hypercholesterolemia (p < 0.004) than those with lower Lp(a) levels. Interestingly, diabetes prevalence was higher in those with Lp(a) < 4 mg/dL (51.5% vs. 33.4%, p < 0.001). Despite the cardiovascular risk, only 26% of patients with elevated Lp(a) levels received interventions to modify risk factors. CONCLUSIONS:Lp(a) testing was infrequent in a tertiary medical setting. Clinical interventions to modify cardiovascular risk factors were insufficient among patients with elevated Lp(a). These findings highlight the need for greater awareness among healthcare providers and the development of comprehensive screening and management algorithms to mitigate Lp(a) -related cardiovascular risk.

Young adulthood is well documented as being a particularly challenging area of type 1 diabetes (T1D) healthcare. Many young adults with T1D (YAT1D) are distracted from effective disease self-management; T1D healthcare service engagement can be problematic and inconsistent, and high rates of unplanned healthcare contacts prevail. Video conferencing use can facilitate services to be flexible and responsive. We aimed to evaluate clinical outcomes and satisfaction related to the use of videoconferencing for T1D healthcare in YAT1D. A quantitative narrative review was undertaken, using a systematic process. PubMed, Scopus and CINAHL were searched (until August 2023) to identify relevant articles, using Medical Subject Headings and keywords. A total of 12 records (eight studies) from four countries were retrieved. Ten records considered clinical outcomes; eight of these records focused on the effectiveness of videoconferencing as part of routine care. Findings largely demonstrate benefits to glycaemic control, particularly when used during the COVID-19 pandemic; no data were available relating to the impact of videoconferencing use on blood pressure and lipid control in YAT1D. Four records considered satisfaction with use of videoconferencing, with data indicating YAT1D were satisfied with the use of videoconferencing technology. There is a need to configure T1D healthcare services to incorporate and offer use of videoconferencing technology, where applicable, appropriate and acceptable for YAT1D, and feasible and workable for service providers. This will require some adjustments from healthcare systems and possible changes to funding mechanisms.

Ensuring the delivery of good quality health services at the primary care level is important if we wish to improve the overall health of the community. One of the pillars of quality assessment is person centred care. Person centred care is that which respects responds to, and resonates with, the necessities and needs of the individual seeking health care. In this review, we describe the various definitions of person centred care, and explore its scope and spectrum, as related to primary care. We suggest ways of incorporating person centricity, and thus improving satisfaction with healthcare services in South Asia.

In Latin America (LATAM), the level of awareness and clinical implementation of lipoprotein(a) (Lp(a)) testing among physicians remain largely unknown. This study aimed to evaluate the knowledge, frequency of use, and clinical management practices related to Lp(a) among LATAM physicians. We conducted a cross-sectional, 36-item Spanish-language online survey using convenience sampling through medical societies in twenty LATAM countries. All items were mandatory. The questionnaire included two sections based on whether respondents requested Lp(a) testing and explored barriers among nonusers. A total of 512 physicians from various LATAM countries responded, with Mexico representing 75.4

Introduction:Diabetes, affecting 18.3% of young adults in Mexico (6), is influenced by both genetic factors and shared unhealthy habits within families. Objective:To determine the metabolic abnormalities in relatives of people with T2D, stratified by body mass index. Materials and Methods:This observational, descriptive study was conducted at the Center for Comprehensive Care for Patients with Diabetes (CAIPaDi). The study involved relatives of participants with type 2 diabetes mellitus (T2DM), recruited between June 2017 and December 2020. The relatives were people without diabetes, including spouses, siblings, offspring, or close family members aged 18 to 65 who spent over four days a week with the patient. Exclusion criteria included relatives diagnosed with diabetes, smokers, or any individual from a patient-relative pair that was excluded. All participants underwent laboratory tests and body measurements. Relatives were classified into three groups based on body weight: normal weight, overweight, and obesity. The relatives attended four monthly visits and then annual evaluations. Ethical approval was obtained. Results:The study enrolled 220 relatives of people with T2DM, 69% women, median age 49±12 years; 19.5% with normal weight, 40.4% overweight, and 40% with obesity. Prediabetes (39.4%), dyslipidemia (67.2%), and abnormal liver function tests (32.2%) were prevalent. Higher levels of triglycerides and LDL cholesterol were associated with increased risk for comorbid conditions. Anxiety and depression showed no significant differences across weight categories. Conclusion:These results highlight the importance of overweight and obesity as factors associated with the presence of comorbidities and the metabolic syndrome. It is essential to implement strategies to promote healthy habits among family members of people with diabetes, especially in those who are overweight or obese to reduce the risk of developing future metabolic and cardiovascular diseases.

Statins are a group of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors aimed at reducing cholesterol synthesis. Since their discovery in 1970, their use has exponentially increased, becoming a regular preventive treatment for cardiovascular diseases. Among their most common adverse effects are myopathies, with the most severe being autoimmune necrotizing myopathy. We present a case of a woman in her 70s, with high cardiovascular-risk comorbid conditions, including autoimmune hypothyroidism, type 2 diabetes, arterial hypertension, and dyslipidemia. After 5 years on atorvastatin, she developed proximal limb weakness and elevated creatine kinase and creatine kinase-MB levels. A muscle biopsy showed autoimmune necrotizing myopathy and blood work confirmed positive 3-hydroxy-3-methylglutaryl coenzyme A reductase antibodies. Based on these findings, a diagnosis of statin-associated autoimmune necrotizing myopathy was made. In this case, treatment with intravenous immunoglobulin and rituximab resulted in complete remission.

BACKGROUND:Latin America has no accepted performance standards for continuous glucose monitoring (CGM) technology evaluation. This has resulted in the emergence of various CGM devices in the market that do not meet strict quality, accuracy, reliability or safety standards. CGM systems are crucial for managing diabetes, as they provide frequent glucose measurements and help detect hypoglycemia or hyperglycemia episodes or even predict these events. Ensuring the reliability and accuracy of CGM devices is essential for patient safety. This consensus statement aims to establish a consensus-driven framework of expert recommendations regarding the metrics that should be evaluated to achieve high standards in CGM devices. MATERIALS AND METHODS:A modified Delphi methodology was employed, engaging endocrinologists, pediatric endocrinologists and diabetologists from Latin America. Experts participated in multiple rounds of surveys and discussions to reach consensus on key characteristics measures, including accuracy thresholds, clinical validation protocols, and post-market surveillance requirements. Quantitative and qualitative data were analyzed to ensure robust recommendations. RESULTS:The expert panel identified major gaps in existing CGM regulations and established 12 key recommendations and one checklist to align Latin American standards with international best practices. These included the implementation of minimum accuracy thresholds, the adoption of standardized clinical validation protocols, and the enforcement of post-market surveillance measures. The panel also emphasized the importance of patient education, healthcare provider involvement in decision-making, and accessibility to enhance CGM adoption and usability. We underscore the necessity of these measures to improve patient outcomes, patient safety, and regulatory consistency in the region, while also enhancing CGM reliability and accuracy. CONCLUSION:This consensus statement highlights the urgent need for a standardized metrics to evaluate CGM devices in Latin America. Implementing standardized accuracy requirements, rigorous validation protocols, and enhanced patient education will ensure device reliability, improve clinical outcomes, and foster a more equitable healthcare landscape for diabetes management in the region.

AIMS:To estimate the relative treatment effect of iGlarLixi (a fixed-ratio combination of insulin glargine 100 U/mL plus lixisenatide) versus premixed insulin IDegAsp (insulin degludec plus insulin aspart) in people with type 2 diabetes (T2D) who advanced from basal insulin to iGlarLixi or IDegAsp in non-Asian studies. MATERIALS AND METHODS:Randomized controlled trials (RCTs) were identified in a systematic review by searching Embase (including congress abstracts from 2021 to 2023), MEDLINE® and CENTRAL on 10 October 2023. Treatment outcomes from non-Asian RCTs for people with T2D previously treated with basal insulin, who switched to iGlarLixi or IDegAsp, were compared using a network meta-analysis (NMA). Data analysis was performed using R, version 4.0.2. RESULTS:The NMA included four RCTs (N = 2535). The results of the NMA showed that iGlarLixi (n = 810) was associated with a significantly greater reduction in HbA1c versus IDegAsp (n = 454) (mean difference [MD]: -0.39 [95% credible interval, CrI: -0.58, -0.21] %-units). iGlarLixi was also associated with a significantly greater likelihood of achieving an HbA1c of <7.0% (risk ratio: 1.42, 95% CrI: 1.18, 1.71). A greater reduction in postprandial glucose was observed with iGlarLixi versus IDegAsp (MD: -1.38 [95% CrI: -2.15, -0.63] mmol/L). A body weight benefit that favoured iGlarLixi versus IDegAsp was documented (MD: -1.54 [95% CrI: -2.26, -0.84] kg). Hypoglycaemia evaluation was inconclusive due to definitional differences between trials. CONCLUSIONS:Once-daily iGlarLixi was associated with superior blood glucose control and body weight benefit compared with IDegAsp in insulin-experienced populations with T2D in non-Asian RCTs.

Humanitarian crises bring unique, and potentially growing challenges to people with type 1 diabetes (T1D). We aimed to determine, in youth with T1D (mean age (± 1SD) 0–17.9 years) within and coming from humanitarian crises settings (HCS), the reported prevalence that meet international consensus targets for glycaemic, blood pressure and lipid management, and incidence of severe hypoglycaemia or diabetic ketoacidosis. A narrative review of quantitative data was conducted, using a systematic process. MEDLINE (Ovid), Global Health, Web of Science, Scopus, Embase, CINAHL, APA PsycINFO, Cochrane trials, and the reference lists of eligible records were searched (January 2014-February 2024); ten records covering ten separate studies were retrieved. Glycaemic management was consistently suboptimal in HCS. However, among individuals coming from HCS, glycaemia varied. Across both groups, data relating to blood pressure, lipids, severe hypoglycaemia or diabetic ketoacidosis were either unavailable or limited. Findings expose the dearth of data relating to defined youth with T1D within and coming from HCS, leaving the status of this population largely uncharacterised. With limited data indicating suboptimal T1D management, there is a pressing need for the development of a consensus guideline on, and core indicators relating to such youth within and coming from HCS, plus monitoring systems and outcome data.

Summary Background The COVID-19 pandemic disrupted care for non-communicable diseases globally. This study synthesizes evidence on disruptions to primary care, focusing on hypertension and diabetes care and mitigation approaches taken during the pandemic in Latin America and the Caribbean (LAC). Methods We conducted a scoping review, searching nine electronic databases for studies from January 2020 to December 2022 on COVID-19-related primary care disruptions and interventions, including studies on hospital-based interventions given their relevance to the pandemic response in LAC. We adapted the Primary Health Care Performance Initiative framework to develop our search strategy and synthesize data. For studies reporting interventions, we included studies conducted outside of LAC. Findings Of 33,510 references screened, 388 studies were included (259 reported disruptions in LAC, 61 interventions in LAC, 63 interventions outside LAC, and five interventions from countries within and outside LAC), with three-quarters presenting data from Brazil, Argentina, Mexico, and Peru; few studies focused on rural areas. Additionally, the few studies that adequately quantified care disruptions reported a reduction in hypertension and diabetes control during the pandemic (e.g., hypertension control rate decreased from 68% to 55% in Mexico). Frequently reported causes of disruption included burnout and mental health challenges among healthcare workers (with disproportionate effects by type of worker), reduced medication supplies, and reduced frequency of clinic visits by patients (e.g., due to financial constraints). The most reported interventions included remote care strategies (e.g., smartphone applications, virtual meeting platforms) and mental health programs for healthcare workers. Remote care strategies were deemed feasible for care delivery, triaging, and clinical support for non-physicians. Patients were generally satisfied with telemedicine, whereas providers had mixed perceptions. Robust evidence on the effectiveness of remote care strategies for diabetes and hypertension care was unavailable in LAC. Interpretation Hypertension and diabetes control appeared to worsen in LAC during the pandemic. Major reported causes of care disruptions were workforce issues, reduced medication supply, and changes in patient perceptions of seeking and receiving primary healthcare. Remote care strategies were feasible for various purposes and were well received by patients. However, the lack of data on intervention effectiveness underscores the importance of strengthening research capacity to generate robust evidence during future pandemics. Developing resilient healthcare systems able to provide care for hypertension and diabetes during future pandemics will depend on investment in the healthcare workforce, medical supply chain, health data and research infrastructure, and technology readiness.