Infections of chronic wounds are a major healthcare burden worldwide and can lead to poor health outcomes such as amputations of limbs and death. Detecting infections early significantly increases the effectiveness of therapeutic interventions. Screening of volatile organic compounds (VOCs) emitted from wound swab samples can potentially serve as a highly specific indicator of infection. Profiling of VOCs from infected and non-infected wounds was carried out. Swab samples were collected from 26 wounds from 23 patients (n = 20 diabetic patients; n = 3 non-diabetic patients). There were 16 wounds sampled that were clinically determined as infected, and 10 as non-infected. Headspace-solid phase microextraction gas chromatography-mass spectrometry (HS-GC-MS) was used to rapidly sample and detect VOCs from the swabs following a short incubation period. A total of 42 compounds were identified and included for analysis. Infected wounds emitted more diverse VOCs compared to non-infected wounds. Higher numbers of compounds with significantly higher abundances were detected from severely infected wounds compared to less severely infected wounds. Abundances of short-chain fatty acids (SCFAs) and branched-chain fatty acids (BCFAs) were found to be the strongest discriminators of infected from non-infected wounds. Further validation is needed, but the results of this pilot study highlight the potential of detecting these compounds as a highly specific and targeted route to predicting or detecting wound infections in the future.

INTRODUCTION:Patients with diabetes have a 2% annual risk of developing a Diabetic Foot Ulcer (DFU). Novel methods of reducing the risk of re-ulceration could reduce the cost of diabetic foot disease. MATERIALS AND METHODS:Fifty-two patients with active foot disease, a history of prior DFU and/or high-risk feet were included in this study. Patients were randomly assigned 50:50 to be educated conventionally by a podiatrist or to view a bespoke foot self-care educational animation developed by the research team for this exploratory pilot study. A modified Nottingham Assessment of Functional Footcare (NAFF) questionnaire was used to record knowledge of safe foot care behaviors pre- and post-intervention. The primary outcome was change in self-care knowledge score. In parallel, a mixed-methods acceptability study was carried out for the 26 patients in the intervention arm, with quantitative data obtained using a 20-item technology acceptance model. Qualitative data were obtained by face-to-face interviews in the clinic setting and examined using thematic analysis. RESULTS:While foot self-care knowledge scores were numerically higher in both groups, only the intervention group showed a statistically significant within-group improvement. There was a trend toward a greater magnitude of increase in the knowledge score in favor of the intervention group, but this did not reach statistical significance. Among the 26 patients who completed the technology acceptability study, the majority of responses were in favor of the educational video. CONCLUSIONS:This randomized controlled and mixed-methods study demonstrated positive results in terms of improvements in foot self-care knowledge and acceptability.

Introduction and Objective: Glucagon-Like Peptide 1 Receptor Agonists (GLP1RAs) reduce the risk of cardiovascular events and death in people with Type 2 Diabetes Mellitus (T2D) at high risk. Platelet hyperactivation and endothelial dysfunction contribute to elevated cardiovascular risk in T2D. Platelet factor-4, glycoprotein V, thromboxane B2, soluble P-selectin and CD40 ligand are markers of platelet activation and inflammation. Matrix metalloproteinase-9 (MMP-9), ICAM-1, VCAM-1 contribute to endothelial dysfunction and atherosclerosis. The aim of this study was to measure plasma levels of these markers of platelet activation and endothelial dysfunction, before and after 16 weeks of GLP1RA treatment in patients with T2D and to correlate this with clinical response. Methods: Plasma levels of each biomarker were measured by ELISA at baseline and 16 weeks after initiation of GLP1RA therapy in 18 people with T2D. Paired student t-tests were used to evaluate for a change in biomarker concentrations following treatment. Simple linear regression was used to evaluate the association between baseline biomarkers, and percentage change in weight and HbA1c following treatment. Results: 61% of participants were male. At baseline, mean age was 53.94 ± 2.84 years. Mean HbA1c was 67 ± 17 mmol/mol. There was no significant association between the concentration of any biomarker and clinical response, in terms of change in HbA1c or body weight. There was a 30% reduction in MMP-9 (504 ± 75 ng/mL pre-treatment to 351 ± 47 ng/mL post-treatment; SEM; p=0.047). There was no difference in concentrations of the other biomarkers following GLP1RA treatment. Conclusion: As elevated MMP-9 is implicated in atherosclerotic plaque destabilization and adverse cardiac events, reduction in MMP-9 may be a possible mechanism contributing to the cardiovascular benefits of GLP1RAs. Disclosure A. Prem Kumar: None. M. Brennan: Research Support; Current; Grifols, S.A., Novartis Pharmaceuticals Corporation. S. Sreenan: Other - Member of the organizing committee for the United Kingdom Consultant Diabetologists' forum, which is sponsored by Eli Lilly. Honorarium received; Current; Eli Lilly and Company. Other - Co-organizer of an educational event for trainee fellows in Endocrinology that is sponsored by the company. Food and lodging provided by the company; Ended; Novo Nordisk. Advisory Panel; Current; Novo Nordisk. Consultant; Ended; Eli Lilly and Company.

AIM:To examine trends in potentially avoidable hospitalisations (PAHs) among people with diabetes in Ireland between 2015 and 2024, and how trends differ by sex and diabetes type. MATERIAL AND METHODS:Using national hospitalisation data from the Republic of Ireland, we estimated rates and trends in PAHs among people with diagnosed type 1 or type 2 diabetes between 2015 and 2024, during which 181 130 PAHs occurred. This included 21 complications, which were used to create a composite measure. We also grouped these into five condition groups including diabetes-specific, cardiovascular-related, infection, lower extremity and acute kidney failure. We calculated age-standardised rates (ASRs) and assessed temporal trends using linear time-trend models and Joinpoint regression analysis. RESULTS:ASRs decreased from 105.0 (95% CI: 100.4, 109.2) per 1000 people with diabetes in 2015 to 91.0 (95% CI: 87.7, 94.3) in 2024 with an average decline of 2.5% (95% CI: -3.1, 1.7) per year. ASRs were consistently higher among individuals with type 1 diabetes compared with those with type 2 diabetes (p < 0.001). When examined by condition group, ASRs declined steadily over time for all except those relating to infections, which showed an increase from 2022 onwards. CONCLUSION:Although PAHs declined over the study period, rates remained high especially among people with type 1 diabetes. The shifting profile of PAHs towards non-diabetes-specific conditions highlights emerging prevention challenges and the need to strengthen primary and community-based care pathways for people living with diabetes.

Type 2 diabetes (T2D) is a highly prevalent condition worldwide. Many patients with T2D monitor blood glucose regularly to guide their diabetes management. In recent years continuous glucose monitoring (CGM) has emerged as a promising alternative to traditional self-monitoring of blood glucose (SMBG). CGM can result in improved glycemic control, fewer diabetes-related hospital admissions and improved quality of life. In Ireland, however, CGM is not currently reimbursed for people with T2D, even those who are insulin-treated. The goal of the present study was to examine the glucose monitoring modalities used by patients attending diabetes outpatient clinics in a secondary care setting in Ireland. The proportions using SMBG and CGM and the patients' diabetes medications were recorded. Data were collected through a self-administered survey from participants attending outpatient diabetes clinics. We found that, of 137 patients surveyed, only 17 (12%) were using CGM for blood glucose monitoring, while 102 (75%) were using SMBG; the remainder were not testing glucose. Amongst 45 patients on insulin therapy, 15 (33%) were using a CGM, and 29 (64%) were using SMBG. This study highlights that a preponderance of patients with T2D in a representative Irish secondary care cohort do not use CGM for blood glucose monitoring, even amongst those on insulin therapy. These findings underscore the lack of access to CGM amongst patients with T2D on insulin in Ireland, which is potentially compromising their level of care and quality of life.

Background Enhanced Community Care (ECC) for type 2 diabetes mellitus (T2DM) in Ireland introduces episodic, community-based, consultant-led multidisciplinary care of diabetes that in turn supports the general practitioner (GP)-delivered chronic disease management programme (CDMP). The Dublin North West (DNW) hub, Ireland’s first fully operational ECC hub, began providing its diabetes service in March 2023. Aims This study reviewed the first year of the DNW hub’s diabetes operations, focusing on referral patterns, patient demographics, clinical characteristics, and CDMP eligibility (only those people living with T2DM with a medical card or a GP visit card are eligible for CDMP for T2DM; otherwise, people living with T2DM must self-pay for GP-provided T2DM care). Methods A retrospective analysis was conducted on patient charts and hospital databases for all referrals to the DNW hub from March 2023 to March 2024. Results Out of 204 referrals, 67% were redirected from hospital waiting lists, 22% were direct GP referrals, and 11% were internal from other hub services. The average wait time from referral to first appointment was 8.6 weeks. Attendees were 44% female and 56% male, with an average age of 56.2 years. Notably, only 46% were eligible for CDMP. During the study period, the number of people living with T2DM waiting for diabetes appointments at Connolly Hospital decreased by 61%, with the average waiting time reduced from 11 to 5 months. Conclusions The first year of activity in the DNW hub illustrates the potential of the ECC model to positively impact hospital waiting lists. Our data also suggests that eligibility to access the CDMP may merit expansion as part of the ongoing implementation of ECC in Ireland.

Background: Point-of-Care Ultrasound (PoCUS) is increasingly recognised as an essential clinical tool, yet there is limited formal exposure in medical school. This study introduced first-year Graduate Entry Medicine (GEM) students to PoCUS through structured teaching, simulation-based workshops, and guided practice, evaluating changes in knowledge, confidence, and attitudes toward curriculum integration, with emphasis on appropriate application and stewardship. Methods: This was a mixed-methods, single-arm pre-post study. GEM Year 1 students (n = 36) were provided a teaching intervention, preparatory online learning, a didactic introduction to PoCUS governance, and a two-hour hands-on workshop across four stations: knobology, ultrasound-guided vascular access, FAST scanning, and simulator-based pathology recognition. Pre- and post PoCUS knowledge were assessed using a 25-item multiple-choice questionnaire (MCQ) covering physics, anatomy, pathology and governance. Practical skills in probe handling, knobology, normal anatomy and pathology recognition were assessed. Attitudes toward PoCUS integration were evaluated, along with a post-session User Experience Questionnaire (UEQ), survey and focus group. Medium term retention was assessed with a repeat MCQ and OSCE 6-weeks post intervention. Results: MCQ scores improved by 37.8% (mean change: 4.2, p<0.001), and all subdomains demonstrated statistically significant gains (p<0.001). The median practical skill score (max 15) was 13 (range, 8 –15). Students rated the experience highly on the UEQ in terms of novelty, efficiency and attractiveness. Thematic analysis of feedback highlighted enthusiasm for hands-on learning, the multimodal teaching format, and relevance to clinical practice. Students expressed a desire for more practice time and the majority (64%, n = 23) supported early integration of PoCUS into the curriculum. There was no significant decline in knowledge or practical scores at 6 weeks, indicating satisfactory medium term retention. Conclusion: This feasibility study demonstrates that structured PoCUS teaching for early medical students is practical, well received, and educationally beneficial. Significant knowledge and skills gains were achieved with retention at six weeks. Importantly, governance emerged as a key educational theme, underscoring the need to teach when not to use PoCUS alongside technical competence. With modest resource requirements, early integration of PoCUS into undergraduate curricula is achievable and may promote responsible adoption in clinical practice.

Background Young adults living with type 1 diabetes (T1D) often experience sub optimal outcomes due to competing life demands, disruptions in care, reduced clinic attendance, and difficulties in self management. To improve outcomes among this population, we developed and piloted the D1 Now intervention using a user centred and theory informed approach. This protocol describes a cluster randomised controlled trial (RCT) to test the effectiveness and cost effectiveness of the D1 Now intervention. Methods A cluster RCT seeking to recruit 348 young adults (aged 18 to 25) with T1D from 12 hospital diabetes centres in Ireland. Centres will be randomised to receive either standard care or the D1 Now intervention, which includes two components: an agenda setting tool and a support worker. The primary outcome is the change in HbA1c from baseline to 12 month follow up. Secondary outcomes include patient reported psychosocial outcomes, clinical outcomes, self management outcomes and healthcare utilisation. We will collect data through blood samples, online patient surveys, and patient records at baseline and 12 months. Additionally, we will conduct a cost effectiveness evaluation and a mixed methods process evaluation. Discussion We anticipate that the D1 Now intervention will be both effective and cost effective in improving clinical and psychosocial outcomes for young adults compared to standard care. The findings from the process evaluation will shed light on how the intervention works (or not) and how implementation into health services (if warranted) can be optimised. If effective, D1 Now will offer a sustainable model of care to support engagement and self management for young adults living with T1D. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial ISRCTN28944606 ### Funding Statement The study is funded by the Health Research Board (HRB), Ireland (DIFA-2023-018). The HRB had no role in the design of the intervention or data collection tools and will not influence the conduct, analysis, or reporting of trial results. All decisions relating to design, analysis, and dissemination rest with the research team and oversight committees. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study will be conducted, analysed, and reported according to the Consolidated Standards of Reporting Trials (CONSORT) 2025 statement extension for cluster RCTs.27 Ethical approval will be sought from the relevant Research ethics committees. Ethics Committee of Galway University Hospital gave ethical approval for this work. Consent for publication Not applicable to the protocol. Participants will provide written informed consent for the use of their anonymised data and quotes in resultant publications. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors